高血压合并高尿酸血症患者尿酸代谢特征及其对肾损害的影响

孙艺祯; 侯紫微; 汪驰; 赵茂翔; 张思锦; 云翠娟; 冯泽锟; 李雁洁; 田露; 薛浩

doi:10.3969/j.issn.2095-5227.2023.06.002

高血压合并高尿酸血症患者尿酸代谢特征及其对肾损害的影响

Uric acid metabolism and its impact on renal damage in hypertensive patients with hyperuricemia

摘要

摘要:
背景尿酸代谢分型有助于指导高尿酸血症(hyperuricemia，HUA)患者个体化的降尿酸治疗，高血压合并高尿酸血症患者尿酸代谢分型的特征鲜有报道，其合并共病及靶器官损害情况尚不明确。
目的探讨高血压合并高尿酸血症患者不同尿酸代谢分型的临床特征及其对肾损害的影响。
方法研究纳入2020年12月 - 2022年8月于解放军总医院第六医学中心心血管病医学部住院的高血压合并高尿酸血症患者174例，根据24 h尿酸排泄量和肾尿酸排泄分数将其分为肾负荷过多型、肾排泄不良型、其他型、混合型4种类型，比较不同尿酸代谢分型的临床特点；采用多元线性回归分析不同尿酸代谢分型对高血压合并高尿酸血症患者肾损害24 h尿微量白蛋白定量及估算肾小球滤过率(estimated glomerular filtration rate，eGFR)的影响。
结果本研究共纳入174例高血压合并高尿酸血症患者。其中，肾负荷过多型占28.16%，肾排泄不良型占30.46%，其他型占14.37%，混合型占27.01%。在肾损害方面，其他型24 h尿微量白蛋白定量最少11.00(5.00，54.00) mg/24 h，eGFR最低(70.64 ± 20.20) mL/(min·1.73 m²)；混合型24 h尿微量白蛋白定量最多(24.00(11.00，48.00) mg/24 h，eGFR最高(100.63 ± 15.34) mL/(min·1.73 m²)。多元线性回归分析显示，肾负荷过多型(β=0.31，P=0.005)、混合型(β=0.35，P=0.002)的24 h尿微量白蛋白水平较肾排泄不良型高；其他型的eGFR较肾排泄不良型低(β=-8.07，P=0.022)，混合型的eGFR较肾排泄不良型高(β=6.84，P=0.017)。
结论高血压合并高尿酸血症患者混合型肾损害以尿微量白蛋白升高为主，其他型肾损害以eGFR降低为主。

Abstract:
Background Clinical classification based on uric acid metabolism is helpful to guide the personalized treatments of hyperuricemia (HUA). However, few studies have investigated the characteristics of different types of HUA in hypertensive patients, and its comorbidities and target organ damage are still unknown.
Objective To analyze the clinical manifestations and renal damage in hypertensive patients with different types of HUA.
Methods From December 2020 to August 2022, 174 inpatients with hypertension and hyperuricemia admitted to Department of Cardiology, the Sixth Medical Center, Chinese PLA General Hospital were recruited. According to 24-h urinary urate excretion (UUE) combined with fractional excretion of urate (FEUA), all patients were divided into 4 metabolic types: renal overload type, underexcretion type, normal type, and combined type. Clinical features of 4 metabolic types were analyzed. Multiple linear regression analysis was used for association of clinical classification with renal damage (24h urinary albumin and eGFR).
Results Of the 174 inpatients with hypertension and hyperuricemia, 28.16% were renal overload type, 30.46% were underexcretion type, 14.37% were normal type and 27.01% were combined type. In terms of renal damage, patients with the normal type had the lowest level of 24 h urinary albumin 11.00 (5.00,54.00) mg/24 h and the lowest level of estimated glomerular filtration rate (eGFR) (70.64 ± 20.20 mL/min·1.73 m²), while the patients with combined type had the highest level of 24 h urinary albumin 24.00 (11.00,48.00) mg/24 h and the highest level of eGFR (100.63 ± 15.34 mL/min·1.73 m²). Multiple linear regression analysis showed that compared with underexcretion type, renal overload type (β=0.31, P=0.005) and combined type (β=0.35, P=0.002) had higher level of 24h urinary albumin. Compared with underexcretion type, the normal type had lower eGFR (β=8.07, P=0.022) and the combined type had higher eGFR (β=6.84, P=0.017).
Conclusion The renal damage in hypertensive patients with hyperuricemia mainly represents elevated urinary albumin level in the combined type, while the normal type is manifested with decreased eGFR.

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