原发性醛固酮增多症37例诊治体会

目的　探讨原发性醛固酮增多症(PA)的诊断和治疗方法。方法　对1990年6月～1999年6月收治的PA患者37例(肾上腺皮质腺瘤29例,肾上腺皮质增生8例)进行回顾性分析。结果　获得随访的肾上腺皮质腺瘤24例(2425)和肾上腺皮质增生3例(37)术后治愈,仍有1例腺瘤和4例皮质增生者需辅以药物治疗。结论　高血压、低血钾、高血浆醛固酮是确诊PA的主要依据。B超、CT、MRI是PA的主要定位诊断方法。开放性手术是主要的治疗手段。     

原发性醛固酮增多症的诊断与外科治疗

目的 提高原发性醛固酮增多症(primary aldosteronism,PA,简称原醛症)的诊治水平.方法 分析1988～2008年该院收治的120例PA的临床资料,其中肾上腺皮质腺瘤111例,肾上腺皮质增生9例.均经手术和病理证实.开放手术79例,后腹腔镜手术41例.肾上腺皮质腺瘤中99例行腺瘤切除,12例行肾上腺部分切除;肾上腺皮质增生采用单侧肾上腺全切手术.所有病例术前均有高血压和低血钾及血浆醛固酮水平升高伴血浆肾素活性降低.结果 术后随访120例2个月～6年,所有病例术后2个月内血钾恢复正常,醛固酮/肾素比值下降,在未用降压药物情况下,80例术后血压恢复正常;无明显并发症发生.结论 体位试验、生化检查、影像学检查联合有助于PA的定性、分型和诊断,B超和CT是pA定位诊断的重要手段,手术是PA的主要治疗方法 ,腹腔镜手术正成为治疗PA的新方法 .     

原发性醛固酮增多症46例报告

目的:探讨原发性醛固酮增多症（PA）的诊断和治疗方法。方法:对1988年～2001年间收治的PA46例进行分析。所有患者均行血醛固酮测定、安体舒通试验及B超、CT检查。40例行肾上腺肿瘤切除术,6例行肿瘤切除术及同侧肾上腺部分切除术。结果:肾上腺皮质腺瘤45例,肾上腺皮质增生1例。46例血钾均低于正常,42例血醛固酮增高,46例安体舒通试验均阳性,B超、CT定位检查,其准确率分别为84.8％、95.6％。46例患者血钾均恢复正常。44例肾上腺腺瘤治愈,1例腺瘤及1例肾上腺皮质增生仍需药物控制血压。结论:安体舒通试验、血醛固酮测定是PA的主要定性诊断方法,血醛固酮体位试验和影像学检查有助于肾上腺皮质腺瘤和增生的鉴别;PA的定位主要依靠B超、CT检查。外科手术是治疗PA的重要方法。     

原发性醛固酮增多症23例临床分析

原发性醛固酮增多症（primary aldosteronism,PA）是由肾上腺皮质分泌过多的醛固酮而引起的高血压、低血钾、肌无力、高醛固酮及低肾素活性为主要特征的综合征。Conn于1955年首先指出肾上腺皮质腺瘤分泌过多的醛固酮是本病的原因,     

原发性醛固酮增多症诊断切点的研究及临床应用

目的 探讨原发性醛固酮增多症(primary aldosteronism,PA)患者立卧位醛固酮、醛固酮/肾素比值(ratio of aldosterone/rennin,ARR)的诊断切点,提高PA诊断的准确率.方法 收集2006-2014年在我院诊断的PA患者45例及年龄相匹配的原发性高血压患者(essential hypertension,EH)50例.PA患者均行病理诊断,其中34例术后病理证实为肾上腺醛固酮腺瘤,11例为肾上腺皮质增生.患者均行血钾、24 h尿钾、立卧位肾素、血管紧张素Ⅱ、醛固酮、皮质醇节律、儿茶酚胺代谢产物等检测,计算ARR,利用受试者工作曲线(ROC)得到诊断PA立卧位醛固酮、ARR的最佳切点,评价不同指标诊断PA的敏感性及特异性.并比较两种不同病理结果间醛固酮及ARR的差异.结果 PA组与EH组间性别、年龄和血压无明显差异,PA组肾素活性、血钾显著低于EH组,而醛固酮、ARR及24 h尿钾均显著高于EH组.诊断PA的立位醛固酮的最佳切点为0.221 ng/mL,敏感性(Sen)=0.561,特异性(Spe)=0.909;卧位醛固酮为0.175 ng/mL,Sen=0.829,Spe=0.795;立位ARR为19.5(ng·dL-1)/(ng·mL-1 ·h-1),Sen=0.878,Spe=0.955;卧位ARR为20.5(ng·dL-1)/(ng·mL-1·h-1),Sen=0.902,Spe=0.841.在PA组中肾上腺醛固酮腺瘤的ARR较肾上腺皮质增生患者高,尤其立位ARR最为明显.结论 立位醛固酮、ARR诊断PA的敏感性较卧位差,但特异性较强,所以临床对高血压患者行上述激素检查时应综合立卧位激素的检查结果,且其水平与病理有关.     

