新疆地区13 100体检人群肾功能相关代谢物的异常状态：“分子水平亚健康”概念的现实临床意义

目的通过检测反映肾功能的生化代谢指标，在常规体检人群中探讨肾功能指标异常的分子水平“亚健康”状态。方法2013 年1 月-2014 年8 月在石河子大学医学院第一附属医院参加健康体检的13 100汉族个体接受了空腹常规血液检测尿酸、尿素氮、肌酐和胱抑素C 4项指标，体检者无症状主诉。结果尿酸、尿素氮、胱抑素C 和肌酐异常升高率分别为14.05%、1.90%、0.82%和0.33%。在尿酸、尿素氮、胱抑素C 和肌酐水平异常的体检者中，80%集中在21～50 岁青壮年。男性尿酸、尿素氮、胱抑素C及肌酐水平与女性比较，差异有统计学意义（p <0.05）。男性：尿酸（353.51±80.44）μmol/L，尿素氮（5.21±1.34）mmol/L，胱抑素C（0.87±0.24）mg/L，肌酐（78.59±13.83）μmol/L；女性：尿酸（245.65±62.24）μmol/L，尿素氮（4.50±1.26）mmol/L，胱抑素C（0.74±0.23）mg/L，肌酐（58.83±10.08）μmol/L。尿素氮、胱抑素C 及肌酐水平与年龄呈正相关，但尿酸水平与年龄无相关。结论首次在新疆地区对汉族体检人群进行大样本调查，在无相关临床症状体检者中发现4 种肾功能相关代谢物血液水平异常升高，藉此首次提出“分子水平亚健康”的概念。这种“分子水平亚健康”可能是肾脏相关疾病的早期预警信号，应该受到预防公共卫生的高度关注。

Abnormal blood levels of renal function-related metabolites among 13,100 physical examination population in Xinjiang: clinical significance of concept of Molecular Sub-healthy

Objective To examine fasting blood metabolites related to the renal function among individualsparticipating in the routine physical examinations and investigate their possible Molecular Sub -healthy status defined by having abnormal blood metabolites without relevant clinical manifestations or diagnosis. Methods Totally 13,100 individuals of Han Chinese attending health checkup in our clinic from January 2013 to August 2014 were tested for blood metabolites and activities related to the renal function after overnight fasting. The examination indexes including uric acid (UA), blood urea nitrogen (BUN), creatinine (CR) and cystatin-C (Cyst-C) were detected using an automated bioanalyzer. Results According to Chinese reference ranges for the 4 blood metabolites, the rates of increased levels of UA, BUN, Cyst-C and Cr were 14.05%, 1.90%, 0.82% and 0.33% respectively. The vast majority (> 80%) of the individuals with abnormal blood metabolites was clustered in 21-50 years of age in both genders, who formed the prime labor force in China. Blood levels of all the 4 metabolites in the males were higher than those in the females (p < 0.05). The levels of BUN, Cyst-C and CR, but not UA, were positively correlated with age in both sexes. Conclusions This is the first investigation using a large sample of Han nationals presenting no clinical symptoms at the physical examination in Shihezi area, Xinjiang. Elevated levels of 4 renal function-related blood metabolites are found and we accordingly propose for the first time a concept of renal function -related Molecular Sub-healthy status, which serves as a pre-warning for asymptomatic renal diseases. Such a concept may be useful in preventive public health for those sub-healthy individuals at molecular level.