血清Klotho、尿调节素表达水平与免疫球蛋白A肾病并发高尿酸血症的相关性

魏迪; 贾利敏; 赵翠; 房晓芳

doi:10.3969/j.issn.1671-2390.2024.09.005

血清Klotho、尿调节素表达水平与免疫球蛋白A肾病并发高尿酸血症的相关性

Correlation between serum Klotho and uromodulin expression levels and IgA nephropathy complicated with hyperuricemia

摘要

摘要:
目的探究血清抗衰老蛋白Klotho、尿调节素（uromodulin，UMOD）表达水平与免疫球蛋白A（immunoglobulin A，IgA）肾病并发高尿酸血症的相关性。
方法选取2018年1月1日至2022年1月1日河北省沧州市人民医院收治的97例IgA肾病患者作为研究对象，根据肾穿刺活栓前的血尿酸水平将97例IgA肾病患者分为IgA肾病并发高尿酸血症组（42例）和血尿酸正常组（55例），另选取同时间段健康体检者97名为对照组。比较3组的血清Klotho、UMOD水平；进行IgA肾病并发高尿酸血症组和血尿酸正常组患者的一般资料比较；采用Pearson法进行IgA肾病并发高尿酸血症患者血清Klotho、UMOD水平与估算肾小球滤过率（estimated glomerular filtration rate，eGFR）、血尿酸和血肌酐水平的相关性分析；采用多因素Logistic回归分析IgA肾病并发高尿酸血症的影响因素；进一步采用受试者工作特征（receiver operating characteristic，ROC）曲线分析血清Klotho、UMOD水平对IgA肾病并发高尿酸血症的诊断价值。
结果 IgA肾病并发高尿酸血症组患者的血清Klotho为（151.66 ± 27.29）ng/L，UMOD水平为（39.65 ± 8.67）g/L，血尿酸正常组血清Klotho为（185.34 ± 38.17）ng/L，UMOD水平为（51.13 ± 12.32）g/L，对照组血清Klotho为（211.53 ± 50.63）ng/L，UMOD水平为（62.39 ± 16.86）g/L，3组血清Klotho和UMOD比较，差异有统计学意义（P＜0.05）；IgA肾病并发高尿酸血症组患者收缩压为（152.62 ± 18.82）mmHg（1 mmHg=0.133 kPa）、舒张压为（98.37 ± 13.65）mmHg、高血压27例（64.29%）、24 h尿蛋白定量为（2.55 ± 0.69）g、血尿酸为（435.26 ± 113.25）μmol/L、血肌酐水平为（352.55 ± 58.62）μmol/L、eGFR为（72.28 ± 13.53）mL·min⁻¹·（1.73m²）⁻¹，血尿酸正常组收缩压为（112.58 ± 15.97）mmHg、舒张压为（72.43 ± 10.34）mmHg、高血压21例（38.18%）、24 h尿蛋白定量为（1.62 ± 0.31）g、血尿酸为（342.59 ± 84.64）μmol/L、血肌酐水平为（103.11 ± 27.47）μmol/L、eGFR为（102.96 ± 35.68）mL·min⁻¹·（1.73m²）⁻¹，IgA肾病并发高尿酸血症组和血尿酸正常组上述指标比较，差异有统计学意义（P＜0.05）；Pearson相关性分析结果显示，IgA肾病并发高尿酸血症患者的血清Klotho、UMOD水平与血尿酸、血肌酐水平均呈负相关，与eGFR均呈正相关（P＜0.05）；高血压、24 h尿蛋白定量、eGFR、血尿酸水平和血清Klotho、UMOD水平为IgA肾病并发高尿酸血症的独立影响因素（P＜0.05）；ROC曲线显示血清Klotho、UMOD单独和联合诊断IgA肾病并发高尿酸血症的曲线下面积分别为0.947、0.882、0.961，且二者联合诊断价值高于单独诊断（Z_{二者联合-Klotho} = 0.887，P = 0.375；Z_{二者联合-UMOD} = 2.423，P = 0.015）。
结论 IgA肾病并发高尿酸血症患者的血清Klotho、UMOD水平下调，均与IgA肾病并发高尿酸血症具有相关性，且联合诊断效果较好，密切监测血清Klotho、UMOD水平对于诊断IgA肾病并发高尿酸血症具有一定的参考价值。