柯兴综合征肾上腺皮质腺瘤术后皮质功能减低(附病例报告5例)

目的 探讨Cushing综合征肾上腺皮质腺瘤术后出现肾上腺皮质功能减低的发生原因及临床表现,提高诊断治疗及预防水平.方法 筛选近10余年来所有Cushing综合征肾上腺皮质腺瘤患者病史资料,针对5例术后出现肾上腺皮质功能减低的典型患者的发病原因,临床表现及处理措施进行回顾性分析.结果 在5例患者中,3例在术后早期出现肾上腺皮质功能减低表现,2例在出院后恢复期间出现肾上腺皮质功能减低表现;4例经及时纠正,症状迅速缓解,1例因未遵医嘱,自行停止治疗,转为慢性肾上腺皮质功能不足,后经近2年补充治疗方恢复正常.结论 肾上腺皮质功能减低是Cushing综合征肾上腺皮质腺瘤术后常见的并发症之一,其出现主要由于短期内患者自身皮质分泌功能未完全恢复,同时围手术期激素补充欠佳所致,针对患者病情及时处置症状多能完全缓解.     

原发性醛固酮增多症87例血脂代谢情况分析

目的分析原发性醛固酮增多症(PA)的临床及血脂代谢特点。方法收集经术后病理证实的PA患者87例,其中肾上腺皮质腺瘤75例,肾上腺皮质增生12例,回顾性分析其临床特征、生化指标、血浆醛固酮(Ald)、肾上腺影像学及疗效情况,并与原发性高血压(EH)患者及血压正常的人群进行对比。结果 (1)PA患者立位和卧位血浆Ald分别为(0.230±0.061)和(0.217±0.065)ng/mL,腺瘤组与增生组间差别无统计学意义(P>0.05),且均高于EH组(P<0.05)。(2)93.1%的PA患者伴有高血压,其中3级高血压占54.0%。(3)62.1%的PA患者表现为高血压伴低血钾,腺瘤组的血钾水平明显低于增生组及EH组[分别为3.19(2.56~3.83),3.80(3.58~4.27),4.04(3.75~4.37)mmol/L];腺瘤组的血钠水平明显高于增生组及EH组[分别为(143.34±3.09),(140.87±2.08),(142.12±2.22)mmol/L,均为P<0.05]。(4)腺瘤组的甘油三酯明显低于增生组及EH组[分别为1.10(0.81~1.53),1.41(1.05~2.44),1.66(0.98~2.71)mmol/L],极低密度脂蛋白胆固醇(VLDL-C)明显低于余2组[分别为0.50(0.36~0.69),0.64(0.48~1.11),0.70(0.44~1.17)mmol/L],高密度脂蛋白胆固醇(HDL-C)水平明显高于余2组[分别为1.35(1.15~1.58),1.08(0.95~1.32),1.24(0.97~1.43)mmol/L,均为P<0.05]。(5)Logistic回归分析提示,高VLDL-C血症(OR=164.688)及高甘油三酯水平(OR=15.740)为肾上腺皮质增生的预测因素;低钾血症(OR=0.103)及高血钠水平(OR=0.653)为肾上腺皮质腺瘤的预测因素(均为P<0.05)。(6)经腹腔镜肾上腺肿物切除术后血压明显下降[术前后血压分别为(178.29±30.53)/(102.53±16.88),(133.99±16.36)/(82.60±10.70)mmHg,P<0.01]。结论肾上腺皮质腺瘤患者更易出现低钾血症,肾上腺皮质增生患者更易出现脂代谢紊乱;手术切除肾上腺肿物可有效降低患者血压。     

