中国长寿地区老年人血尿酸水平与慢性肾脏病发病风险研究  

Association between Serum Uric Acid Level and the Risk of Chronic Kidney Disease among the Elderly in Longevity Areas of China

作　　者：张鹏[1] 高鹰[2] 杨洪喜 万春晓[1] ZHANG Peng;GAO Ying;YANG Hongxi;WAN Chunxiao(Department of Rehabilitation Medicine,Tianjin Medical University General Hospital,Tianjin 300052,China;Health Management Center,Tianjin Medical University General Hospital,Tianjin 300052,China;Department of Bioinformatics,School of Basic Medical Sciences,Tianjin Medical University,Tianjin 300070,China)

机构地区：[1]天津医科大学总医院康复医学科,天津市300052 [2]天津医科大学总医院健康管理中心,天津市300052 [3]天津医科大学基础医学院生物信息系,天津市300070

出　　处：《中国全科医学》2023年第31期3884-3889,3907,共7页Chinese General Practice

基　　金：国家自然科学基金资助项目(72104179);天津市卫生健康科技项目(KJ20178);天津市医学重点学科(专科)建设项目(TJYXZDXK-060B)。

摘　　要：背景血尿酸(SUA)升高导致的高尿酸血症(HUA)已被证实是慢性肾脏病(CKD)发生发展的独立危险因素,但国内关于老年人SUA水平与CKD发生发展关联的队列研究较少。目的探讨中国长寿地区老年人基线SUA水平及其变化与CKD发病风险及估算的肾小球滤过率(eGFR)变化关联。方法2021年12月—2022年5月,基于中国老年健康影响因素跟踪调查(CLHLS)子队列——老年健康生物标志物队列研究(HABCS),选取2012、2014年接受健康体检并采集生物医学指标的老年人为研究对象,收集基线及随访期老年人年龄、性别、血压、血脂、血糖等生物医学指标。采用Cox比例风险回归模型分析不同SUA水平与CKD发病风险关联;采用Spearman秩相关和广义线性模型分别分析老年人基线SUA水平与基线eGFR的相关性及老年人SUA水平变化与eGFR变化的相关性。结果共纳入研究对象981名,中位年龄79(70,88)岁,HUA患病率为6.8%(67/981),累积随访2029人年,中位随访2.05年,CKD新发病例共179例,随访期间CKD累积发病率为18.2%[95%CI(15.9%,20.8%)],发病密度88.22/1000人年[95%CI(76.24/1000人年,101.41/1000人年)]。以SUA四分位数分组为因变量的Cox比例风险回归模型分析结果显示,与基线SUA最低四分位数组(Q1)相比,最高四分位数组(Q4)老年人CKD发病风险的HR值为2.08[95%CI(1.27,3.41),P=0.004]。以SUA水平为因变量的Cox比例风险回归模型分析结果显示,基线SUA水平每升高10μmol/L,老年人CKD发病风险增加4%(P<0.001)。以是否患HUA为因变量的Cox比例风险回归模型分析结果显示,与基线未患HUA老年人相比,患HUA老年人CKD发病风险增加,HR值为2.00[95%CI(1.20,3.24),P=0.007]。老年人基线SUA中位数为270.60(223.10,325.90)μmol/L,基线eGFR中位数为84.07(73.08,98.38)mL·min^(-1)·(1.73 m^(2))-1,Spearman秩相关分析结果显示,二者呈负相关(rs=-0.363,P<0.001)。广义线性模型分析结果显示,老年人基线SUA水平每升高10μBackground Hyperuricemia(HUA)caused by elevated serum uric acid(SUA)has been shown to be an independent risk factor for the development and progression of chronic kidney disease(CKD).However,there are few cohort studies on the correlation of SUA level with the development and progression of CKD in the elderly of China.Objective To explore the association of baseline SUA level and its changes with the risk of chronic kidney disease(CKD)and estimated glomerular filtration rate(eGFR)in the elderly in longevity areas of China.Methods Based on the Healthy Aging and Biomarkers Cohort Study(HABCS),a sub cohort of the Chinese Longitudinal Healthy Longevity Survey(CLHLS),the older adults who received physical examination and with biomedical indicators in 2012 and 2014 were selected as the study subjects from December 2021 to May 2022.The age,gender,blood pressure,blood lipids,blood glucose and other biomedical indicators were collected at baseline and follow-up period.Cox proportional hazards regression model was used to analyze the association of different SUA levels with the risk of CKD.Spearman rank correlation and generalized linear model analysis were used to analyze the association between baseline SUA level and baseline eGFR level and the linear correlation between changes in SUA level and eGFR changes in the elderly,respectively.Results A total of 981 subjects were included in the study,with the median age of 79(70,88)years,the prevalence of HUA of 6.8%(67/981),the cumulative follow-up of 2029 person-years and the median follow-up of 2.05 years,including 179 new cases of CKD,the cumulative incidence of CKD during the follow-up was 18.2%〔95%CI(15.9%,20.8%)〕,and the incidence density was 88.22/1000 person-years〔95%CI(76.24/1000 person-years,101.41/1000 person-years)〕.Cox proportional hazards regression analysis with SUA quartile grouping as the independent variable showed that compared with the lowest quartile group of baseline SUA level(Q1),the HR value for the risk of CKD in the highest quartile group of b

关 键 词：慢性肾脏病 高尿酸血症 肾小球滤过率 老年人 队列研究 长寿地区 

分 类 号：R681.1[医药卫生—骨科学]