IgA肾病患者血尿酸与肾脏病理及预后的相关性研究

Correlation of Serum Uric Acid with Renal Pathology and Prognosis in Patients with IgAN

目的:探讨IgA肾病(IgAN)患者血尿酸水平与肾脏病理及预后的关系。方法:选取2016年8月-2020年8月在锦州医科大学附属第一医院肾脏内科经肾活检确诊为原发性IgAN患者101例,根据肾活检前血尿酸水平将患者分为高尿酸血症组44例和正常血尿酸组57例,比较两组患者的临床和病理资料之间的差异。以血肌酐较基线值倍增,或进展至终末期肾病为终点事件,用Kaplan-Meier法比较两组患者的肾脏存活率。结果:高尿酸血症组高血压比例和血肌酐、尿素氮、甘油三酯水平均较正常血尿酸组高,而估算的肾小球滤过率(eGFR)水平较正常血尿酸组低,差异均有统计学意义(P<0.05)。高尿酸血症组患者的肾小管萎缩/间质纤维化发生情况与正常血尿酸组比较,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,尿素氮[OR=1.592,95%CI(1.139,2.223),P=0.006]、肾小管萎缩/间质纤维化[OR=4.996,95%CI(1.621,15.394),P=0.005]是IgAN伴发高尿酸血症的独立危险因素。Kaplan-Meier生存曲线显示,IgAN伴高尿酸血症组患者的肾脏存活率较正常血尿酸组低(P<0.05)。结论:IgAN伴高尿酸血症患者的肾脏病理损伤更重,肾脏存活率更低,提示高尿酸血症参与肾脏病理损害的过程。

Objective:To investigate the relationship between blood uric acid levels and renal pathology and prognosis in patients with IgA nephropathy (IgAN).Method:A total of 101 patients with the diagnosis of primary IgAN by renal biopsy at the Department of Nephrology of the First Affiliated Hospital of Jinzhou Medical University from August 2016 to August 2020 were selected,according to the serum uric acid level before renal biopsy,the patients were divided into hyperuricemia group (n=44) and normal serum uric acid group (n=57),the clinical and pathological data of the two groups were compared.Renal survival was compared between the two groups by Kaplan-Meier method with doubling of serum creatinine from baseline or progression to end-stage renal disease as the end point.Result:The proportion of hypertension and serum creatinine,urea nitrogen and triglyceride levels in hyperuricemia group were higher than those in normal serum uric acid group,while the estimated glomerular filtration rate (eGFR) level was lower than that in normal serum uric acid group,the differences were statistically significant (P<0.05).The occurrence of renal tubular atrophy/interstitial fibrosis in hyperuricemia group was significantly different from that in normal serum uric acid group (P<0.05).Multivariate logistic regression analysis showed that urea nitrogen[OR=1.592,95%CI (1.139,2.223),P=0.006],renal tubular atrophy/interstitial fibrosis[OR=4.996,95%CI (1.621,15.394),P=0.005]were independent risk factors for hyperuricemia associated with IgAN.Kaplan-Meier survival curve showed that the renal survival rate of IgAN patients with hyperuricemia was lower than that of normal serum uric acid group (P<0.05).Conclusion:Patients with IgAN with hyperuricemia have more severe renal pathological damage and lower renal survival,thus suggesting that hyperuricemia is involved in the process of renal pathological damage.