慢性肾脏病患者高尿酸血症与高血压的关联分析

doi:10.16150/j.1671-2870.2023.02.009

摘要/Abstract

摘要：

目的： 探讨慢性肾脏病(chronic kidney disease，CKD)患者中高尿酸血症与高血压之间的关系。方法：回顾分析2020年1月至2020年3月上海交通大学附属瑞金医院肾脏科门诊确诊的530例CKD患者，收集其人口学资料，测量血压并检测各项临床生化指标。采用多因素logistic回归分析评估CKD患者血尿酸水平与高血压间的相关性。结果：CKD患者的高尿酸血症患病率为42.6%，高血压患病率为60.4%。CKD 1~5期患者的高血压患病率分别为37.3%、57.4%、74.0%、78.8%、83.6%，高尿酸血症患病率分别为19.5%、35.7%、65.4%、61.5%、55.2%。不同CKD分期患者间的高血压及高尿酸血症患病率差异均有统计学意义。将患者依据尿酸水平进行四分位分组，尿酸水平第一分位为对照组，第二、三、四分位尿酸组的合并高血压风险依次升高，分别为1.588倍、1.368倍和2.542倍。最高四分位尿酸组患者的高血压风险是最低四分位组的2.542倍（P<0.05）。结论：CKD患者中，高尿酸血症与高血压之间存在明显的相关性，随着血尿酸水平升高，其发生高血压的风险逐渐增加。临床应重视对CKD患者无症状高尿酸血症的处理。

关键词: 慢性肾脏病, 高尿酸血症, 高血压

Abstract:

Objective: To investigate the relationship between hyperuricemia and hypertension in patients with chronic kidney disease (CKD). Methods: The demographic characteristics, blood pressure and biochemical indicators in 530 outpatients of CKD were analyzed in this study from Jan 2020 to Mar 2020 in the Nephrology Department of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. Multivariate logistic regression analysis was used to evaluate the correlation between serum uric acid and hypertension in CKD patients. Results: The prevalence of hyperuricemia in CKD patients was 42.6%, and the prevalence of hypertension was 60.4%. In patients with CKD from stages 1 to 5, the prevalence of hypertension was 37.3%, 57.4%, 74.0%, 78.8%， 83.6% respectively, and the prevalence of hyperuricemia was 19.5%， 35.7%， 65.4%， 61.5%， 55.2% respectively. The prevalence of both hyperuricemia and hypertension among CKD 1-5 were significantly different. By comparison with the serum uric acid level in the first quartile (Q1，the multivariate-adjusted odds for hypertension in the Q2, Q3 and Q4 were 1.588, 1.368 and 2.542 times respectively. Among them, the risk of hypertension in the highest quartile group was 2.542 times as the risk in Q1. Conclusions: Among CKD patients, there is a significant correlation between hyperuricemia and hypertension. The risk of hypertension increases with the rise of serum uric acid level. More attention should be paid to CKD patients with asymptomatic hyperuricemia.

Key words: Chronic kidney disease, Hyperuricemia, Hypertension

中图分类号:

R692
R544.1

钱莹, 马晓波, 高琛妮, 张春丽, 马骏, 张文, 陈晓农. 慢性肾脏病患者高尿酸血症与高血压的关联分析[J]. 诊断学理论与实践, 2023, 22(02): 160-165.

QIAN Ying, MA Xiaobo, GAO Chenni, ZHANG Chunli, MA Jun, ZHANG Wen, CHEN Xiaonong. Association between hyperuricemia and hypertension in chronic kidney disease[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(02): 160-165.

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Stages	eGFR [mL/（min?1.73 m²）]	ICD-10
1	≥90	585.1
2	60-89	585.2
3	30-59	585.3
4	15-29	585.4
5	<15	585.5

Parameters	Hyperuricemic group （n=226）	Normal group （n=304）	Z/t/χ²	P
Sex, Male(%)	121（53.5）	107（41.8）	7.205	0.007
Age（years）	57.2（18.3）	53.9（17.6）	-2.059	0.040
BMI（kg/m²）	23.9（3.4）	22.7（3.6）	-3.925	<0.001
SBP(mmHg)	144（130-150）	130（120-130）	-7.862	<0.001
DBP(mmHg)	88（80-90）	75（70-80）	-7.231	<0.001
TG(mmol/L)	5.02（4.20-5.83	4.93（4.05-5.63）	-1.013	0.311
TC(mmol/L)	1.40（1.03-2.43	1.76（1.30-2.85）	-3.336	0.001
HDL-C(mmol/L)	1.23（1.01-1.51）	1.35（1.10-1.60）	-2.280	0.023
LDL-C(mmol/L)	2.77（2.22-3.58）	2.85（2.23-3.50）	-0.021	0.959
Creatinine(μmol/L)	132.0（95.0-228.3）	81.0(64.0-124.5)	-8.155	<0.001
Glucose(mmol/L)	6.8（5.1-8.9）	5.6（5.0-7.1）	-2.230	0.045

Uric acid quartile	Hypertension		χ²	P
Uric acid quartile	No	Yes	χ²	P
Q1	78（59.5）	53（40.5）	31.717	<0.001
Q2	52（38.8）	82（61.2）
Q3	47（35.6）	85（64.4）
Q4	33（24.8）	100（75.2）

UA	β	SE	χ²	OR(95%CI)	P
Q1			7.066	1.000	0.070
Q2	0.462	0.329	1.971	1.588（0.833-3.029）	0.160
Q3	0.314	0.351	0.798	1.368（0.687-2.724）	0.372
Q4	0.933	0.367	6.477	2.542（1.239-5.215）	0.011