原发性免疫球蛋白A肾病非透析患者高尿酸血症危险因素分析  

Risk factors of hyperuricemia in non-dialysis patients with primary immunoglobulin A nephropathy

作　　者：刘思梦 邢鹏[1] 任红[1] 张文[1] 陈晓农[1] 李晓[1] LIU Simeng;XING Peng;REN Hong;ZHANG Wen;CHEN Xieonong;LI Xiao.(Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, Chin)

机构地区：[1]上海交通大学医学院附属瑞金医院肾脏科,上海200025

出　　处：《上海医学》2018年第2期95-99,共5页Shanghai Medical Journal

基　　金：国家自然科学基金(81170671)

摘　　要：目的探讨原发性免疫球蛋白A(IgA)肾病非透析患者高尿酸血症(HUA)患病率及其发生的危险因素。方法收集于2005年1月—2009年1月在上海交通大学医学院附属瑞金医院肾脏科住院,年龄>18岁,肾穿刺明确诊断为原发性IgA肾病的914例非透析患者的临床资料和实验室检查结果,采用Spearman或Pearson相关分析血尿酸(SUA)水平与其他生化指标的相关性,二分类多因素logistic回归分析原发性IgA肾病伴发HUA的危险因素,加权logistic回归分析血三酰甘油(TG)水平与HUA患病危险度的关系。结果914例患者的总体HUA患病率为45.8%,其中男性HUA患病率为51.9%(255/491),显著高于女性的38.8%(164/423,P<0.001);年龄≥45岁的患者,男、女HUA患病率的差异无统计学意义(P=0.258)。CKD 1至5期患者的HUA患病率分别为12.2%(31/254)、33.2%(72/217)、65.1%(164/252)、84.0%(89/106)、74.1%(63/85),随着肾功能的下降,CKD 1至4期患者的HUA患病率逐渐升高(P<0.05)。HUA患者中的男性构成比、BMI、高血压患者比例、TG、血磷、血肌酐、SUA和24h尿蛋白定量均显著高于非HUA患者(P值分别<0.01、0.05),年龄、血红蛋白(Hb)和估算的肾小球滤过率(eGFR)均显著低于非HUA患者(P值分别<0.05、0.01)。相关性分析显示,SUA水平与BMI(r=0.142,P<0.001)、TG(r=0.278,P<0.001)、血磷(r=0.217,P<0.001)、24h尿蛋白(r=0.255,P<0.001)均呈正相关,与Hb(r=-0.102,P=0.007)和eGFR(r=-0.580,P<0.001)均呈负相关,与年龄、血白蛋白、空腹血糖、胆固醇、低密度脂蛋白、血钙均不相关(P值均>0.05)。多因素logistic回归模型分析结果显示,校正多因素后原发性IgA肾病非透析患者伴发HUA的独立危险因素为血TG(OR=1.297,95%CI为1.125~1.497,P<0.001)和CKD分期(OR=2.612,95%CI为2.108~3.236,P<0.001)。进一步将患者按血TG水平五分位数由低到高分为<1.20mmol/L组、1.20~<1.61mmol/L组、1.61~<2.17mmol/L组、2.17~<3.02mmol/L组、≥3.02mmol/L组,以<1.20mmol/L组作为参照组,�Objective To investigate the prevalence and risk factors of hyperuricemia （HUA） in nondialysis patients with primary immunoglobulin A （IgA） nephropathy. Methods Clinical data and laboratory examination results of 914 non-dialysis inpatients （〉 18 years old） with IgA nephropathy confirmed by renal puncture between January 2005 and January 2009 were collected. The Spearman＇s or Pearson＇s correlation analysis was used to analyze the correlation between serum uric acid （SUA） levels and other biochemical indexes. Binary logistic regression analysis was used to identify the risk factors of HUA. Weighted logistic regression analysis was used to assess the correlation between triglyceride （TG） and HUA risks. Results The prevalence of HUA was 45.8% in overall 914 patients. And the prevalence of HUA in men （51.9%, 255/491 ） was significantly higher than that in women （38.8%, 164/423, P〈0. 001 ）, but no statistical difference was found between males and females aged 45 years and elder （P = 0. 258）. The prevalences of HUA at stages 1 to 5 of chronic kidney disease （CKD）were 12.2% （31/254）, 33.2% （72/217）, 65. 1% （164/252）, 84.0% （89/106）and 74. 1% （63/85）, respectively, which increased with the worsening of renal function in CKD stages 1 to 4 （P〈0.05）. Male constituent ratio, body mass index （BMI）, hypertension patient proportion, TG, serum phosphorus, serum creatinine, SUA and 24-hour urinary albumin levels in HUA patients were significantly higher than those in patients without HUA （P〈0.05, 0.01）, whereas age, hemoglobin （Hb） and estimated glomerular filtration rate （eGFR） in HUA patients were significantly lower than those without HUA （P〈0.05, 0.01 ）. Correlation analyses revealed that SUA levels were positively correlated with BMI （r=0. 142, P〈0.001）, TG （r=0.278, P〈0.001）, serum phosphorus （r=0.217, P〈0.001） and 24-hour urinary albumin （r =0.255, P〈0.001）, and negatively correlated withHb （r=-0.102, P=

关 键 词：高尿酸血症 原发性IGA肾病 三酰甘油 危险因素 

分 类 号：R589.7[医药卫生—内分泌] R692[医药卫生—内科学]