慢性肾脏病与高尿酸血症

慢性肾脏病(CKD)是一种以肾损伤和肾功能下降为主要表现的综合性疾病,全球发病率约为13.1%,且会导致心血管及全因死亡率升高,严重影响患者生活质量和寿命。目前,CKD的治疗仍存在很大的困难和挑战,需要明确可干预的危险因素,以延缓疾病进展。既往人们认为高尿酸血症(HUA)是肾功能下降的标志物,最近的观察性研究表明HUA是CKD发生和进展的一个独立危险因素。CKD患者血尿酸水平随估算的肾小球滤过率(eGFR)下降而升高,血尿酸与CKD之间的因果关系存在争议,越来越多的证据表明HUA可导致肾功能下降,通过促进炎症反应、氧化应激、激活肾素血管紧张素(RAS)系统、促肾脏纤维化等机制损伤肾脏。目前,降尿酸治疗是否可延缓CKD的发生和进展尚存在争议,未来需要更多大型随机对照研究来确定干预时机和阈值。     

高尿酸血症与老年慢性肾脏病患者肾功能的相关性研究

目的:探讨高尿酸血症与老年慢性肾脏病(chronic kidney disease, CKD)患者肾功能的相关性。方法:收集2014年1月至2018年11月我院肾脏科和老年病科诊治的308例CKD1～4期老年患者的临床及随访资料。采用尿酸酶过氧化物酶法检测血尿酸,根据血尿酸水平将患者分为高尿酸血症组(血尿酸≥420μmol/L)和正常尿酸组(血尿酸420μmol/L),比较2组患者基线临床及预后指标。结果:308例老年CKD患者中伴高尿酸血症者113例(36.7%)。与正常尿酸组相比,高尿酸血症组舒张压、体质量指数、白细胞、三酰甘油及血肌酐均较高,而估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)较低。校正性别、年龄、尿蛋白量、血肌酐等因素后,多元线性回归分析显示尿酸水平与e GFR呈负相关(β=-0.099,P=0.001)。多因素Cox回归分析显示,高尿酸血症独立于性别、年龄、血红蛋白、白蛋白、蛋白尿和eGFR,为老年CKD患者e GFR下降≥30%或终末期肾脏病的独立危险因素[风险比为1.003,95%可信区间:1.000～1.007,P=0.038]。结论:老年CKD患者肾功能与尿酸呈负相关,伴高尿酸血症是老年CKD患者预后不良的独立危险因素。     

高尿酸血症对慢性肾脏病影响的研究进展

［摘要］　慢性肾脏病（CKD）发病率高、危害大,早期发现及干预对CKD治疗至关重要。高尿酸血症是CKD常见并发症及合并症,其不仅是肾功能减退的结果,也是肾功能恶化进展的危险因素。该文就高尿酸血症对CKD发生发展的影响、致病机制以及降尿酸治疗对CKD产生的影响作一综述。     

广西城市社区居民高尿酸血症流行病学调查及其与慢性肾脏病的关系

目的 通过社区人群筛查了解广西城市原住民中高尿酸血症(HUA)的患病率及其与慢性肾脏病(CKD)的关系,并探讨影响HUA肾损害的风险因素.方法 选择桂林市城区原住居民集中的象山社区,对18～75岁居民(n=6 273)采取横断面进行筛查.收集空腹血及晨尿进行血糖、肾功能、血脂、胰岛素和尿蛋白等检测,同时进行问卷调查和体格检查.结果 社区居民中HUA总患病率为23.5%,其中男性HUA患病率显著高于女性(28.4%对19.7%,P＜0.01).社区居民中CKD患病率为21.6%,其中男性居民CKD患病率较女性显著增高(24.9%对19.0%,P＜0.01).在HUA人群中CKD检出率显著高于尿酸正常人群(30.4%对18.9%,P＜0.01).男性HUA人群CKD检出率显著高于同性别正常血尿酸人群(34.3%对21.2%,P＜0.01),也显著高于女性HUA人群(25.9%,P＜0.01).Logistic回归分析发现,CKD仅与收缩压、低密度脂蛋白胆固醇和血糖水平独立相关(P＜0.01).结论 广西城市社区居民中HUA患病率显著增加,与CKD患病率增高有关,且血尿酸轻度增高即增加CKD患病率.

