CAJ | 학술논문

目的系统评价尿酸与肾脏疾病发生和预后的关系,为防治肾脏疾病提供参考.方法检索中国生物医学文献数据库(CBM)(1982年1月-2010年3月)、荷兰医学文摘(EMBASE)(1966年1月-2010年3月)以及美国医学索引(Medline)(1950年1月-2010年3月),筛选尿酸与肾脏疾病发生和预后的相关文献,只纳入队列研究.根据Newcastle-Ottawa质量评价量表评价纳入研究的偏倚风险,2名研究人员独立筛选、评价文献和收集数据.采用Stata10.0软件进行统计学分析.结果共纳入21篇高质量队列研究文章,其中与肾脏疾病发生相关11篇,共276 801例研究对象;与肾脏疾病预后相关10篇,共3004例研究对象.对纳入研究中校正了除尿酸外其他影响肾脏疾病发生和预后因素的数据进行Meta分析,结果显示:(1)尿酸与肾脏疾病发生:尿酸水平升高会增加肾脏疾病的发生风险(RR=1.49,95%CI1.27～1.75).(2)尿酸与肾脏疾病预后:高尿酸可导致肾功能恶化(RR=1.35,95%CI1.12～1.63)和肾脏疾病患者死亡风险增加(RR=1.67,95%CI1.29～2.16).结论尿酸是肾脏疾病发生和已患肾脏疾病患者预后不佳的独立危险因素.今后需开展高质量、长随访的临床试验,明确降低尿酸是否能降低肾脏疾病的发生风险和改善肾脏疾病患者的预后,为进一步明确尿酸与肾脏疾病的关系和高尿酸患者的防治提供直接依据.
목적 계통평개뇨산여신장질병발생화예후적관계,위방치신장질병제공삼고.방법 검색중국생물의학문헌수거고(CBM)(1982년1월-2010년3월)、하란의학문적(EMBASE)(1966년1월-2010년3월)이급미국의학색인(Medline)(1950년1월-2010년3월),사선뇨산여신장질병발생화예후적상관문헌,지납입대렬연구.근거Newcastle-Ottawa질량평개량표평개납입연구적편의풍험,2명연구인원독립사선、평개문헌화수집수거.채용Stata10.0연건진행통계학분석.결과 공납입21편고질량대렬연구문장,기중여신장질병발생상관11편,공276 801례연구대상;여신장질병예후상관10편,공3004례연구대상.대납입연구중교정료제뇨산외기타영향신장질병발생화예후인소적수거진행Meta분석,결과현시:(1)뇨산여신장질병발생:뇨산수평승고회증가신장질병적발생풍험(RR=1.49,95%CI1.27～1.75).(2)뇨산여신장질병예후:고뇨산가도치신공능악화(RR=1.35,95%CI1.12～1.63)화신장질병환자사망풍험증가(RR=1.67,95%CI1.29～2.16).결론 뇨산시신장질병발생화이환신장질병환자예후불가적독립위험인소.금후수개전고질량、장수방적림상시험,명학강저뇨산시부능강저신장질병적발생풍험화개선신장질병환자적예후,위진일보명학뇨산여신장질병적관계화고뇨산환자적방치제공직접의거.
Objective To evaluate the association of serum uric acid and the incidence and prognosis of kidney diseases systematically, so as to provide reference for the treatment and prevention of kidney diseases. Methods Literatures related to the associations between serum uric acid and incidence and prognosis of kidney diseases were selected from the Chinese Biomedical Literature Database ( CBM) (January 1982 to March 2010), EMBASE (January 1966 to March 2010) and Medline (January 1950 to March 2010) for cohort studies. Two researchers independently screened the studies, assessed the risk of bias of included studies using the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies and extracted data. Stata 10. 0 was used to calculate the pooled relative risk. Results Twenty-one eligible cohort studies were selected, of which 11 on incidence of kidney diseases (n =276 801 ) , and 10 on the prognosis of kidney diseases ( n = 3004). Meta analysis was performed based on data influencing incidence and prognosis factors of kidney diseases except for serum uric acid. The results showed, (1) uric acid and incidence of kidney diseases: hyperuricemia could increase the risk of kidney diseases ( RR = 1. 49, 95% CI 1. 27-1. 75) ; (2) uric acid and prognosis of patients with kidney diseases:hyperuricemia could deteriorate the kidney function (RR = 1. 35, 95%CI 1. 12-1.63) and increase the risk of mortality (RR = 1.67, 95% CI 1.29-2.16). Conclusion Uric acid is an independent risk factor for incidence of kidney diseases and poor prognosis of patients with kidney diseases. Further high quality clinical trials with long-term follow up should be conducted to determine whether lowering uric acid levels would be of clinical benefit in the prevention and treatment of kidney diseases, so as to provide direct evidence for clarifying correlation between uric acid and kidney diseases and the prevention and treatment for patients with high uric acid.