高尿酸血症对特发性膜性肾病患者肾小管萎缩/间质纤维化的预测价值

Predictive value of hyperuricemia on tubular atrophy/interstitial fibrosis in patients with idiopathic membranous nephropathy

目的:探讨尿酸(UA)与特发性膜性肾病(IMN)患者肾小管萎缩/间质纤维化(TA/IF)之间的关系及预测价值。方法:本研究纳入2018—2021年在天津医科大学总医院经肾活检证实的390例IMN患者。收集肾活检时的各项临床参数。根据肾穿刺活检前的UA值将患者分为正常尿酸组(normal-UA group,N-UA组,n=229)、高尿酸组(high-UA group,H-UA组,n=161)。根据TA/IF的程度,将患者分为T1组(无/轻度,n=154)、T2组(中度,n=167)、T3组(重度,n=69)。通过单因素和多因素Logistic回归对TA/IF程度的影响因素进行分析。采用受试者工作特征(ROC)曲线分析UA对TA/IF程度的预测价值。结果:与N-UA组相比,H-UA组中重度TA/IF的比例明显较高(χ^(2)=84.352,P<0.000),评估的肾小球滤过率(eGFR)显著降低(t=2.532,P=0.012)。UA水平为中重度TA/IF的独立危险因素[OR=1.026(95%CI:1.021~1.031),OR=1.036(95%CI:1.030~1.042),P<0.000]。模型4(HUA+血清球蛋白+24 h尿蛋白)的曲线下面积(AUC)大于其他3个模型。结论:合理控制UA可能减少中重度TA/IF发生的风险。

Objective:To investigate the relationship and predictive value between uric acid(UA)and renal tubular atrophy/interstitial fibrosis(TA/IF)in patients with idiopathic membranous Nephropathy(IMN).Methods:The present study enrolled 390 patients with IMN confirmed by renal biopsy in the General Hospital of Tianjin Medical University from 2018 to 2021.The clinical parameters of renal biopsy were collected.According to the UA value before renal biopsy,the patients were divided into normal UA group(N-UA,n=229)and high UA group(H-UA,n=161).According to the degree of TA/IF,the patients were divided into T1 group(n=154),T2 group(n=167)and T3 group(n=69).Univariate and multivariate Logistic regression for factors influencing extent of TA/IF was analyzed.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of UA on the degree of TA/IF.Results:Compared with N-UA group,the proportion of moderate and severe TA/IF was significantly higher in H-UA group(χ^(2)=84.352,P<0.000),and the evaluated glomerular filtration rate(eGFR)was significantly lower(t=2.532,P=0.012).UA level was an independent risk factor for moderate and severe TA/IF[OR=1.026(95%CI:1.021-1.031),OR=1.036(95%CI:1.030-1.042),P<0.000].The area under the curve(AUC)of model 4(HUA+Glb+24 h urinary protein)was greater than that of the other three models.Conclusion:Reasonable control of UA may reduce the risk of moderate and severe TA/IF to some extent.