长期无症状高尿酸血症对慢性肾脏病心肾结局的影响

Effect of long-term asymptomatic HUA on the heart and kidney outcome of CKD

目的探讨长期无症状高尿酸血症(HUA)对慢性肾脏病(CKD)心肾结局的影响。方法选取2016年1―12月安庆市立医院肾脏内科住院的CKD病人148例,男76例(51.4%),女72例(48.6%),年龄50.2岁,范围为18~79岁。根据其血尿酸(UA)水平分为正常UA组和高UA组。病人入组时采集一般资料及生化检测指标。研究时间从病人住院开始,观察到发生终点事件或到2020年12月,记录两组病人预后转归情况。结果148例病人均获得长期随访,观察时间46.31~55.70月。其中正常尿酸CKD组3例(3.70%)发生痛风急性发作,高尿酸CKD组4例(5.97%)发生痛风急性发作;正常尿酸CKD组3例(3.70%)发生心血管事件,高尿酸CKD组9例(13.43%)发生心血管事件;正常尿酸CKD组12例(14.82%)出现肌酐倍增或进入终末期肾脏疾病(ESRD),高尿酸CKD组31例(46.27%)出现肌酐倍增或进入ESRD。Kaplan-Meier生存分析显示高尿酸CKD组痛风急性发作与正常尿酸CKD组病人差异无统计学意义(χ^(2)=0.37,P=0.541);高尿酸CKD组心血管事件高于正常尿酸CKD组(χ^(2)=3.69,P=0.05);高尿酸CKD组肾脏预后明显差于正常尿酸CKD组病人(χ^(2)=16.62,P=0.000)。COX回归模型多因素生存分析,结果表明高UA可作为评估CKD病人预后的一项独立指标(P<0.05)。此外,年龄、糖尿病、肾小球滤过率(eGFR)也具有独立的预后评估意义(P<0.05)。结论高UA水平的无症状CKD病人并未增加痛风发生率,但心脏及肾脏预后差。

Objective To investigate the effect of long-term asymptomatic hyperuricemia(HUA)on the heart and kidney outcome of chronic kidney disease(CKD).Methods One hundred and forty-eight CKD patients in the Department of Nephrology,Anqing Municipal Hospital from January to December 2016 were selected,including 72 females(48.6%)and 76 males(51.4%),with an average age of 50.2 years,ranging from 18 to 79 years old.According to their blood UA levels,they were assigned into normal UA group and high UA group.General data and biochemical test indicators were collected when patients were enrolled.The study time started from the patient's hospitalization,the end-point event was observed or to December 2020,and the prognostic outcome of the two groups of patients was recorded.Results All 148 patients received long-term follow-up,with an average observation time of 46.31~55.70 months.Among them,3 patients(3.70%)in the normal uric acid CKD group had acute gout attacks,4 patients(5.97%)in the high uric acid CKD group had acute gout attacks,3 patients(3.70%)in the normal uric acid CKD group had cardiovascular events,and 9 patients(13.43%)in the high uric acid CKD group had cardiovascular events,12 patients(14.82%)in the normal uric acid CKD group had double creatinine or entered ESRD,and 31 patients(46.27%)in the high uric acid CKD group had double creatinine or entered ESRD.Kaplan-Meier survival analysis showed that the acute onset of gout in the hyperuric acid CKD group was not statistically different from the normal uric acid CKD group(χ^(2)=0.37,P=0.541);the hyperuric acid CKD group had higher cardiovascular events than the normal uric acid CKD group(χ^(2)=3.69,P=0.05);the renal prognosis of the hyperuric acid CKD group was significantly worse than that of the normal uric acid CKD group(χ^(2)=16.62,P=0.000).Multivariate survival analysis of COX regression model showed that high UA can be used as an independent indicator to evaluate the prognosis of CKD patients(P<0.05).In addition,age,diabetes,and eGFR also had independent prognostic significance(P<0.05).Conclusion Asymptomatic CKD patients with high UA levels did not increase the incidence of gout,but the cardiovascular and renal prognosis is poor.