Abstract：

Objective To detect the prevalence of hyperuricemia and its relationship to chronic kidney disease(CKD) in the residents of Guangxi, and to discuss the risk factors for the hyperuricemia associated renal damage. Methods The residents aged 18-75 years old(n=6 273) in Xiangshan community,Guilin, were screened by means of cross-sectional study. Blood pressure was measured at 8:00-9:00.Fasting blood and urine samples were collected to determine blood glucose, lipid, insulin, creatinine, and urine albumin. Results The prevalence of hyperuricemia in the community residents was 23.5% in all cohort, being significantly higher in male residents than in female(28.4% vs 19.7%,P＜0.01). The prevalence of CKD was 21.6% in all cohort, and was 24.9% in males and 19.0% in females(P＜0.01). The prevalence of CKD was 30.4% and 18.9% respectively in residents with and without hyperuricemia(P＜0.01).The prevalence of CKD in males with hyperuricemia(34.3%) was significantly higher than in males without hyperuricemia(21.2%) and females with hyperuricemia(25.9%, all P＜0.01). CKD was only positively related to low-density lipoprotein cholesterol, blood glucose, and systolic blood pressure shown by logistic regression analysis. Conclusions The prevalence of hyperuricemia markedly increases in the urban residents, which contribute to the raised prevalence of CKD. Slightly elevated blood uric acid level is associated with raised prevalence of CKD.     

老年慢性肾脏病患者合并高尿酸血症影响因素分析

目的 研究老年慢性肾脏病患者合并高尿酸血症(HUA)情况,分析其危险因素,为及时采取慢性肾脏病干预和治疗措施提供参考。方法 采用问卷调查、体格检查和实验检查收集慢性肾脏病患者数据资料,分为慢性肾脏病合并高尿酸血症组和慢性肾脏病非合并高尿酸血症组,比较两组间影响因素差异,再用多因素Logistic回归模型分析慢性肾脏病合并高尿酸血症的影响因素。结果 310例慢性肾脏病患者中,合并高尿酸血症患者130例。单因素分析结果显示：两组患者合并糖尿病病例数比较,差异有统计学意义(P<0.05)。与慢性肾脏病非合并高尿酸血症组比较,慢性肾脏病合并高尿酸血症组血尿酸、血肌酐、血尿素氮均值较高,eGFR、血红蛋白均值较低,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示：年龄、血肌酐、血尿素氮水平升高是慢性肾脏病患者合并高血尿酸血症的危险因素。结论 老年人群临床检查出现血清肌酐、血尿素氮、血尿酸水平均有明显升高时,应进一步检查肾功能其他指标,检查肾功能受损原因和损伤程度,以便早期采取干预和治疗措施。     

慢性肾脏病并发脓毒血症40例的临床分析

目的:分析慢性肾脏病(CKD)并发脓毒血症的临床特征,为临床诊治提供依据.方法:回顾性分析慢性肾脏病并发脓毒血症40例的临床病历资料.结果:在40例CKD的患者中,肾衰竭30例(75％),深静脉置管22例(55％),使用免疫抑制剂和糖皮质激素12例(30％),18例患者合并泌尿系统和呼吸系统感染.分离的病原菌中,大肠埃希菌13例,金黄色葡萄球菌(金葡菌)11例(60％),其它16例;有4例(10％)合并了真菌感染.金葡菌对青霉素G均耐药,对环丙沙星和克林霉素耐药＞50％.死亡8例,32例经有效抗生素治疗3～4周康复.结论:CKD患者易罹患脓毒血症,除与贫血、低蛋白血症和其它的感染因素有关外,与肾功能的下降、深静脉留置导管和免疫抑制剂的应用相关.     

