非透析糖尿病肾病患者合并高尿酸血症的危险因素及非布司他的保护作用  

Risk factors of non-dialysis diabetic nephropathy patients complicated with hyperuricemia and the protective effect of febuxostat

作　　者：李敬[1] 刘旭颖 高燕[1] 王倩 杜勇[3] 樊星[1] Li Jing;Liu Xuying;Gao Yan;Wang Qian;Du Yong;Fan Xing(Department of Renal Medicine,Affiliated Hospital of Hebei University,Baoding 071000,China;Department of Endocrinology,Affiliated Hospital of Hebei University,Baoding 071000,China;Department of Rheumatology and Immunology,Affiliated Hospital of Hebei University,Baoding 071000,China)

机构地区：[1]河北大学附属医院肾内科,保定071000 [2]河北大学附属医院内分泌科,保定071000 [3]河北大学附属医院风湿免疫科,保定071000

出　　处：《中国医师进修杂志》2022年第9期800-806,共7页Chinese Journal of Postgraduates of Medicine

基　　金：保定市科技计划项目(2041ZF298)。

摘　　要：目的探讨非透析糖尿病肾病(DN)患者合并高尿酸血症(HUA)的危险因素,观察非布司他治疗对肾脏的保护作用。方法回顾性分析2018年1月至2021年2月河北大学附属医院317例未透析DN患者的临床资料。其中,发生HUA 148例(HUA组),HUA发生率为46.69%;未发生HUA 169例(非HUA组)。HUA组中,采用非布司他治疗74例(观察亚组),采用别嘌醇治疗74例(对照亚组)。采用多因素Logistic回归分析影响DN患者发生HUA的独立危险因素;采用R 4.0.2软件建立预测DN患者发生HUA的列线图模型,采用受试者工作特征(ROC)曲线评估列线图模型的预测能力,通过校正曲线和偏差校正C-index验证预测模型的校准度和有效性。结果两组性别构成及糖尿病视网膜病变、糖尿病周围神经病变和糖尿病足发生率比较差异无统计学意义(P>0.05);HUA组年龄、体质量指数(BMI)、DN病程>3年率、吸烟率、饮酒率、糖尿病家族史率、每周食用海产品>2次率及高血压、高血脂、冠心病、肾结石和脑卒中发生率明显高于非HUA组[(57.96 ± 5.25)岁比(56.14 ± 4.71)岁、(24.18 ± 3.95) kg/m2比(23.06 ± 3.12) kg/m2、78.38%(116/148)比30.77%(52/169)、84.46%(125/148)比28.99%(49/169)、93.92%(139/148)比40.24%(68/169)、62.84%(93/148)比50.30%(85/169)、46.62%(69/148)比15.38%(26/169)、41.89%(62/148)比20.71%(35/169)、73.65%(109/148)比45.56%(77/169)、39.86%(59/148)比18.34%(31/169)、45.95%(68/148)比26.04%(44/169)和50.68%(75/148)比8.28%(14/169)],差异有统计学意义(P<0.01或<0.05)。多因素Logistic回归分析结果显示,年龄、BMI、DN病程、吸烟、饮酒、高血压、高血脂、冠心病、肾结石、脑卒中和每周食用海产品次数是影响DN患者发生HUA的独立危险因素(OR = 1.053、1.062、3.192、3.638、5.397、1.371、1.690、1.404、1.392、2.295和2.581,95%CI 1.028~1.078、1.031~1.093、2.517~3.867、2.754~4.522、4.169~6.625、1.253~1.489、1.482~1.898、1.237~1.571、1.284~1.501、1.730~2.860和1.862Objective To investigate the risk factors of hyperuricemia(HUA)in non-dialysis diabetic nephropathy(DN)patients,and to observe the protective effect of febuxostat on kidney.Methods The clinical data of 317 DN patients without dialysis in Affiliated Hospital of Hebei University from January 2018 to February 2021 were analyzed retrospectively.Among them,HUA occurred in 148 cases(HUA group),the incidence of HUA was 46.69%,and no HUA occurred in 169 cases(non-HUA group).In HUA group,74 patients were treated with febuxostat(observation subgroup),and 74 patients with allopurinol(control subgroup).Multivariate Logistic regression analysis was used to analyze the independent risk factors of HUA in patients with DN;a nomogram model for predicting the occurrence of HUA in patients with DN was established by R 4.0.2 software,the predictive ability of the nomogram model was evaluated by receiver operating characteristic(ROC)curve,and the calibration and validity of the prediction model were verified by correction curve and deviation correction C-index.Results There were no significant difference in gender composition and the incidence of diabetic retinopathy,diabetic peripheral neuropathy,diabetic foot between the two groups(P>0.05);the age,body mass index(BMI),DN course>3 years rate,smoking rate,drinking rate,family history of diabetes rate,seafood consumption more than 2 times a week rate,and the incidences of hypertension,hyperlipidemia,coronary heart disease,nephrolithiasis,stroke in HUA group were significantly higher than those in non-HUA group:(57.96±5.25)years old vs.(56.14±4.71)years old,(24.18±3.95)kg/m2 vs.(23.06±3.12)kg/m2,78.38%(116/148)vs.30.77%(52/169),84.46%(125/148)vs.28.99%(49/169),93.92%(139/148)vs.40.24%(68/169),62.84%(93/148)vs.50.30%(85/169),46.62%(69/148)vs.15.38%(26/169),41.89%(62/148)vs.20.71%(35/169),73.65%(109/148)vs.45.56%(77/169),39.86%(59/148)vs.18.34%(31/169),45.95%(68/148)vs.26.04%(44/169)and 50.68%(75/148)vs.8.28%(14/169),and there were statistical differences(P<0.01 or<0.05).Multivariate

关 键 词：糖尿病肾病 高尿酸血症 危险因素 治疗结果 非布司他 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学] R589.7[医药卫生—临床医学]