血尿酸水平的变化对肾小球滤过率的影响  

Effects of Changes in Serum Uric Acid Levels on Glomerular Filtration Rate

作　　者：刘剑 余戈平 俞夏莲 刘韵子 夏子茹 李欣[1] 郑金鑫 王伟铭[1] LIU Jian;YU Geping;YU Xialian(Department of Nephrology,Ruijin Hospital,Shanghai Jiaotong University,School of Medicine,Shanghai,200025;不详)

机构地区：[1]上海交通大学医学院附属瑞金医院肾脏科,上海交通大学医学院肾脏病研究所,上海200025 [2]桐庐县第一人民医院肾内科,桐庐311599

出　　处：《中国中西医结合肾病杂志》2023年第10期871-875,I0002,共6页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：卫生行业科研专项项目(No.201002010);国家自然科学基金资助项目(No.81270782,30771000,81700647,81870492);国家重点基础研究发展计划(973计划)项目(No.2012CB517701);国家临床重点专科建设项目;上海市卫计委重中之重学科建设项目;科技部“十二五”科技攻关项目(No.2011BAI10B00)。

摘　　要：目的:为探索健康人群中血尿酸水平的变化对肾小球滤过率(estimated glomerular filtration rate,eGFR)的影响。方法:对桐庐第一医院体检中心的体检人群进行回顾性研究,纳入2011年—2018年至少有3次就诊且基线eGFR≥60 ml·min^(-1)·m^(-2)的人群,应用线性混合模型探索尿酸(uric acid,UA)与eGFR之间的关联,采用Logistic回归模型检验UA水平变化斜率与eGFR下降之间的关系以及不同UA变化与eGFR快速下降的风险的关系。结果:共纳入10470例研究参与者。在高尿酸血症(hyperuricemia,HUA)和非HUA组中,线性混合模型显示调整混杂因素后,UA与eGFR呈独立负相关(P<0.001)。在HUA和非HUA组中,UA变化的斜率和eGFR快速下降之间呈非线性关系(P<0.001)。根据基线UA水平及UA变化斜率进行分组,分为低-下降组、低-稳定组、低-增加组、高-下降组、高-稳定组以及高-增加组,我们发现,在男性中,与低-稳定组相比,低-增加组(校正后的OR[95%CI]=2.884[2.217,3.752])和高-增加组(3.701[2.680,5.110])eGFR快速下降的风险更高;在女性中,与低-稳定组相比,低-上升组(2.325[1.810,2.986])、高-下降组(1.737[1.009,2.990])、高-稳定组(2.051[1.425,2.951])和高-上升组(3.982[2.643,5.999])eGFR快速下降风险较高。结论:本研究发现,在eGFR≥60 ml·min^(-1)·1.73 m^(2)的人群中,基线的UA水平与eGFR呈负相关,不同UA变化与eGFR快速下降的相关性不同。Objective:To determine the effect of the changes of serum uric acid(UA)on estimated glomerular filtration rate(eGFR)in a healthy population.Methods:We conducted a retrospective study of a health examination center database in China.Subjects who had at least 3 visits from 2011 to 2018 were enrolled.A linear mixed-effects regression model was used to calculate the association between UA levels and eGFR.A logistic regression model was used to test the relationship between the slope of the changes in UA levels and rapid eGFR decline and the risk of rapid eGFR decline in different trajectories.Results:In total,10470 study participants were included in this analysis.In a linear mixed model,after adjusting for confounders,UA was independently inversely associated with eGFR(P<0.001)in the HUA and non-HUA groups.We observed a nonlinear relationship(P for nonlinear association<0.001 in the HUA and non-HUA groups)between the UA slope and rapid eGFR decline(P<0.001 in the non-HUA and HUA groups).Compared with the low-stable group,low-increasing(adjusted OR[95%CI]=2.884[2.217,3.752])and high-increasing(3.701[2.680,5.110])had higher risk of faster decrease in eGFR in men and low-increasing(2.325[1.810,2.986]),high-decreasing(1.737[1.009,2.990]),high-stable(2.051[1.425,2.951])and high-increasing(3.982[2.643,5.999])had higher risk of faster decrease in eGFR in women.Conclusion:Our study found that UA was independently inversely associated with eGFR in individuals in healthy participants.The distinct changes of UA are differently associated with faster decrease of eGFR.

关 键 词：尿酸变化 肾小球率过滤 危险因素 

分 类 号：R692[医药卫生—泌尿科学]