高尿酸血症研究进展

<正>高尿酸血症(HUA)在临床诊断时男性血清尿酸>417μmol/L,女性>357μmol/L即为高尿酸。高尿酸除了可能会引发痛风,还与心血管疾病、糖尿病(DM)、高血压、肥胖症、高脂血症、慢性肾脏病等疾病息息相关。美国国家健康和营养调查(NHANES)显示,1988~1994年全国HUA的患病率为3.2%,而2007~2008年HUA的患病率上升至21.4%~([1])。澳     

高尿酸血症与冠心病

冠心病是严重危害人类健康的疾病之一，其危险因素很多，多项研究表明高尿酸血症与冠心病及AMI发病密切相关，本文就此作一回顾。     

高尿酸血症与冠心病的相关性研究

目的探讨高尿酸血症与冠心病的相关性。方法选择冠心病患者180例,分为急性冠脉综合征组及稳定型心绞痛组,另设对照组150例。分别测定血清尿酸、血糖以及血压、体重指数（BMI）、血脂水平。结果冠心病患者尤其是急性冠脉综合征患者血清尿酸水平与对照组相比,有统计学显著意义（P〈0．01）,相关分析提示血清尿酸水平与冠心病显著相关。结论高尿酸血症是冠心病尤其是急性冠脉综合征的危险因素之一。     

不同年龄男性高尿酸血症危险因素分析

目的探讨不同年龄阶段男性高尿酸血症的危险因素。方法200例男性高尿酸血症患者和286例尿酸正常的男性对照按年龄分组,调查饮食和疾病史,检测生化指标,测量一般身体指标。结果49岁以下人群中,病例组肥胖、腹型肥胖、高血压、高血脂、空腹血糖异常升高率、吸烟量、白酒、啤酒量和嘌呤食物摄入量均高于对照组(P<0.05),而49岁及以上人群中,病例组高血压发生率、空腹血糖、肌酐、尿素氮异常升高率和啤酒摄入量较对照组升高(P<0.05)。Logis-tic回归显示,49岁以下男性发生高尿酸血症的危险因素为体重指数、甘油三酯、胆固醇、啤酒和嘌呤食物的摄入;49岁及以上男性发生高尿酸血症的危险因素为啤酒、血肌酐和血糖。结论49岁以下男性血尿酸升高的危险因素主要为不良的饮食结构和多种代谢紊乱,而49岁以上男性尿酸水平受到不良饮食结构的影响较少(啤酒除外),血糖、尿素氮、血肌酐异常升高与尿酸升高紧密关联。     

慢性肾脏病所致心血管疾病概述

慢性肾脏病(CKD)是心血管疾病(CVD)的高危因素,CKD患者的CVD患病率很高,非常值得重视。本文将对CKD时的冠状动脉粥样硬化性心脏病、尿毒症心肌病、尿毒症心包炎、脑卒中及外周动脉病做一简介。     

Effect of chronic kidney disease on the association between hyperuricemia and new‐onset hypertension in the general Japanese population: ISSA‐CKD study

We aimed to investigate the association between serum uric acid (SUA) level and development of hypertension as well as the interaction effect of chronic kidney disease (CKD) on this relationship in the general Japanese population. We included 7895 participants aged ≥30 years from the ISSA‐CKD study, a population‐based retrospective cohort study that used annual health check‐up data of residents from Iki Island, Japan. After the exclusion of 1881 with l < 1‐year follow‐up, 2812 with hypertension at baseline, and 165 with missing information on SUA, a total of 3037 participants were enrolled in this analysis. Participants were divided into four groups according to the quartiles of SUA level at baseline, and multivariable‐adjusted hazard ratios for new‐onset hypertension were calculated. Stratified analyses were performed for each subgroup (defined by sex, age, alcohol intake, and CKD) to assess the interaction effects. During a mean follow‐up period of 4.4 years, 943 participants developed hypertension. The first quartile group was set as the reference group, and the multivariable‐adjusted hazard ratios (95% confidence interval) for new‐onset hypertension were 1.11 (0.90–1.36) in the second quartile, 1.25 (1.02–1.54) in the third quartile, and 1.35 (1.07–1.70) in the fourth quartile compared with those in the reference group (p = .007 for trend). The stratified analyses showed that the association between SUA and hypertension was significantly stronger in participants with CKD than in those without CKD (p = .035 for interaction). SUA level is an independent risk factor for new‐onset hypertension. This tendency was significantly stronger in participants with CKD.     