带血管蒂肾上腺移位术治疗原醛型肾上腺皮质增生11例

醛固酮增多症可分为原发性和继发性2类,原发性醛固酮增多症（原醛症）系一种继发性高血压症,占高血压症的0.5%～2.0%,主要由于肾上腺皮质腺瘤或皮质增生分泌醛固酮过多所致,增生约占该病30%以上,临床表现和生化改变与腺瘤相似,其肾上腺病变为双侧球状带细胞增生,有时可伴有结节,其发病原因尚不明确.腺瘤手术效果较好,增生的手术治疗尚存争议,现将作者近期采用带血管蒂肾上腺移位术治疗的11例原醛型肾上腺皮质增生患者的临床资料总结报道如下.     

H295R细胞在原发性醛固酮增多症研究中的应用

原发性醛固酮增多症(primary aldosteronism,PA)是临床上常见的疾病,在泌尿外科、心血管科及内分泌科中更为常见.PA在一般人群中的发病率是0.5%～2%,在高血压患者中占5%～12%,是难治性高血压的常见病因之一[1].除此之外,醛固酮自身也可以单独引起心脑病变、血管炎症、靶器官损害等[2-4].人肾上腺皮质癌细胞H295R细胞具有稳定分泌醛固酮及其他类固醇激素的特点,是为数不多的肾上腺皮质细胞系之一.由于H295R细胞在激素分泌和细胞特征上与原代培养的人肾上腺皮质细胞最接近,因此H295R细胞成为目前研究人肾上腺皮质的主要细胞甚至是惟一细胞[5].     

原发性醛固酮增多症18例临床诊治分析

目的 探讨原发性醛固酮增多症(PA)的临床特点,以提高对PA的诊治水平.方法 分析总结18例PA患者的临床资料.结果 PA的临床表现以高血压为主,其次为低血钾,B超诊断敏感性低,13例醛固酮瘤患者经手术治愈,3例醛固酮病患者及2例特发性醛固酮增多症患者经药物治疗病情稳定.结论 手术治疗可使醛固酮瘤患者得到治愈,特发性醛固酮增多症药物治疗效果良好,轻、中年高血压病人应严格进行PA的相关检查,防止误诊.     

原发性醛固酮增多症肾上腺切除术后慢性肾功能不全1例

We report one case of estimated glomerular filtration rate (eGFR) decline after taking unilateral adrenalectomy due to aldosterone adenoma. A 60-year-old male with 23-year history of hypertension was reported to the endocrinologist due to hypokalemia (serum potassium 3.01 mmol/L). Urine microalbumin/creatinine (ALB/CR) was 70.15 mg/g, serum creatinine was 82 μmol/L and eGFR was 89.79 mL/(min·1.73 m²). Random serum aldosterone was 172.2-203.5 ng/L, and random plasma rennin activity was 0-0.17 μg/(L·h). His captopril challenge test suggested that his aldosterone le-vels were suppressed by 8% (< 30%) and the adrenal enhanced computed tomography scan revealed a left adrenal tumor. The patient was diagnosed with primary hyperaldosteronism (PA), aldosterone adenoma and underwent left laparoscopic adrenalectomy. Histological examination confirmed adrenal cortical adenoma. One week after the operation, his serum creatinine was increased to 127 μmol/L compared with preoperative level; eGFR was 32.34 mL/(min·1.73 m²). His systolic blood pressure (SBP) was 110 mmHg and diastolic blood pressure (DBP) was 60 mmHg (hypotensive drugs discontinued), and serum potassium level was 5.22 mmol/L. At the end of the 2-year follow up, the serum creatinine of this patient remained at 109-158 μmol/L and eGFR fluctuated from 63.28-40.12 mL/(min·1.73 m²). PA is one of the most common causes of secondary hypertension. Several studies have reported renal function deterioration of PA patients after unilateral adrenalectomy, like the patient in this article. Age, preoperative plasma aldosterone concentration, albuminuria and preoperative potassium level might be significant predictors of a decrease in the eGFR. Growing evidence suggests that aldosterone could contribute to structural kidney damage, arterial injury and hemodynamic disorder. At the same time, patients with PA exhibit glomerular hyperfiltration and glomerular vascular hypertension, leading to the misinterpretation of renal function in PA patients as subtle kidney damage may be masked by the glomerular hyperfiltration before treatment. After a unilateral adrenalectomy, glomerular hyperfiltration by aldosterone excess is resolved and renal damage can be unmasked. In conclusion, kidney function deterioration after adrenalectomy can be detected in some patients with PA. Thus, accurate evaluation of kidney function in patients with PA may be essential, especially for those with preoperative risk factors for postoperative renal impairment. After unilateral adrenalectomy, close monitoring of renal function and adequate management are required for PA patients.     

Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: a position statement

The systematic staging of chronic kidney disease (CKD) by glomerular filtration measurement and proteinuria has allowed the development of rational and appropriate management plans. One of the barriers to early detection of CKD is the lack of a precise, reliable and consistent measure of kidney function. The most common measure of kidney function is currently serum creatinine concentration. It varies with age, sex, muscle mass and diet, and interlaboratory variation between measurements is as high as 20%. The reference interval for serum creatinine concentration includes up to 25% of people (particularly thin, elderly women) who have an estimated glomerular filtration rate (eGFR) that is significantly reduced (< 60 mL/min/1.73 m2). The recent publication of a validated formula (MDRD) to estimate GFR from age, sex, race and serum creatinine concentration, without any requirement for measures of body mass, allows pathology laboratories to "automatically" generate eGFR from data already acquired. Automatic laboratory reporting of eGFR calculated from serum creatinine measurements would help to identify asymptomatic kidney dysfunction at an earlier stage. eGFR correlates well with complications of CKD and an increased risk of adverse outcomes such as cardiovascular morbidity and mortality. We recommend that pathology laboratories automatically report eGFR each time a serum creatinine test is ordered in adults. As the accuracy of eGFR is suboptimal in patients with normal or near-normal renal function, we recommend that calculated eGFRs above 60 mL/min/1.73 m2 be reported by laboratories as "> 60 mL/min/1.73 m2", rather than as a precise figure.     

影响原发性醛固酮增多症患者肾小球滤过率相关因素分析

探讨原发性醛固酮增多症（PA）患者肾小球滤过率（GFR）状况及影响因素。选择PA患者156例,另选择原发性高血压（EH）患者189例作为对照,比较两组相关生化指标,估算肾小球滤过率（eGFR）等。PA组与EH组血清肌酐、eGFR、24h尿蛋白定量比较差异均有统计学意义（均P〈0．05）。多元回归分析结果显示PA患者血浆醛固酮浓度（P=0．003）及血清肌酐（P=0．001）与eGFR呈负相关,其eGFR低于EH患者;24h尿蛋白排泄率高于EH组患者。     

Significant differences when using creatinine, modification of diet in renal disease, or cystatin C for estimating glomerular filtration rate in ICU patients

Background

Renal dysfunction is associated with increased morbidity and mortality in intensive care patients. In most cases the glomerular filtration rate (GFR) is estimated based on serum creatinine and the Modification of Diet in Renal Disease (MDRD) formula, but cystatin C-estimated GFR is being used increasingly. The aim of this study was to compare creatinine and MDRD and cystatin C-estimated GFR in intensive care patients.

Methods

Retrospective observational study was performed, on patients treated within the general intensive care unit (ICU) during 2004–2006, in a Swedish university hospital.

Results

GFR markers are frequently ordered in the ICU; 92% of the patient test results had cystatin C-estimated GFR (eGFR_cystatinC) ≤ 80 mL/min/1.73 m², 75% had eGFR ≤ 50 mL/min/1.73 m², and 30% had eGFR ≤ 20 mL/min/1.73 m². In contrast, only 46% of the patients had reduced renal function assessed by plasma creatinine alone, and only 47% had eGFR_MDRD ≤ 80 mL/min/1.73 m². The mean difference between eGFR_MDRD and eGFR_cystatinC was 39 mL/min/1.73 m² for eGFR_cystatinC values ≤ 60 mL/min/1.73 m².

Conclusions

GFR is commonly assessed in the ICU. Cystatin C-estimated GFR yields markedly lower GFR results than plasma creatinine and eGFR_MDRD. Many pharmaceuticals are eliminated by the kidney, and their dosage is adjusted for kidney function. Thus, the differences in GFR estimates by the methods used indicate that the GFR method used in the intensive care unit may influence the treatment.     

