慢性肾脏病患者高血尿酸水平的危险因素研究

目的　探讨慢性肾脏病（CKD）患者高血尿酸水平的影响因素。方法　选取2012年12月—2015年12月于天津市第一中心医院肾内科就诊的321例CKD患者为研究对象。根据血清尿酸水平的中位数（379.00 μmol/L），将纳入的321例CKD患者分为高血尿酸水平组（n=161）和低血尿酸水平组（n=160）；同时根据CKD诊断标准，将患者分为估算肾小球滤过率（eGFR）≥60 ml?min-1?（1.73 m2）-1组（n=156）、eGFR<60 ml?min-1?（1.73 m2）-1组（n=165）。采用Logistic 回归分析探讨CKD患者高血尿酸水平的危险因素。结果　多因素Logistic逐步回归分析结果显示，男性、体质指数（BMI）高、eGFR低、血尿素氮（BUN）高是CKD患者高血尿酸水平的危险因素；BMI高、受教育程度低、eGFR低、TG高是CKD男性患者高血尿酸水平的危险因素；BUN高、TG高是CKD女性患者高血尿酸水平的危险因素；男性、BMI高是eGFR≥60 ml?min-1?（1.73 m2）-1的CKD患者高血尿酸水平的危险因素；男性、年龄大、BMI高、舒张压高、BUN高是eGFR<60 ml?min-1?（1.73 m2）-1的CKD患者高血尿酸水平的危险因素（P<0.05）。结论　不同性别、eGFR的CKD患者发生高血尿酸水平的危险因素不同，应采取针对性的个体化措施防治不同特征群体的高血尿酸水平。

Risk Factors of High Serum Uric Acid Level in Patients with Chronic Kidney Disease

Objective　To characterize the risk factors of high serum uric acid level in patients with chronic kidney disease（CKD）．Methods　321 CKD patients were sampled from Department of Nephrology，Tianjin First Central Hospital from December 2012 to December 2015，including 161 with high serum uric acid level and 160 with low uric acid level（high or low serum uric acid level was defined as greater or lower than the median level of 379.00 μmol/L）．They were assigned to eGFR≥60 ml·min-1·（1.73 m2）-1 group （n=156） and eGFR<60 ml·min-1·（1.73 m2）-1 group （n=165）by the eGFR used for CKD diagnosis.Logistic regression analyses were performed to characterize the risk factors of high serum uric acid level.Results　Multivariate stepwise Logistic regression analysis showed that male，high body mass index （BMI），low eGFR，high blood urea nitrogen（BUN） were risk factors of high serum uric acid level in CKD patients（P<0.05）；high BMI，low educational level，low eGFR，and high TG were risk factors of high serum uric acid level in male patients；high BUN and TG were the risk factors of hyperuricemia in female patients（P<0.05）；male，high BMI were the risk factors of high serum uric acid level in CKD patients with eGFR≥60 ml·min-1·（1.73 m2）-1（P<0.05）；male，older age and high BMI，high diastolic blood pressure and high BUN were the risk factors of high serum uric acid level in CKD patients with eGFR<60 ml?min-1?（1.73 m2）-1（P<0.05）．Conclusion　The risk factors of high serum uric acid level in CKD patients differed significantly by sex and eGFR level，suggesting that preventive and treatment measures should be taken according to the characteristics of the patients. Chronic kidney disease；Hyperuricemia；Risk factors；Glomerular filtration rate