高尿酸血症肾损的特征性因素分析及其诊断模型建立

Analysis of characteristic factors and establishment of diagnostic model for hyperuricemia caused renal impairment

目的筛选高尿酸血症患者发生肾损的特征性因素,分析其诊断价值并建立诊断模型。方法选取南京医科大学附属南京市中医院2018年12月至2022年12月诊断为高尿酸血症的住院患者2405例。根据估算肾小球滤过率(eGFR)将其分为肾损组(n=1343)及非肾损组(n=1062)。通过Lasso和logistic回归筛选并分析高尿酸血症肾损的特征性因素,建立诊断模型,利用受试者工作特征(ROC)曲线评估各特征性因素及诊断模型的诊断价值,限制性立方样条(RCS)拟合发现特征性因素与结果间的变化规律。结果年龄、尿酸(UA)、胱抑素-C(Cys-C)、视黄醇结合蛋白(RBP)是高尿酸血症肾损的特性因素。联合诊断模型:logit(P)=-8.70+0.602×年龄(10岁)+0.033×UA(10μmol/L)+0.277×Cys-C(0.1 mg/L)+0.189×RBP(10 mg/L),联合诊断模型ROC曲线下面积(AUC)为0.893,95%CI:0.880~0.905。血UA每升高10μmol/L,高尿酸血症造成肾损的风险增加3%;年龄每增长10岁,高尿酸血症造成肾损的风险增加83%;RBP每升高10 mg/L,高尿酸造成肾损的风险增加21%;Cys-C每升高0.1 mg/L,高尿酸血症造成肾损的风险增加32%。结论联合诊断模型对高尿酸血症患者是否发生肾损具有较好的诊断价值,Cys-C值得重点关注。

Objective To screen the characteristic factors of renal impairment occurrence in the patients with hyperuricemia,and to analyze its diagnostic value and establish a diagnostic model.Methods A total of 2405 inpatients with diagnosed hyperuricemia in the Nanjing Municipal Hospital of Traditional Chinese Medicine,Nanjing University of Traditional Chinese Medicine from December 2018 to December 2022 were selected and divided into the kidney lesion group(n=1343)and the non-kidney lesion group(n=1062)according to eGFR.The characteristic factors of hyperuricemia caused renal impairment were screened and analyzed by Lasso and logistic regression and the diagnostic model was constructed.The diagnostic value of characteristic factors and diagnostic model were evaluated by the receiver operating characteristic(ROC)curve,and the change rule between the characteristic factors and the results was found by the restricted cubic splines(RCS)fitting.Results The age,uric acid(UA),cystatin-C(Cys-C)and retinol-binding protein(RBP)were the characteristic factors of hyperuricemia caused renal impairment.The combined diagnostic model:logit(P)=-8.70+0.602×age(10 years old)+0.033×UA(10μmol/L)+0.277×Cys-C(0.1 mg/L)+0.189×RBP(10 mg/L),the area under the ROC curve(AUC)of the combined diagnosis model was 0.893(95%CI:0.880-0.905).For every 10μmol/L increase in blood UA,the risk of renal impairment occurrence in hyperuricemia was increased by 3%;for every 10 years increase in age,the risk of renal impairment occurrence in hyperuricemia was increased by 83%;for every 10 mg/L increase in RBP,the risk of kidney damage occurrence of renal impairment in hyperuricemia was increased by 21%;for every 0.1 mg/L increase in Cys-C,the risk of renal impairment occurrence in hyperuricemia was increased by 32%.Conclusion The combined diagnostic model for whether the renal impairment in the patients with hyperuricemia occurring has good diagnostic value,and Cys-C deserves more attention.