武汉市新冠肺炎流行期间一例输入性恶性疟死亡病例分析

目的 探讨新型冠状病毒肺炎流行期内一例恶性疟死亡病例发生因素,为重大公共卫生事件暴发时输入性疟疾提供防控策略参考。方法 收集该死亡病例流行病学、实验室检测及临床治疗等资料并进行分析。结果 该病例发病-诊断时间7 d,疟原虫密度>5.0×10⁵ /μL血,红细胞3.10×10¹²/L,血红蛋白89.00 g/L,血小板2.00×10⁹/L,白细胞18.85×10⁹ /L,总胆红素296.10 μmol/L,尿素55.30 μmol/L,肌酐799.00 μmol/L,葡萄糖2.20 mmol/L,乳酸 15.00 mmol/L, D-二聚体>7.80 μg/mL,诊断为恶性疟（脑型）、贫血、感染性休克、低血糖、肝肾功能衰竭、代谢性酸中毒及凝血功能异常。结论 重大公共卫生事件暴发时应制定分类指导,统筹兼顾的科学防控措施,应加强疟疾防治健康教育、病人排查并提供就医通道。     

沙库巴曲/缬沙坦对肾脏影响的研究进展

第1个血管紧张素受体-脑啡肽酶抑制剂（ARNI）代表药沙库巴曲/缬沙坦（LCZ696）是2018年心力衰竭指南中新增的药物治疗推荐。指南中指出,血肌酐>221?μmol/L（2.5?mg/dl）或估算肾小球滤过率（eGFR）<30 ml/（min·1.73 m2）的患者慎用ARNI,可见ARNI对肾功能的影响。该文总结现有的动物实验和临床研究,综述LCZ696对肾脏的影响。LCZ696虽然可能引起尿白蛋白比肌酐比值（UACR）的轻微升高,但是LCZ696能够延缓eGFR的下降和肾功能恶化,降低血压,改善肾脏组织病理,且具有良好的安全性和耐受性。     

化脓性脑膜炎患儿血清和脑脊液hs-CRP、S-100β、NSE及BMP的临床意义

目的探讨化脓性脑膜炎患儿血清和脑脊液(cerebrospinal fluid, CSF)中超敏C反应蛋白(hypersensitivity C reactive protein, hs-CRP) 、S-100β蛋白（S-100 beta protein , S-100β）、神经元特异性烯醇化酶(neuron specific enolase , NSE)和髓鞘碱性蛋白（myelin basic protein, BMP）的含量变化及其临床意义。方法收集驻马店市中心医院2014年1月—2016年12月儿科病区收治的化脓性脑膜炎患儿106例作为研究组,同时随机选取本院54例呼吸道感染住院患儿做为对照组,排除颅内感染及中枢神经系统疾病。采用免疫比浊法定量检测hs-CRP在血清及CSF中的表达水平,采用酶联免疫吸附实验（enzyme linked immunosorbent assay,ELISA）测定S-100β、NSE及BMP在血清及CSF中表达水平,进行组间比较,并分析其与疾病严重程度的相关性。结果患儿血清中hs-CRP、S-100β、NSE和BMP的表达高于对照组[（33.17±5.72） mg/L vs （8.86±2.42） mg/L、（1.85±0.49）μg/L vs （0.54±0.08）μg/L、（17.71±2.27）μg/L vs （8.56±1.58）μg/L、（12.74±2.75）μg/L vs （4.29±1.25）μg/L]。患儿CSF中hs-CRP、S-100β、NSE和BMP的表达高于对照组[（10.36± 2.54）mg/L vs （3.81±1.84） mg/L、（2.27±0.61）μg/L vs （0.78±0.12）μg/L、（25.32±4.26）μg/L vs （11.87±3.11）μg/L、（18.89±3.37）μg/L vs （6.48±2.72）μg/L]。患儿hs-CRP、S-100β、NSE和BMP的表达水平随着病情加重逐渐升高,与患儿的临床病情正相关(P<0.01);各检测指标之间存在一定程度正相关(P<0.01) 。结论联合检测血清及CSF中的hs-CRP、S-100β、NSE及BMP的表达水平,有助于化脓性脑膜炎患儿脑神经损伤早期诊断及损害程度的判断。     

