IgA肾病伴高尿酸血症患者的危险因素及其预后分析  

Analysis of Risk Factor and Prognosis in Patients with IgA Nephropathy with Hyperuricemia

作　　者：周涵 张森 张宗玮 胡宏图 梁伟[1] 丁国华[1] ZHOU Han;ZHANG Sen;ZHANG Zong-wei;HU Hong-tu;LIANG Wei;DING Guo-hua(Department of Nephrology,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院肾内科,武汉430060

出　　处：《微循环学杂志》2024年第3期61-65,共5页Chinese Journal of Microcirculation

摘　　要：目的:分析IgA肾病(IgAN)伴高尿酸血症(HUA)患者的危险因素及其预后。方法:2014-01-2022-05经肾活检确诊为原发性IgAN患者471例,根据其血尿酸(UA)水平分为HUA组(n=278)和正常尿酸组(NUA组,n=193)。比较两组患者基线时的临床和病理资料,采用Logistic回归分析IgAN伴HUA的危险因素。依据随访期间(中位随访时间50.4个月)患者终点事件,即肾小球滤过率(eGFR)较基线降低50%,或血肌酐(Scr)水平大于基线两倍,或进展至终末期肾病(ESRD),采用COX回归分析IgAN伴HUA患者不良预后的影响因素,Kaplan-Meier生存曲线比较两组肾脏生存率。结果:HUA组高血压比例、Scr、甘油三酯(TG)、24h尿蛋白(UTP)、肾小管萎缩/间质纤维化(T1-T2)及新月体病变(C1-C2)比NUA组更严重,而白蛋白(Alb)水平较NUA组降低(P<0.05或P<0.01)。Logistic回归分析显示IgAN伴HUA的独立危险因素为UTP(OR:1.231;95%CI:1.042-1.454,P<0.05)、高血压(OR:1.884;95%CI:1.143-3.104,P<0.05)和Scr(OR:1.018;95%CI:1.006-1.030,P<0.01)。随访期内15.92%患者出现终点事件,HUA组(14.44%)显著高于NUA组(1.49%)(χ^(2)=5.16,P<0.01)。COX回归分析提示UTP(HR:1.192;95%CI:1.051-1.352,P<0.01)和高血压(HR:3.186;95%CI:1.757-5.776,P<0.01)是IgAN伴HUA患者不良预后的独立危险因素。Kaplan-Meier生存曲线分析显示HUA组的肾脏生存率显著低于NUA组(92.68%vs 97.92%,χ^(2)=12.35,P<0.01)。结论:积极干预IgAN伴HUA患者的危险因素有助于改善患者预后。Objective:To evaluate the risk factors and the prognosis of IgA nephropathy(IgAN)with hyperuricemia(HUA).Method:A total of 471 patients diagnosed with IgAN by renal biopsy from 2014-01 to 2022-05 were recruited.They were divided into HUA group(n=278)and normal uric acid(NUA)group(n=193)based on uric acid(UA)levels.The clinical and pathological characteristics of both groups were compared,and logistic regression analysis was used to identify the risk factors in IgAN patients with HUA.Based on endpoint events of a 50%decline in estimated glomerular filtration rate(eGFR),doubling of serum creatinine(Scr)level,or end-stage renal disease(ESRD)during the follow-up period(median follow-up time 50.4 months),Cox proportional-hazards analysis was used to analyze the risk factors of poor prognosis in IgAN patients with HUA and Kaplan-Meier survival curves was used to compare the renal survival rate in two groups.Results:The proportion of hypertension,Scr,24h urine total protein(UTP),triglyceride(TG)levels,tubular atrophy/interstitial fibrosis(T1-T2)and cellular/fibrous crescent(C1-C2)were higher in the HUA group than in the NUA group,while albumin(Alb)was lower than in the NUA group(P<0.05 or P<0.01).Logistic regression analysis showed that UTP(OR:1.231;95 CI:1.042-1.454,P<0.05),hypertension(OR:1.884;95%CI:1.143-3.104,P<0.05)and Scr(OR:1.018;95%CI:1.006-1.030,P<0.05)were risk factors in IgAN patients with HUA.During the follow-up period,15.92%of patients had an endpoint event,which was higher in the HUA group(14.44%)than in the NUA group(1.49%)(χ~2=5.16,P<0.01).Cox regression analysis suggested that UTP(HR:1.192;95%CI:1.051-1.352,P<0.01)and hypertension(HR:3.186;95%CI:1.757-5.776,P<0.01)were independent risk factors of poor prognosis in patients of IgAN with HUA.The Kaplan-Meier survival curve suggested that renal survival rate was lower in HUA group than NUA group(92.68%vs 97.92%,χ~2=12.35,P<0.01).Conclusion:The risk factors in IgAN patients with HUA should be actively intervened to improve the prognosis of patients.

关 键 词：IGA肾病 高尿酸血症 危险因素 预后 

分 类 号：R692.31[医药卫生—泌尿科学] R589.7[医药卫生—外科学]