新疆多中心慢性肾脏病无症状高尿酸血症患病率及预后研究
Prevalence and prognosis of asymptomatic hyperuricemia in chronic kidney disease in Xinjiang: a multicenter study
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摘要: 目的 了解新疆6家医院慢性肾脏病(chronic kidney disease,CKD)患者无症状高尿酸血症(asymptomatic hyperuricemia,AH)患病率及预后,为今后制定合理措施提供依据。方法 采取整群抽样的方法收集2019年1月至2019年12月新疆维吾尔自治区人民医院、新疆维吾尔自治区莎车县医院、新疆军区总医院北京路医疗区、新疆维吾尔自治区和田地区人民医院、新疆维吾尔自治区友谊医院、新疆生产建设兵团医院等6家医院收治的CKD1~5期非透析患者。记录患者一般资料及实验室相关检查,分析不同CKD分期人群AH患病情况、危险因素以及预后。结果 本研究共筛选出CKD患者1346例,符合纳排标准且资料完整非透析CKD患者共767例,年龄范围18~87岁,年龄(51±15)岁。AH患者334例,患病率为43.5%,尿酸水平为(489.22±85.71)μmol/L。CKD合并AH组男性高于女性(60.5%比39.5%);汉族高于少数民族(55.4%比44.6%,P<0.05)。与正常尿酸组比较,AH组中CKD患者合并高血压病、肥胖症例数较高,收缩压、体重指数、尿素氮、血肌酐、C-反应蛋白、胆固醇、血磷、血镁、甲状旁腺激素均较高,差异有统计学意义,而估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、血红蛋白均较低且差异有统计学意义。多因素Logistic回归分析显示,低血红蛋白及低白蛋白是CKD患者发生eGFR下降≥30%或肾脏替代治疗的独立危险因素,而AH与终点事件的发生无明显相关性。对225例随访的CKD合并AH患者进一步分析,未达标组终点事件发生率显著高于达标组及未治疗组,差异有统计学意义(P<0.05)。结论 新疆地区CKD合并AH患病率高于普通人群,降尿酸治疗可能有利于延缓肾功能进展,改善CKD患者预后。Abstract: Objective To explore the prevalence and prognosis of asymptomatic hyperuricemia(AH) in patients with chronic kidney disease(CKD) in Xinjiang Uygur Autonomous Region and provide rationales for optimizing management strategies.Methods From January 2019 to December 2019,1346 patients of CKD stages 1-5 without receiving dialysis hospitalized at People’s Hospital of Xinjiang Uygur Autonomous Region,Hospital of Shache County,Beijing Road Medical Area,General Hospital of Xinjiang Military Command,People’s Hospital of Xinjiang Hetian District,Xinjiang Friendship Hospital,Xinjiang Production & Construction Corps Hospital in Xinjiang Uygur Autonomous Region were enrolled through cluster sampling.Medical history and laboratory test results were recorded.The prevalence,risk factors and prognosis of AH patients at different CKD stages were examined.767 CKD patients without receiving dialysis having complete medical record data and fulfilling the inclusion/exclusion criteria were enrolled.The average age was(51±15)(18-87) years.There were 334 AH patients with a prevalence of 43.5% and serum level of uric acid was(489.22±85.71) μmol/L.The prevalence of AH was higher in male CKD patients than that in female CKD counterparts(60.5% vs 39.5%).The prevalence of patients of Han ethnicity were higher than that of minority ethnicities(55.4% vs 44.6%,P<0.05).As compared with those with normal serum level of uric acid,AH patients had significantly higher comorbidities of hypertension,obesity,body mass index(BMI),blood urea nitrogen,creatinine,C-reactive protein,cholesterol,phosphorus,magnesium and parathyroid hormone.Estimated glomerular filtration rate(eGFR) and serum hemoglobin in AH patients were significantly lower than CKD patients without AH.Multivariate Logistic regression analysis revealed that low serum levels of hemoglobin and albumin were independent risk factors for endpoint events of ≥30% decline of eGFR or requirement of kidney replacement therapy in CKD patients.AH was not an independent risk factor for endpoint event.And 225 follow-up CKD patients with AH were further examined.The incidence of endpoint events in patients with non-normalized serum level of uric acid after treatment was significantly higher than that in those with normalized level of uric after treatment and those without treatment(P<0.05).Conclusion The prevalence of AH in CKD patients in Xinjiang Uygur Autonomous Region is higher than that in general population.Correcting hyperuricemia in CKD patients with AH helps to arrest the deterioration of kidney function and improve patient prognosis.