高尿酸血症是脓毒症患者发生急性肾损伤的独立危险因素  

Hyperuricemia is an independent risk factor for acute kidney injury in sepsis patients

作　　者：蒋远霞 唐艳 易扬 刘福岗 周静文[2] 史应龙[2] 周红卫[2] 谢恺庆[1] Jiang Yuanxia;Tang Yan;Yi Yang;Liu Fugang;Zhou Jingwen;Shi Yinglong;Zhou Hongwei;Xie Kaiqing(Department of Blood Purification,the Second Affiliated Hospital of Guangxi Medical University,Nanning 530007,China;Department of Blood Purification,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第二附属医院血液净化部,南宁530007 [2]广西医科大学第一附属医院血液净化部,南宁530021

出　　处：《中华急诊医学杂志》2020年第9期1178-1183,共6页Chinese Journal of Emergency Medicine

基　　金：广西自然科学基金(2018GXNSFAA050057)。

摘　　要：目的探究高尿酸血症对脓毒症患者发生急性肾损伤(acute kidney injury,AKI)的影响。方法采用回顾性队列研究方法,分析2014年3月至2019年6月入住广西医科大学第一附属医院内科重症监护病房(intensive care unit,ICU)、2017年1月至2019年6月入住广西医科大学第二附属医院ICU的459例成年脓毒症患者。根据入住ICU后24 h内首次血清尿酸水平将患者分为高尿酸血症组及非高尿酸血症组,比较两组患者入住ICU后7 d内AKI的发生率,通过单因素分析和二分类Logistic回归分析探讨高尿酸血症对脓毒症患者发生AKI的影响。结果纳入的459例脓毒症患者,高尿酸血症组81例,占17.6%;发生AKI的患者共127例,占27.7%,其中高尿酸血症组49例(49/81,60.5%),非高尿酸血症组78例(78/378,20.6%),差异有统计学意义(χ2=52.954,P<0.01);在校正了性别、伴发疾病(糖尿病和冠心病)、入住ICU当天序贯器官功能衰竭评分(SOFA评分)、入住ICU前后1周内使用利尿剂、有创机械通气、基础肾功能、血清乳酸、降钙素原水平等影响因素后,二分类Logistic回归分析显示高尿酸血症是脓毒症患者发生AKI的独立危险因素(OR=5.091,95%CI:2.768~9.362,P<0.01);脓毒症患者血清尿酸值每升高1 mg/dL,发生AKI的风险增高28.4%(OR=1.284,95%CI:1.165~1.414,P<0.01)。结论AKI是ICU脓毒症患者常见的并发症,高尿酸血症是脓毒症患者发生AKI的独立危险因素。Objective To investigate the effect of hyperuricemia on acute kidney injury in sepsis patients.Methods It is a retrospective cohort study of 459 adult sepsis patients who were admitted to the Department of Intensive Care Unit(ICU)of the First Affiliated Hospital of Guangxi Medical University from March 2014 to June 2019,and the Second Affiliated Hospital of Guangxi Medical University from January 2017 to June 2019.The patients were divided into the hyperuricemia group and the nonhyperuricemia group according to the first serum uric acid level within 24 h after ICU admission,and the incidence of AKI within 7 days after ICU admission was compared between the two groups.The effect of hyperuricemia on sepsis-associated AKI was analyzed by univariate analysis and binary logistic regression analysis.Results Among the 459 sepsis patients,81 patients(17.6%)had hyperuricemia,and 127 patients(27.7%)had AKI.The incidence of AKI in the hyperuricemia group and the non-hyperuricemia group were 60.5%(49/81)and 20.6%(78/378),respectively,which showed significantly statistical difference(χ2=52.954,P<0.01).After adjusting for gender,associated diseases(diabetes,coronary heart disease),sequential organ failure score(SOFA)on the day of ICU admission,the use of diuretics within one week before and after ICU admission,invasive mechanical ventilation,basal renal function,lactic acid,and procalcitonin,binary logistic regression analysis showed that hyperuricemia was an independent risk factor for AKI in sepsis patients(OR=5.091,95%CI:2.768-9.362,P<0.01);For every 1 mg/dL increase in serum uric acid in sepsis patients,the risk of developing AKI increased by 28.4%(OR=1.284,95%CI:1.165-1.414,P<0.01).Conclusions AKI is a common complication in sepsis patients admitted to ICU,and hyperuricemia is an independent risk factor for AKI in sepsis patients.

关 键 词：高尿酸血症 脓毒症 肾功能不全 急性 危险因素 急性肾损伤 

分 类 号：R459.7[医药卫生—急诊医学] R692[医药卫生—治疗学]