高尿酸合并高血压对肾功能影响的分析

目的 探讨高血压、高尿酸血症（HUA）对肾功能损害的作用.方法 回顾分析2000年12月至2002年12月1 209例体检者（1 164例）及肾脏病患者（45例）的临床资料,测定指标有血压、身高、体重、肾功能、肝功能及肾小球滤过率（GFR）,其中血压、血尿酸水平均正常者832例（正常对照组）、单纯高血压者134例（高血压组）、单纯HUA者185例（HUA组）、高血压合并HUA者58例（高血压＋ HUA组）,分析各组间GFR水平的差异.结果 ①HUA者的高血压率为23.9％（58/243）,血尿酸水平正常者的高血压率为13.9％ （134/966）,两者差异有统计学意义（x^2=14.52,P =0.000）.②高血压＋HUA组GFR最低,HUA、高血压组GFR水平依次递增,分别为（69.1±30.5）、（82.8±25.3）和（90.1±21.7）ml·min^-1·（1.73 m^2）^-1,正常对照组为（94.9±20.5）ml·min·^-1·（1.73 m^2）^-1.③logistic回归分析显示,影响GFR的危险因素依次是血尿酸水平、收缩压和年龄.（521例体检者5年后,HUA组（66例）、高血压＋HUA组（52例）的GFR水平显著下降,正常对照组（238例）、高血压组（165例）、HUA组和高血压＋HUA组分别为（90.6±17.1）、（85.6±17.6）、（62.1 ±8.2）和（49.3±9.8）ml·min-·（1.73 m^2）-],影响GFR长期因素是血尿酸水平和年龄（x^2值分别为81.10和12.18,均P=0.000）.结论 HUA、高血压是影响肾功能的重要因素,高血尿酸较高血压作用明显.高血压合并HUA对肾功能的损害最显著.

Impairment of renal function in patients with hyperuricemia and hypertension

Objective To investigate the effect of hypertension and hyperuricemia （HUA） on renal function. Method Total 1 209 subjects undergoing health check up from December 2000 to December 2002 and 45 patients with renal disorders were enrolled in the study. The blood pressure, height, weight, renal function and liver function were measured; and the glomerular filtration rate （GFR） was calculated. The GFR in patients with hypertension, HUA and hypertension with HUA was compared. Results The incidence of hypertension in HUA group and non-HUA was 23.9% （58/243） and 13.9% （134/966） , respectively （ X^2 = 14. 52, P = 0. 000）. GFR in HUA with hypertension, HUA and hypertension groups were （69. 1 ± 30. 5 ）, （82. 8 ± 25.3 ） and （90. 1 ± 21.7 ） ml · min^-1 · （ 1.73 m^2 ）^-1, respectively （P 〈 0. 01 ）. Logistic regression analysis showed that the risk factors for GFR were UA, systolic pressure and age. After 5 years of follow up, GFR in hypertension group was significantly decreased from （90. 7 ± 18. 1 ） to （85.6 ± 17.6）ml·min^-1· （1.73 m^2）^-1m, in HUA group from （86.3±10.9） to （62.1 ±8.2） and inHUAwith hypertension group from （77.9 ± 18.9） to （49.3 ±9.8） ml · min^-1 . （1.73 m^2）^-1 , UA and age were the long-term factors that affect GFR （ P 〈 0. 05 ）. Conclusions Both hyperuricemia and hypertension can impair the kidney function, if hypertension is complicated with hyperurecemia the effect is more marked.