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原发性IgA肾病非透析患者高尿酸血症危险因素分析
Risk factors of hyperuricemia in non-dialysis patients with IgA nephropathy
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DOI:
作者:
刘思梦 邢鹏 任红 张文 陈晓农 李晓
LIU Simeng, XING Peng, REN Hong, ZHANG Wen, CHEN Xiaonong, LI Xiao
作者单位:
上海交通大学医学院附属瑞金医院肾脏科
Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
关键词:
高尿酸血症;原发性IgA肾病;甘油三酯;危险因素
Hyperuricemia; Primary IgA nephropathy; Triglyceride; Risk factors
摘要:
目的 了解原发性IgA肾病非透析患者高尿酸血症(hyperuricemia ,HUA)患病率,分析其发生的危险因素。方法 收集2005.1-2009.1年于我院肾脏科住院、年龄>18岁且肾穿刺明确诊断为原发性IgA肾病的非透析患者资料,分析原发性IgA肾病患者血尿酸(serum uric acid ,SUA)水平与其他生化指标相关性和伴发HUA的危险因素。结果 914例原发性IgA肾病非透析患者HUA患病率为37.3%。与非HUA组相比,HUA组男性比例高、高血压患者比例高,有更高水平的身体质量指数(body mass index,BMI)、SUA、甘油三酯(triglyceride ,TG)、血磷、24小时尿蛋白定量;而肾小球率过滤(estimated glomerular filtration rate,eGFR)及血红蛋白(hemoglobin,Hb)更低(均P <0.001)。相关分析显示SUA与TG、血磷、24小时尿蛋白呈正相关(r分别=0.278、0.217、0.255);与eGFR呈负相关(r=-0.580)(均P <0.001)。经Logistic回归模型分析显示,原发性IgA肾病非透析患者伴发HUA的危险因素为慢性肾脏病(chronic kidney disease ,CKD)分期(OR=2.612,CI:2.108-3.236,P<0.001)和血TG水平(OR=1.297,CI:1.125-1.497,P=0.001)。进一步将TG水平按五分位数由低到高分为五组,以最低水平组作为参比组(第一组),校正多变量后,第二、三、四组HUA的风险均高于第一组(OR/P分别=1.688/0.102,1.896/0.045,2.306/0.009,3.521/<0.001)。按照上述五分位数分组,TG水平越高,HUA患病危险度OR值越高(趋势P<0.001)。结论 本研究提示原发性IgA肾病非透析患者中有较高的HUA患病率,其发生可能与肾功能受损及代谢紊乱均密切相关,血TG水平可能与HUA患病风险高度相关。
Objective To investigate the prevalence and risk factors of hyperuricemia (HUA) in patients with IgA nephropathy. Methods We collected the data of 914 non-dialysis patients with IgA nephropathy aged 18 years and older in our department from 2005.1 to 2009.1. Then we analyzed the correlation between serum uric acid (SUA) levels and other biochemical indexes and estimated the risk factors of HUA. Results The prevalence of HUA in our cohort was 37.3%. When compared, male, hypertension, body mass index (BMI), SUA,triglyceride (TG) , serum phosphorus and 24h urinary albumin were found higher in HUA patients (P<0.001). Whereas, estimated glomerular filtration rate (eGFR) and hemoglobin (Hb) were lower in HUA patients(P<0.001). Otherwise, SUA levels were positively correlated with TG,serum phosphorus and 24h urinary albumin (r=0.278, 0.217, 0.255, P<0.001). Meanwhile, SUA levels were negatively correlated with eGFR (r=-0.580, P<0.001). Logistic regression analysis showed that the risk factors for HUA were chronic kidney disease (CKD) stages (OR = 2.612, CI: 2.108-3.236, P <0.001) and TG (OR = 1.297, CI: 1.125-1.497, P = 0.001). The TG levels were further divided into five groups from the lowest to the fifth, and the lowest was used as the reference group (group 1). After adjusting for multiple factors, the risk of HUA in group 2, 3 and 4 was higher than bottom (OR/P =1.688/0.102, 1.896/0.045, 2.306/0.009, 3.521/<0.001). The multivariate OR of HUA increased with increasing serum TG levels (P for trend <0.001). Conclusion There was a high prevalence of HUA in non-dialysis IgA nephropathy patients. The occurrence of HUA may be closely related to renal injury and metabolic disorder. Serum triglyceride levels maybe highly associated with the frequency of HUA.
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