中老年人群血清尿酸的长期变化对肾小球滤过率的影响——5年前瞻性队列研究  

Effects of longitudinal trend of serum uric acid levels on glomerular filtration rate in the middle-aged and elderly population:a 5-year prospective cohort study

作　　者：李婷[1] 王兰花[2] 黄文勇[2] 蔡小燕[3] 张建瑜[1] Li Ting;Wang Lanhua;Huang Wenyong;Cai Xiaoyan;Zhang Jianyu(Department of Rheumatology,The Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,Guangdong,China;State Key Laboratory of Ophthalmology,Zhongshan Ophthalmic Center,Sun Yat-Sen University,Guangzhou 510060,Guangdong,China;Department of Rheumatology,Guangzhou First People's Hospital,Guangzhou 510180,Guangdong,China)

机构地区：[1]广州医科大学附属第三医院风湿免疫科,广东广州510150 [2]中山大学中山眼科中心眼科学国家重点实验室,广东广州510060 [3]广州市第一人民医院风湿免疫科,广东广州510180

出　　处：《中国医学前沿杂志（电子版）》2022年第8期39-47,共9页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：广东省医学科学技术研究基金项目(B2021267)。

摘　　要：目的探讨中老年人群中血清尿酸(uric acid,UA)在5年内的纵向变化趋势和波动及其对肾小球滤过率(glomerular filtration rate,GFR)的影响。方法纳入在中国广州进行的岭头队列研究中≥40岁的参与者。2008年进行了基线检查,随访检查每年进行一次,直到2012年。UA趋势计算为每次检查时UA的水平线性回归的斜率系数。UA波动定义为计算个体5年内所有的血尿的测量值的标准差和均方根误差(root mean square error,RMSE)。GFR采用慢性肾病流行病学协作方程进行计算。在5年期间,有基线UA和至少3次UA测量值的参与者被纳入分析。结果共纳入4014例参与者,2012年平均年龄(62.6±8.7)岁,男性2375例(59.2%)。5年平均UA水平为(6.23±1.34)mg/dl,并随时间升高。高基线UA组的UA波动更显著,其标准差和RMSE波动也较大。2012年的GFR水平随着UA水平的增高而降低(P<0.001),进一步对性别分层后发现,这一趋势在女性受试者中表现显著(P<0.001),而在男性中没有统计学意义(P=0.076)。在校正了潜在的混杂因素后,较高的基线UA和较大的UA变异性(长期趋势和波动)仍然与较低的GFR相关。结论中老年人群中UA水平升高及其波动与GFR降低独立相关。UA可能会增加这一人群发生肾功能不全的风险。因此,早期管理不断增加的UA水平是必要的。Objective This study aimed to explore the 5-year longitudinal trends and fluctuations in serum uric acid(UA and their impact on the glomerular filtration rate(GFR)in the middle-aged and elderly population.Method Participants aged≥40 years were recruited from the Lingtou Cohort Study in Guangzhou Southern China.Baseline tests were performed in 2008,and follow-up tests were performed annually until 2012.The UA trend was calculated as the slope coefficient of linear regression of UA level across each time of examination.UA fluctuation was defined as the standard deviation and root mean square error(RMSE)in multiple visits.GFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation.Participants with baseline UA and at least 3 UA measurements over the 5-year period were included in the analysis.Result A total of 4014 participants were included,with a mean age of(62.6±8.7)years in 2012,and 2375(59.2%)were men.The 5-year mean UA was(6.23±1.34)mg/dl and increased over time.UA fluctuation was more significant in the higher baseline UA group,which also presented larger standard deviation and RMSE fluctuations.We found that GFR levels in 2012 tended to decrease as UA levels increased(P for trend<0.001),and the analysis stratified by gender showed that this trend was significant only in female subjects(P for trend<0.001),but not in males(P for trend=0.076).After adjusting for potential confounders,higher baseline UA and greater UA variability(long-term trend and fluctuation)remained associated with lower GFR.Conclusion Elevated UA levels and their fluctuations are independently associated with reduced GFR in the Chinese middle-aged and elderly population.UA may increase the risk of renal insufficiency in this population.Therefore,early management of increasing UA levels is warranted.

关 键 词：尿酸 肾小球滤过率 长期趋势 波动 前瞻性队列研究 

分 类 号：R692[医药卫生—泌尿科学]