≥60岁人群血尿酸轨迹与肾功能进展的相关性

Correlation between serum uric acid trajectory and the progression of renal function in individuals aged 60 and above

目的探究≥60岁人群血尿酸轨迹与肾功能进展的相关性。方法本研究为回顾性队列研究,选取2015年3月至2023年12月于首都医科大学附属北京友谊医院医疗保健中心行健康体检的≥60岁人群,多次测量尿酸水平,采用组间轨迹模型(group-based trajectory modelling,GBTM)识别血尿酸的变化轨迹,根据不同的轨迹,分成高轨迹组(86例)、中轨迹组(176例)及低轨迹组(101例),采用多因素Cox回归分析血尿酸轨迹对老年人肾功能快速进展的影响。结果共纳入363例≥60岁人群,平均随访时间为8.1年,截至随访结束,共计50例≥60岁人群出现不同程度的肾功能下降。校正多种混杂因素,Cox回归分析显示,高轨迹组出现GFR<60 ml·min^(-1)·(1.73 m^(2))^(-1)、eGFR下降率≥25%及复合终点事件[eGFR<60 ml·min^(-1)·(1.73 m^(2))^(-1)、eGFR下降>3 ml·min^(-1)·(1.73 m^(2))^(-1)·年^(-1)或较基线值下降≥25%]的风险分别增加了4.54倍(95%CI:1.47~20.76)、3.75倍(95%CI:1.06~21.21)和3.74倍(95%CI:1.44~115.59)。此外,未观察到基线尿酸水平和肾功能进展存在相关性(均P>0.05)。结论高尿酸轨迹增加≥60岁人群肾功能快速进展的风险。

Objective To explore the relationship between serum uric acid trajectory and the progression of renal function in individuals aged 60 and above.Methods This study was a retrospective cohort study.Individuals aged 60 years and above who received health checkups in Beijing Friendship Hospital,Capital Medical University,from March 2015 to December 2023 and met the criteria of baseline estimated glomerular filtration rate(eGFR)≥60 ml·min^(-1)·(1.73 m^(2))^(-1),were selected as the research subjects.The serum uric acid data of multiple measurements were collected and identified as different serum uric acid trajectories by group-based trajectory modeling(GBTM).According to the serum uric acid trajectories,the subjects were divided into a low trajectory group(101 cases),a middle trajectory group(176 cases),and a high trajectory group(86 cases).Cox regression analysis was used to examine the effect of serum uric acid trajectory on the progression of renal function in the elderly.Results A total of 363 elderly were included.The mean follow-up time was 8.1 years.At the end of the follow-up,a total of 50 elderly individuals had experienced varying degrees of renal function decline.After adjusting for multiple confounding factors by Cox regression analysis,the risks of eGFR<60 ml·min^(-1)·(1.73 m^(2))^(-1),eGFR reduction rate≥25%and composite endpoints[eGFR<60 ml·min^(-1)·(1.73 m^(2))^(-1),eGFR reduction rate≥25%or>3 ml·min^(-1)·(1.73 m^(2))^(-1)·year-1]in the high trajectory group were significantly higher than those in the low trajectory group,with an HR of 4.54(95%CI:1.47-20.76),3.75(95%CI:1.06-21.21),and 3.74(95%CI:1.44-115.59),respectively.In addition,there was no significant difference between baseline serum uric acid and renal function progression(all P>0.05).Conclusion The high serum uric acid trajectory increases the risk for the progression of renal function in individuals aged 60 and above.