社区人群中尿酸对肾功能的独立预测作用研究

曹瑞华; 朱兵; 王亮; 王浩; 肖文凯; 秦爱梅; 叶平

doi:10.3969/j.issn.2095-5227.2021.09.006

社区人群中尿酸对肾功能的独立预测作用研究

Uric acid in prediction of renal function in a community-based prospective study

摘要

摘要:
背景高尿酸血症与年龄、高血压、慢性肾疾病(chronic kidney disease，CDK)及心血管疾病等密切相关，而高尿酸血症与慢性肾疾病之间的因果关系仍存在争议。
目的本研究探讨了在基线肾功能正常的社区人群中尿酸对肾功能减退和早期慢性肾疾病的预测作用。
方法纳入北京石景山苹果园社区2007年9月- 2009年1月参加健康调查的肾小球滤过率(estimated glomerular filtration rate，eGFR) > 60 mL/(min·1.73 m²)的社区居民1 394例(45～96岁，753例女性)，根据基线尿酸水平三分位数将受试者分为 ≤ 254.5 μmol/L组(A组，465例)，254.6～318.0 μmol/L组(B组，465例)，≥ 318.1 μmol/L组(C组，464例)，收集入选者临床基线资料，并计算eGFR。2013年9月末次随访，随访4.5～5.2(4.8 ± 0.9)年，终点事件包括eGFR快速下降和新发CKD。
结果随访结束时，平均eGFR水平由基线时的(94.42 ± 14.25) mL/(min·1.73 m²)下降至(86.00 ± 15.57) mL/(min·1.73 m²)，eGFR快速下降发生率和新发CKD发生率分别为21.7%和6.0%。多元线性回归分析显示，年龄、体质量指数、尿酸和同型半胱氨酸与肾功能变化相关(P < 0.05)。Logistic回归显示：在校正了多种混杂因素后，基线尿酸与肾功能快速下降独立相关，与A组比较，C组受试者尿酸与肾功能快速下降的相关性更强(OR：1.699，95% CI：1.167～2.473，P=0.006)。Cox回归显示基线尿酸水平与新发CKD也呈独立相关(HR=2.526，95% CI：1.366～4.671，P=0.003)。
结论在基线eGFR ≥ 60 mL/(min·1.73 m²)的社区人群中，血清尿酸水平是肾功能改变的独立相关因素，包括肾功能快速下降和新发CKD。

Abstract:
Background Hyperuricemia is a very common biochemical finding associated with aging, hypertension, chronic kidney disease (CKD), and cardiovascular disease. Nevertheless, the evidence for a causal link between hyperuricemia and these disorders is still controversial.
Objective To investigate the prognostic properties of uric acid for renal function decrement and early chronic kidney disease (CKD) in community-dwelling populations with normal renal function at baseline.
Methods From September 2007 to January 2009, a total of 1 394 subjects with estimated glomerular filtration rate (eGFR) > 60 mL/(min·1.73 m²) (45-96 years, 753 females) were recruited from a community-based population in Beijing. Participants were divided into three groups according to baseline uric acid levels, with 465 subjects in ≤ 254.5 μmol/L group (group A), 465 subjects in 254.6-318.0 μmol/L group (group B), 464 subjects in ≥ 318.1 μmol/L group (group C). The baseline data were collected and eGFR were calculated. The follow-up lasted for 4.5-5.2 (4.8 ± 0.9) years with the last follow-up of September 2013. The main outcomes were the rapid eGFR decline and the new incidence of CKD.
Results At the end of follow-up, the mean eGFR decreased from 94.42 ± 14.25 mL/(min·1.73 m²) to 86.00 ± 15.57 mL/(min·1.73 m²), and the incidence of rapid eGFR decline and CKD were 21.7% and 6.0%, respectively. In multivariate linear regression analysis, age, BMI, uric acid, and concentration of homocysteine were independent determinants of the change in renal function. After adjusting for various confounders, uric acid was independently associated with the rapid eGFR decline. Compared with subjects in group A, subjects in group C demonstrated a stronger correlation of CKD (OR: 1.699, 95% CI: 1.167-2.473, P=0.006). Baseline uric acid levels were also independently associated with new occurrence of CKD (HR=2.526, 95% CI: 1.366-4.671, P=0.003).
Conclusion The study shows that uric acid is an independent predictor of the decline in renal function.

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