非透析糖尿病肾脏疾病患者发生高尿酸血症的影响因素分析

Analysis of influencing factors of hyperuricemia in non-dialysis diabetic kidney disease patients

目的探讨非透析状态的2型糖尿病肾脏疾病(ND-DKD)患者发生高尿酸血症(HUA)的影响因素。方法收集2018年1月1日至2021年12月31日在山西医科大学第二医院肾内科住院的326例ND-DKD患者的临床资料,根据HUA的诊断标准将患者分为HUA组和非HUA组,根据患者的估算肾小球滤过率(eGFR)分为CKD 1~2期和CKD 3~5期。比较两组临床资料,采用logistic回归分析ND-DKD患者发生HUA的影响因素。结果326例ND-DKD患者的HUA发生率为50.3%,其中CKD 1~2期和CKD 3~5期ND-DKD患者的HUA发生率分别为34.0%和58.2%。HUA组血小板、谷氨酰转移酶(GGT)、白蛋白、球蛋白、总蛋白、尿素氮、血肌酐、胱抑素C(CysC)、α1微球蛋白、β2微球蛋白、血钾、血磷、QTc间期,高血压病史,贫血、CKD 3~5期、高甘油三酯血症发生率高于非HUA组,差异有统计学意义(P<0.05);HUA组糖化血红蛋白、碳酸氢根、eGFR、尿pH低于非HUA组,差异有统计学意义(P<0.05)。logistic回归分析结果显示,GGT(OR=1.013,95%CI:1.003~1.024)、总蛋白(OR=1.071,95%CI:1.040~1.104)、CysC(OR=2.760,95%CI:1.750~4.353)、血磷(OR=3.717,95%CI:1.296~10.658)、高甘油三酯血症(OR=2.424,95%CI:1.440~4.081)为ND-DKD患者发生HUA的影响因素(P<0.05)。结论ND-DKD患者HUA的发生率随着肾功能的下降而升高,GGT、总蛋白、CysC、血磷、高甘油三酯血症是ND-DKD患者发生HUA的影响因素。加强对ND-DKD患者的饮食指导及健康宣教,低脂低磷精蛋白饮食可降低ND-DKD患者HUA的发生率,对延缓疾病进展有着积极意义。

Objective To investigate the influencing factors of hyperuricemia(HUA)in patients with type 2 diabetic kidney disease in non-dialysis state(ND-DKD).Methods Clinical data of 326 patients with ND-DKD admitted to the Department of Nephrology,the Second Hospital of Shanxi Medical University from January 1,2018 to December 31,2021 were collected and divided into HUA group and non-HUA group according to the diagnostic criteria of HUA.Based on the estimated glomerular filtration rate(eGFR),patients were divided into stages 1 to 2 of CKD and 3 to 5 of CKD.The clinical data of the two groups were compared,and the influencing factors of ND-DKD patients with HUA were analyzed by logistic regression.Results The incidence of HUA in 326 patients with ND-DKD was 50.3%,and the incidence of HUA in patients with CKD stage 1 to 2 and CKD stage 3 to 5 was 34.0%and 58.2%,respectively.The level of platelet,glutamyltransferase(GGT),albumin,globulin,total protein,urea nitrogen,serum creatinine,cystatin C(CysC),α1 microglobulin,β2 microglobulin,blood potassium,blood phosphorus,QTc interval,the history of hypertension,the incidence of anemia,3 to 5 of CKD,and hypertriglyceridemia in HUA group were higher than those in non-HUA group,and the differences were statistically significant(P<0.05).The glycosylated hemoglobin,bicarbonate,eGFR,and urine pH in HUA group were lower than those in non-HUA group,and the differences were statistically significant(P<0.05).Logistic regression analysis showed that GGT(OR=1.013,95%CI:1.003-1.024),total protein(OR=1.071,95%CI:1.040-1.104),CysC(OR=2.760,95%CI:1.750-4.353),blood phosphorus(OR=3.717,95%CI:1.296-10.658),hypertriglyceridemia(OR=2.424,95%CI:1.440-4.081)were the factors influencing the occurrence of HUA in ND-DKD patients(P<0.05).Conclusion The incidence of HUA in ND-DKD patients increases with the decline of renal function,and GGT,total protein,CysC,blood phosphorus,and hypertriglyceridemia are the influencing factors for the occurrence of HUA in ND-DKD patients.Dietary guidance and health education for patients with ND-DKD should be strengthened.Low-fat and low-phosphorus high-quality protein diet can reduce the incidence of HUA in patients with ND-DKD,which has a positive significance in delaying disease progression.