探讨尿酸/白蛋白比值与慢性肾病腹膜透析患者发生心脑血管事件的关系  

Association of uric acid to albumin ratio with cardiovascular and cerebrovascular events in patients with chronic kidney disease taking peritoneal dialysis

作　　者：顾芸芸 顾进[1] 孙敦坡 王益松 李静[1] Gu Yunyun;Gu Jin;Sun Dunpo;Wang Yisong;Li Jing(Department of Clinical Laboratory,Affiliated Lianyungang Hospital,Nanjing University of Chinese Medicine,Lianyungang 222004,China;Department of Acupuncture,Affiliated Lianyungang Hospital,Nanjing University of Chinese Medicine,Lianyungang 222004,China)

机构地区：[1]南京中医药大学连云港附属医院检验科,连云港222004 [2]南京中医药大学连云港附属医院针灸科,连云港222004

出　　处：《国际医药卫生导报》2025年第6期1020-1026,共7页International Medicine and Health Guidance News

基　　金：江苏省中医药科技发展计划(YB2020073)。

摘　　要：目的探讨尿酸/白蛋白比值(UAR)与慢性肾病(CKD)腹膜透析(PD)患者心脑血管事件发生的关系。方法采用回顾性研究,收集2017年10月至2024年5月南京中医药大学连云港附属医院CKD5期首次接收腹膜置管术的患者533例,以患者UAR受试者操作特征曲线(ROC)最佳截断值为分界线,将患者分为低UAR组[321例,其中男175例、女146例,年龄53(45,61)岁]和高UAR组[212例,其中男122例、女90例,年龄59(48,66)岁]。采用t检验、Mann-Whitney U检验、χ^(2)检验比较两组患者资料,Kaplan-Meier法绘制PD患者心脑血管事件生存曲线,Log-Rank法分析其生存率,Cox回归分析心脑血管事件发生的独立风险因素。结果PD患者发生心脑血管事件UAR的ROC结果显示,曲线下面积(AUC)为0.726,95%置信区间(CI)0.681~0.772,灵敏度为49.10%,特异度为88.00%,最佳截断值为14.77,以最佳截断值将PD患者分为低UAR组(UAR<14.77,321例)和高UAR组(UAR≥14.77,212例)。两组资料比较:高UAR组年龄、白细胞(WBC)、中性粒细胞(Neu)、红细胞(RBC)、红细胞分布宽度标准差(RDW-SD)、碱性磷酸酶(ALP)、尿酸(UA)、中性粒细胞/淋巴细胞比值(Neu/Lym,NLR)均高于低UAR组,差异均有统计学意义(均P<0.05);淋巴细胞(Lym)、平均红细胞血红蛋白浓度(MCHC)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、白蛋白(Alb)水平均低于低UAR组,差异均有统计学意义(均P<0.05)。Kaplan-Meier生存曲线分析显示,高UAR组PD患者心脑血管事件发生率高于低UAR组(Log-Rankχ^(2)=11.498,P<0.001);高UAR组12个月、24个月、36个月、48个月、60个月心脑血管事件发生率分别为21.4%、39.1%、56.2%、74.7%、86.5%。多因素Cox回归分析结果显示,UAR水平升高(HR=1.042,95%CI 1.021~1.063,P<0.05)和ALP水平降低(HR=0.998,95%CI 0.997~0.999,P<0.05)均是PD患者发生心脑血管事件的独立风险因素。结论UAR和ALP对PD患者心脑血管事件的发生具有预测价值,UObjective To investigate the association of uric acid to albumin ratio(UA/Alb,UAR)with cardiovascular and cerebrovascular events in patients with chronic kidney disease taking peritoneal dialysis.Methods The clinical data of 533 patients with stage 5 chronic kidney disease taking peritoneal catheterization at Affiliated Lianyungang Hospital,Nanjing University of Chinese Medicine from October 2017 to May 2024 were retrospectively collected.According to the optimal cut-off value of UAR obtained by the receiver operating characteristic curve(ROC),the patients were divided into a low UAR group(321 cases),including 175 males and 146 females who were 53(45,61)years old,and a high UAR group(212 cases),including 122 males and 90 females who were 59(48,66)years old.The t test,Mann-Whitney U test,andχ^(2) test were used to compare the data between the two groups.The survival curves of cardiovascular and cerebrovascular events in the patients were drawn by the Kaplan-Meier method.The patients'survival rate was analyzed by the Log-Rank method.The independent risk factors were analyzed by the Cox regression.Results The area under the ROC(AUC)of UAR was 0.726(95%CI 0.681-0.772);the sensitivity was 49.10%;the specificity was 88.00%;the optimal cut-off value was 14.77.Taking UAR 14.77 as the optimal cut-off value,the patients were divided into a low UAR group(UAR<14.77,321 patients)and a high UAR group(UAR≥14.77,212 patients).The age,white blood cell(WBC),neutrophils(Neu),red blood cell(RBC),standard deviation of red blood cell distribution width(RDW-SD),alkaline phosphatase(ALP),uric acid(UA),and neutrophil/lymphocyte ratio(Neu/Lym,NLR)in the high UAR group were higher than those in the low UAR group,with statistical differences(allΡ<0.05).The levels of lymphocyte(Lym),mean erythrocyte hemoglobin concentration(MCHC),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),and albumin(Alb)in the high UAR group were lower than those in the low UAR group,with statistical diff

关 键 词：慢性肾病 腹膜透析 心血管疾病 尿酸/白蛋白比值 

分 类 号：R73[医药卫生—肿瘤]