Abstract:
Objective To explore the correlation between the expression levels of serum Klotho and uromodulin （UMOD） and immunoglobulin A （IgA） nephropathy complicated with hyperuricemia.
Methods From January 1, 2018 to January 1, 2022, 97 hospitalized IgA nephropathy were selected as study subjects. Based upon blood uric acid level before renal puncture, they were assigned into two groups of IgA nephropathy complicated with hyperuricemia （n=42） and normal blood uric acid （n=55）. Additionally, 97 healthy individuals during the same period were designated as control group. Serum levels of Klotho and UMOD and basic profiles of three groups were compared. Pearson’s method was applied for examining the correlation between serum levels of Klotho and UMOD, estimated glomerular filtration rate （eGFR）, uric acid and creatinine levels in patients with IgA nephropathy complicated by hyperuricemia. Multivariate Logistic regression was utilized for analyzing the influencing factors of IgA nephropathy complicated with hyperuricemia. Receiver operating characteristic （ROC） curve was employed for examining the diagnostic value of serum levels of Klotho and UMOD for IgA nephropathy complicated with hyperuricemia.
Results Serum Klotho was （151.66±27.29） ng/L and serum UMOD （39.65±8.67） g/L in IgA nephropathy complicated with hyperuricemia group; serum Klotho was （185.34±38.17） ng/L and serum UMOD （51.13±12.32） g/L in normal blood uric acid group; serum Klotho was （211.53±50.63） ng/L and serum UMOD （62.39±16.86） g/L in control group. Statistically significant differences existed in serum levels of Klotho and UMOD among three groups （P＜0.05）. Systolic blood pressure was （152.62±18.82） mmHg（1mmHg=0.133 kPa）, diastolic blood pressure （98.37±13.65）mmHg, proportion of hypertension 27（64.29）, 24-hour urine protein quantification （2.55±0.69）g, blood uric acid （435.26±113.25）μmol/L, creatinine （352.55±58.62） μmol/L and eGFR （72.28±13.53）mL·min⁻¹·（1.73m²）⁻¹ in IgA nephropathy complicated with hyperuricemia group; systolic blood pressure was （112.58±15.97）mmHg, diastolic blood pressure （72.43±10.34）mmHg, proportion of hypertension 21（38.18）, 4-hour urine protein quantification （1.62±0.31）g, blood uric acid （342.59±84.64）μmol/L, creatinine （103.11±27.47）μmol/L and eGFR （102.96±35.68）mL·min⁻¹·（1.73m²）⁻¹in normal blood uric acid group. The inter-group differences of the above parameters were statistically significant （P＜0.05）. Pearson’s correlation analysis results indicated that serum levels of Klotho and UMOD in patients with IgA nephropathy complicated by hyperuricemia were correlated negatively with blood uric acid and creatinine and positively with eGFR（P＜0.05）; hypertension, 24-hour urine protein quantification, eGFR, blood uric acid and serum levels of Klotho and UMOD were independent influencing factors for IgA nephropathy complicated with hyperuricemia （P＜0.05）. ROC curve showed that area under the curve （AUC） of serum Klotho and UMOD for diagnosing IgA nephropathy complicated by hyperuricemia alone and in combination was 0.947, 0.882 and 0.961 respectively and combined diagnostic value of the two was higher than that of single diagnosis（Z_{combination-Klotho}=0.887,P=0.375; Z_{combination-UMOD}=2.423, P=0.015）.
Conclusion Serum levels of Klotho and UMOD are down-regulated in patients with IgA nephropathy complicated by hyperuricemia. Correlation exists between IgA nephropathy and hyperuricemia and a combined diagnosis has an excellent effect. Close monitoring of serum levels of Klotho and UMOD has some reference value for diagnosing IgA nephropathy complicated by hyperuricemia.

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