血尿酸在维持性血液透析患者中的意义

The significance of serum uric acid in maintenance hemodialysis patients

目的分析维持性血液透析(MHD)患者血尿酸(SUA)与全因死亡及心血管(CV)死亡情况的关系,探讨SUA在MHD患者中的意义。方法收集284例MHD患者的基本资料,SUA为稳定透析3个月透析前SUA水平,根据SUA水平分为组1(57例),<379.6μmol/L,即<20百分位数;组2(170例),379.6~560.2μmol/L,即20~80百分位数;组3(57例),>560.2μmol/L,即>80百分位数。比较三组患者的基本资料、临床及实验指标、死亡率(全因死亡及心血管死亡率),分析MHD患者死亡事件的多因素。结果三组患者的年龄、体质量指数(BMI)、透析龄及女性、高血压、吸烟占比比较无明显差异(P>0.05);三组患者的糖尿病和使用非布司他占比比较有统计学意义(P<0.05)。与组1相比,组2及组3患者的血红蛋白、白蛋白、肌酐、尿素氮、血磷、SUA、甘油三酯、C反应蛋白、铁蛋白均较高,有统计学意义(P<0.05);三组患者的白细胞、血钾、血钙、低密度脂蛋白胆固醇、尿素清除指数(Kt/V)、心脏射血分数(EF)比较均无明显差异(P>0.05)。组1全因死亡16例(28.1%)、心血管死亡5例(8.8%),组2全因死亡54例(31.8%)、心血管死亡22例(12.9%),组3全因死亡21例(36.8%)、心血管死亡11例(19.3%),三组患者的全因死亡率及心血管死亡率比较,无明显差异(P>0.05)。采用Cox比例风险模型分析SUA每增加100μmol/L与全因死亡率及心血管死亡率的关系,发现矫正年龄、性别、种族、BMI、透析龄、降尿酸药物、肿瘤、高血压及糖尿病及EF值后,SUA每增加100μmol/L,全因死亡风险增加,死亡风险比为1.246[95%CI=(1.028,1.511),P=0.025<0.05];但SUA与全因死亡率呈非线性关系,SUA波动于约470~650μmol/L时全因死亡率低。SUA每增加100μmol/L,心血管死亡风险增加,死亡风险比为1.509[95%CI=(1.077,2.113),P=0.017<0.05];但SUA与心血管死亡率亦呈非线性关系,SUA波动于约470~650μmol/L时心血管死亡率低。结论MHD患者SUA与全因死亡率及心血管死亡率呈非线性关系,SUA在相对较高水平时死亡率较低。

Objective To analyze the correlation of serum uric acid(SUA)with all-cause mortality and cardiovascular(CV)death in maintenance hemodialysis(MHD)patients,and explore the significance of SUA in MHD patients.Methods The basic data of 284 MHD patients were collected,and SUA was the pre-dialysis SUA level after 3 months of stable dialysis.According to SUA level,they were divided into Group 1(57 cases),<379.6μmol/L,i.e.,<20 percentiles;Group 2(170 cases),379.6-560.2μmol/L,i.e.,20-80 percentiles;Group 3(57 cases),>560.2μmol/L,i.e.>80 percentiles.The basic data,clinical and experimental indicators,and mortality rates(all-cause mortality and cardiovascular mortality)of the three groups were compared,and the multi-factor death events of MHD patients were analyzed.Results There were no significant differences in age,body mass index(BMI),years of dialysis,percentage of female,hypertension and smoking among the three groups(P>0.05).Comparison of percentage of diabetes mellitus and use of febuxostat among the three groups was statistically significant(P<0.05).Compared with group 1,patients in Group 2 and Group 3 had higher hemoglobin,albumin,creatinine,urea nitrogen,blood phosphorus,SUA,triglycerides,C-reactive protein,and ferritin,and there were statistical significance(P<0.05).There was no significant difference in the comparison of white blood cells,blood potassium,blood calcium,low-density lipoprotein cholesterol,urea clearance index(Kt/V),and ejection fraction(EF)among the three groups(P>0.05).Group 1 had all-cause mortality in 16 cases(28.1%)and cardiovascular deaths in 5 cases(8.8%);Group 2 had all-cause mortality in 54 cases(31.8%)and cardiovascular deaths in 22 cases(12.9%);Group 3 had all-cause mortality in 21 cases(36.8%)and cardiovascular deaths in 11 cases(19.3%);comparison of all-cause mortality and cardiovascular mortality among patients in the three groups showed no significant difference(P>0.05).Cox proportional risk model was used to analyze the relationship between every 100μmol/L increase in SUA and all-cause mortality and cardiovascular mortality,and it was found that each 100μmol/L increase in SUA was associated with an increased risk of all-cause mortality,with a mortality risk ratio of 1.246[95%CI=(1.028,1.511);P=0.025<0.05]after correcting for age,sex,ethnicity,BMI,years of dialysis,uric acid-lowering medications,tumors,hypertension and diabetes mellitus,and EF values;however,SUA was nonlinearly related to all-cause mortality,and all-cause mortality was low when SUA fluctuated at about 470-650μmol/L.The risk of cardiovascular mortality increased with every 100μmol/L increase in SUA,and the mortality risk ratio was 1.509[95%CI=(1.077,2.113);P=0.017<0.05];however,there was also a nonlinear relationship between SUA and cardiovascular mortality,and cardiovascular mortality was low when SUA fluctuated at about 470-650μmol/L.Conclusion SUA has a nonlinear relationship with all-cause mortality and CV mortality in MHD patients.MHD patients with higher SUA seemed to have lower mortality.