一种新型环孢素A慢性肾毒性大鼠模型的建立

目的 建立新型环孢素A慢性肾毒性大鼠模型并探讨其特点.方法 雄性SD大鼠(正常盐饮食)分为假手术组(sham-ADX组)、肾上腺切除组(ADX组)及肾上腺切除及注射环孢素A组(CsA组).后两组先行双侧肾上腺切除术,2周后分别注射安慰剂或环孢素A.6周后检测尿蛋白定量、肌酐清除率、血和尿醛固酮及钠钾水平、肾组织醛固酮及其合成酶CYP11B2表达和肾组织病理改变.结果 ADX和CsA组术后2d血和尿未检测到醛固酮,尿钠增多、血钠减低,尿钾减少、血钾升高.6周实验结束时,CsA组大鼠尿蛋白增加、肌酐清除率下降,肾组织病理检查呈现明显肾间质纤维化;ADX和CsA组大鼠肾组织CYP11B2 mRNA表达和醛固酮均显著上调,再次出现血和尿醛固酮,钠钾代谢紊乱改善.结论 用肾上腺切除和正常盐饮食制作环孢素A慢性肾毒性大鼠模型成功.消除循环醛固酮后,肾组织醛固酮表达上调并释放入血,维持钠钾平衡.     

Effect of differences in serum creatinine estimation methodologies on estimated glomerular filtration rate

INTRODUCTIONSerum creatinine is crucial in glomerular filtration rate (GFR) estimation. Various methods of measuring GFR have been developed, which vary in their ability to estimate the prevalence of chronic kidney disease (CKD) and predict consequences associated with CKD. The use of different laboratory devices also results in uncertainty in estimated GFR (eGFR). The purpose of our study was to discuss the effect of differences in laboratory devices on eGFR when performing serum creatinine measurements.METHODS163 participants aged 51.22 ± 18.66 years were enrolled during a community health screening programme conducted on 18 June 2011. Samples were sent to four different hospitals using four different devices to check serum creatinine by the Jaffe and enzymatic creatinine methods.RESULTSUsing Roche Cobas Integra 400, Beckman LX20, Hitachi 7180 and Toshiba TBA – c8000, the proportion of the population with eGFR < 60 mL/min/1.73 m² was 11.04%, 6.75%, 20.25% and 20.86%, respectively. Moreover, 3.68% of the participants had eGFR < 60 mL/min/1.73 m² in the laboratory when Roche Cobas Integra 400 was used with the enzymatic creatinine method and compensated Jaffe method.CONCLUSIONAlthough standardisation of serum creatinine measurement has been achieved by using isotope dilution mass spectrometry, differences in measurement devices still cause substantial bias in the overall results. This affects the application of GFR in the estimation of CKD progression and outcomes associated with CKD.     

中老年人群血尿酸水平和早期肾功能损害的关系

目的 研究血肌酐正常的中老年人群血尿酸(UA)水平和早期肾功能损害的关系及其早期肾功能损害的患病率.方法 对成都的社区自然人群按照随机抽样方法抽取样本,对血肌酐正常的1023人,平均年龄(63±6)岁;进行了相关心血管危险因素的调查,其中包括血肌酐和血UA水平.评价肾功能采用MDRD方程估算的肾小球滤过率(eGFR).根据资料分析该人群早期肾功能损害[89≥eGFR≥60 ml·min~(-1)·(1.73 m~2)~(-1)]的患病率,并将人群按血UA水平四分位间距分为4组:UA<282 μmol/L(A组)、282μmol/L≤UA<331 μmol/L(B组),331 μmol/L≤UA<379 μmol/L(c组),UA≥379 μmol/L(D组),分析血UA水平与早期肾功能损害的关系.结果 该组人群中早期肾功能损害的患病率为28.1%,其中男性的患病率为35.8%,女性为19.5%,差异有统计学意义(P<0.01).在男女两性中,血UA水平均和eGFR呈负相关,男性D组肾功能损害的患病率是A组的4.5倍(45.1%比10.6%),女性D组肾功能损害患病率为A组的3.8倍(38.7%比9.9%).采用Logistic回归模型校正了性别,年龄,腰围,体质指数,甘油三酯,高密度酯蛋白胆固醇,总胆固醇,高血压病史及糖尿病病史等因素后,以A组为对照,早期肾功能损害的OR值B组为1.740(95%CI:0.817～3.706;P=0.151),C组为3.599(95%CI:1.742-7.433;P=0.01)及D组为5.488(95%CI:2.613～11.525;P<0.01).结论 在血肌酐正常的中老年人群中,血UA水平和早期肾功能损害独立相关,男性早期肾功能损害的患病率高于女性.