别嘌醇对慢性肾脏病患者治疗效益的评价

目的了解别嘌醇在慢性肾脏病(chronic kidney disease,CKD)患者中的应用并探讨其在此类患者中的有效性和安全性。方法通过前期研究的随机方法,收集2012年12月至2014年11月在北京协和医院应用别嘌醇、资料完整且非痛风所致的CKD患者共100例,采集初诊及随访临床资料、辅助检查、别嘌醇应用情况,行统计学比较。结果患者服用别嘌醇后第2个月起血尿酸(sUA)较基线显著下降(P<0.001)。单因素分析显示,性别、年龄和服用别嘌醇时尿酸水平(P=0.006、0.019、0.001)可能与降尿酸效果有关。多因素分析显示,年龄高可能为尿酸达标率的有利因素(P=0.031,OR值1.107,95%CI为1.031~1.483),而基线尿酸值高可能是不利因素(P=0.003,OR值0.524,95%CI为0.415~0.878)。对年龄和基线尿酸水平分层进行Kaplan-Meier法分析示年龄≤45岁组尿酸达标率显著低于45~65岁(P=0.017)、>65岁(P=0.023)组,sUA≤480μmol/L组尿酸达标率显著高于480~540μmol/L(P=0.000)、>540μmol/L(P=0.007)组。别嘌醇治疗后肾小球滤过率(eGFR)值无显著变化,别嘌醇剂量、CKD分期对eGFR无显著影响。所有患者中出现白细胞减低6例,肝功能受损8例,皮疹1例。结论CKD患者服用别嘌醇降尿酸效果可,对肾功能无显著损害,安全性较好,年龄较高、起始尿酸水平较低者治疗后尿酸达标率较高,可为别嘌醇在慢性肾脏病患者临床治疗的合理应用提供初步依据。     

Synergistic association of hyperuricemia and hyperhomocysteinemia with chronic kidney disease in middle-aged adults and the elderly population

Chronic kidney disease (CKD) is a major global public health issue. Both hyperhomocysteinemia (HHcy) and hyperuricemia are independent risk factors for CKD. In this study, we evaluated the association of HHcy and hyperuricemia with CKD in the middle-aged and elderly populations in Taiwan.In this cross-sectional study, we collected the data of 5910 patients aged ≥50 years after their self-paid health examination at a single medical center. Homocysteine (Hcy) levels were divided into 4 quartiles (Q1, <8.2; Q2, 8.2–9.8; Q3, 9.9–11.7; and Q4, >11.7 μM/L). Renal function was determined using the Chronic Kidney Disease Epidemiology Collaboration equation. Patients were considered to have CKD if their estimated glomerular filtration rate was < 60 mL/min/1.73 m².The prevalence of CKD significantly increased with the quartiles of uric acid (UA) and Hcy. In multiple logistic regression analysis, the odds ratios (ORs) of CKD increased with the quartiles of Hcy, independent of UA. There was 22.9 in Q4 in the normal serum UA group and 18.3 in the hyperuricemia group compared with Q1 of Hcy. Both hyperuricemia (OR 2.9) and Q4 of Hcy (OR 8.1) were significant independent risk factors for CKD. Furthermore, hyperuricemia and HHcy had significant synergistic association (synergy index, 1.7) with CKD.The ORs of CKD increased with the quartiles of Hcy, independent of hyperuricemia. Hyperuricemia and HHcy had synergistic association with CKD.     

慢性肾脏病对心血管系统的影响

慢性肾脏病(CKD)患者是心血管疾病(CVD)的高危人群,CVD已成为CKD患者死亡的主要病因,有效干预CKD多重CVD的危险因素,有助于控制CKD患者CVD的发生和发展。     

转录激活因子3在急性肾损伤及慢性肾脏病中的作用机制研究进展

肾功能不全依据肾功恶化的速度及病因可分为急性肾损伤(AKI)及慢性肾脏病(CKD).在我国,每年约有140～290万AKI患者入院,院内死亡率高达12.4％[];经流行病学调查,2017年全球CKD平均患病率为9.1％,较1990年增加了29％,其中近六分之一CKD患者在中国,我国患病总人数高达1.32亿[2],可见A...     

成纤维细胞生长因子23与慢性肾脏病患者心血管疾病的关系

心血管疾病是慢性肾脏病(CKD)患者最常见的致死原因.成纤维细胞生长因子23(FGF23)在CKD患者中明显升高,且与左心室肥厚和心血管事件发生率密切相关.其机制包括FGF23激活肾素-血管紧张素-醛固酮系统和非klotho依赖左心室肥厚等.目前针对降低FGF23干预性治疗尚无定论,低磷饮食、磷结合剂与西那卡塞可降低CKD患者FGF23水平,但其有效性还需进一步的临床研究加以证实.