尿酸与肾脏疾病发生和预后关系的系统评价和荟萃分析  

The correlation between uric acid and the incidence and prognosis of kidney diseases： a systematic review and meta-analysis of cohort studies

作　　者：李雨璘[1] 王凌[3] 李静[1] 黄艳[1] 袁文明[2] 

机构地区：[1]四川大学华西医院循证医学与流行病学教研室,成都610041 [2]四川大学华西医院肾脏内科,成都610041 [3]四川绵阳市人民医院,621000

出　　处：《中华内科杂志》2011年第7期555-561,共7页Chinese Journal of Internal Medicine

摘　　要：目的系统评价尿酸与肾脏疾病发生和预后的关系，为防治肾脏疾病提供参考。方法检索中国生物医学文献数据库（CBM）（1982年1月-2010年3月）、荷兰医学文摘（EMBASE）（1966年1月-2010年3月）以及美国医学索引（Medline）（1950年1月-2010年3月），筛选尿酸与肾脏疾病发生和预后的相关文献，只纳入队列研究。根据Newcastle—Ottawa质量评价量表评价纳入研究的偏倚风险，2名研究人员独立筛选、评价文献和收集数据。采用Stata10．0软件进行统计学分析。结果共纳入21篇高质量队列研究文章，其中与肾脏疾病发生相关11篇，共276801例研究对象；与肾脏疾病预后相关10篇，共3004例研究对象。对纳入研究中校正了除尿酸外其他影响肾脏疾病发生和预后因素的数据进行Meta分析，结果显示：（1）尿酸与肾脏疾病发生：尿酸水平升高会增加肾脏疾病的发生风险（RR=1．49，95％C11．27—1．75）。（2）尿酸与肾脏疾病预后：高尿酸可导致肾功能恶化（RR=1．35，95％CI1．12—1．63）和肾脏疾病患者死亡风险增加（RR=1．67，95％CI1．29—2．16）。结论尿酸是肾脏疾病发生和已患肾脏疾病患者预后不佳的独立危险因素。今后需开展高质量、长随访的临床试验，明确降低尿酸是否能降低肾脏疾病的发生风险和改善肾脏疾病患者的预后，为进一步明确尿酸与肾脏疾病的关系和高尿酸患者的防治提供直接依据。Objective To evaluate the association of serum uric acid and the incidence and prognosis of kidney diseases systematically, so as to provide reference for the treatment and prevention of kidney diseases. Methods Literatures related to the associations between serum uric acid and incidence and prognosis of kidney diseases were selected from the Chinese Bion%dical Literature Database （CBM） （January 1982 to March 2010）, EMBASE （January 1966 to March 2010） and Medline （January 1950 to March 2010） for cohort studies. Two researchers independently screened the studies, assessed the risk of bias of included studies using the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies and extracted data. Stata 10.0 was used to calculate the pooled relative risk. Results Twenty-one eligible cohort studies were selected, of which 11 on incidence of kidney diseases （n = 276 801 ）, and 10 on the prognosis of kidney diseases （n = 3004）. Meta analysis was performed based on data influencing incidence and prognosis factors of kidney diseases except for serum uric acid. The results showed, （ 1 ） uric acid and incidence of kidney diseases： hyperuricemia could increase the risk of kidney diseases （RR = 1.49, 95% CI 1.27-1.75 ） ; （2） uric acid and prognosis of patients with kidney diseases ： hyperuricemia could deteriorate the kidney function （RR = 1.35, 95% CI 1.12-1.63 ） and increase the risk of mortality （RR = 1.67, 95% CI 1.29-2. 16）. Conclusion Uric acid is an independent risk factor for incidence of kidney diseases and poor prognosis of patients with kidney diseases. Further high quality clinical trials with long-term follow up should be conducted to determine whether lowering uric acid levels would be of clinical benefit in the prevention and treatment of kidney diseases, so as to provide direct evidence for clarifying correlation between uric acid and kidney diseases and the prevention and treatment for patients with high uric acid.

关 键 词：尿酸 肾疾病 META分析 系统评价 

分 类 号：R692[医药卫生—泌尿科学]