血尿酸/血肌酐比值与狼疮性肾炎患者肾脏预后的关系  

The Relationship Between Serum Uric Acid to Creatinine Ratio and the Prognosis of Kidney in Patients with Lupus Nephritis

作　　者：陶彩 胡豪飞 万启军[1,2] 许日聪 刘洋[1,2] 唐飞 TAO Cai;HU Haofei;WAN Qijun(Shenzhen Second People’s Hospital,the First Affiliated Hospital of Shenzhen University,Shenzhen,518035)

机构地区：[1]深圳大学第一附属医院,深圳518035 [2]深圳市第二人民医院,深圳518035

出　　处：《中国中西医结合肾病杂志》2023年第6期497-501,共5页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：深圳市医学重点学科建设经费资助项目(No.SZXK009);国家自然科学基金资助项目(No.81900639);深圳市科技研发基金资助项目(No.JCYJ20190806162807125)。

摘　　要：目的:探索狼疮性肾炎患者血尿酸/血肌酐比值与肾脏预后的关系。方法:连续纳入2010年3月1日—2021年3月30日深圳大学第一附属医院肾内科经肾穿刺活检确诊为狼疮性肾炎患者132例。按血尿酸/血肌酐比值中位数二分组。随访终点事件为血清肌酐翻倍或ESRD。随访截止至2021年9月30日。采用Cox回归分析血尿酸/血肌酐比值与肾脏预后关系,Kaplan-Meier生存曲线比较血尿酸/血肌酐比值组间终点事件发生情况,血尿酸、eGFR分组行血尿酸/血肌酐比值与肾脏预后关系的分层分析,并对结果进行交互检验。结果:经过纳排标准后共有99例狼疮性肾炎患者进行分析,截止至本研究终点,平均随访时间(40.3±27)月,13例患者达到随访终点。单因素Cox回归分析提示血尿酸/血肌酐比值与肾脏预后不良呈负相关(HR=0.403,95%CI 0.261,0.622,P<0.001)。多因素Cox回归分析,校正了性别、年龄、收缩压、血红蛋白、血白蛋白、SLEDAI评分、核碎裂、肾小管萎缩、血管纤维素样坏死、初始治疗方案等多个混杂因素后,结果提示血尿酸/血肌酐比值与肾脏预后不良独立负相关(HR=0.468,95%CI 0.245,0.896,P=0.022)。将eGFR分为<90 ml·min^(-1)·1.73 m-2组和≥90 ml·min^(-1)·1.73 m^(-2)组,将血尿酸分为≤420μmol/L组和>420μmol/L组,行分层分析并对结果进行交互检验,结果提示狼疮性肾炎患者伴或不伴高尿酸血症以及伴或不伴肾功能异常对血尿酸/血肌酐比值与肾脏预后关系无影响。结论:血尿酸/血肌酐比值与狼疮性肾炎患者肾脏预后不良独立负相关,基线肾功能水平和血尿酸水平对血尿酸/血肌酐比值与肾脏预后的关系无影响。Objective:To explore the relationship between serum uric acid to creatinine ratio and renal prognosis in patients with lupus nephritis.Methods:A total of 132 patients diagnosed with lupus nephritis by renal biopsies from March 2010 to March 2021 in the First Affiliated Hospital of Shenzhen University were enrolled.All patients were divided into two groups according to median of serum uric acid to creatinine ratio.The follow-up endpoint was defined as the doubling of serum creatinine or ESRD.The follow-up ended on September 2021.The Kaplan-Meier curve and Cox regression model were used to analyze the relationship between serum uric acid and creatinine ratio and renal prognosis.The interaction was used for stratification analysis in serum uric acid and eGFR.Results:99 patients with lupus nephritis were included for data analysis.The average follow-up time was(40.3±27)months.A total of 13 patients reached the endpoint.Univariate Cox regression analysis indicated that the serum uric acid to creatinine ratio was a predictive factor for renal prognosis(HR=0.403,95%CI 0.261,0.622,P<0.001).Multivariate Cox regression analysis,after adjusted for gender,age,systolic blood pressure,hemoglobin,albumin,SLEDAI score,nuclear fragmentation,renal tubular atrophy,vascular fibrinoid necrosis,the results suggested the serum uric acid to creatinine ratio is an independent factor of renal prognosis(HR=0.468,95%CI 0.245,0.896,P=0.022).The interaction analysis found that baseline renal function and serum uric acid did not affect the relationship between the serum uric acid to creatinine ratio and renal prognosis.Conclusion:Serum uric acid to creatinine ratio is an independent negatively correlated factor for renal poor prognosis in patients with lupus nephritis.The baseline renal function and serum uric acid level do not affect the relationship between serum uric acid to creatinine ratio and renal prognosis.

关 键 词：血尿酸/血肌酐比值 狼疮性肾炎 预后 

分 类 号：R593.242[医药卫生—内科学]