CAJ | 학술논문

目的分析老年原发性高血压患者血尿酸水平与估算肾小球滤过率(eGFR)的相关关系,探讨血尿酸变化对肾功能的影响.方法采用回顾性队列研究方法.病例来自2007年8月至2009年9月间在福建省立医院住院的1 648例高血压病患者,随访3年后再入院的患者465例.多元回归法分析患者血尿酸水平与3年前后肾功能变化的关系.结果 465例研究对象平均随访时间3.9年,基线平均年龄(68.3±9.7)岁.3年后血尿酸水平与基线血尿酸水平相比差异无统计学意义(P＞0.05).调整年龄、性别、糖尿病、BMI和血压等因素后,多元线性回归分析结果显示:血尿酸基线值每增高100 μmol/L,eGFR基线值下降4.40 ml· min-1·(1.73 m2)-1[95％ CI:-6.25～-2.55,P＜0.01].根据3年后血尿酸水平变化情况分为尿酸下降组和尿酸升高组,两组eGFR基线值的差异无统计学意义(P＞0.05),3年后尿酸升高组eGFR较尿酸下降组降低[(70.63±21.54)比(79.62±21.16) ml· min-1 · (1.73m2)-1,P＜ 0.01].调整增龄、性别、糖尿病、血压、降压药物强度积分、血脂变化等因素后,多元二分类logistic回归分析结果显示:因血尿酸基线值升高导致3年后eGFR下降超过10 ml· min-1· (1.73 m2)-1的风险比为2.11(95％CI:1.24 ～ 3.59,P＜0.01);与尿酸下降组相比,3年后尿酸升高组eGFR下降的风险比为2.60(95％CI:1.67～ 4.07,P＜0.01).结论血尿酸基线值高的老年高血压病患者,随访3年后eGFR较尿酸下降组降低,患慢性肾脏病的风险增高;3年后血尿酸水平下降的患者,肾功能减退的程度较轻.提示血尿酸水平下降有助于延缓老年高血压患者的肾功能恶化.
목적 분석노년원발성고혈압환자혈뇨산수평여고산신소구려과솔(eGFR)적상관관계,탐토혈뇨산변화대신공능적영향.방법 채용회고성대렬연구방법.병례래자2007년8월지2009년9월간재복건성립의원주원적1 648례고혈압병환자,수방3년후재입원적환자465례.다원회귀법분석환자혈뇨산수평여3년전후신공능변화적관계.결과 465례연구대상평균수방시간3.9년,기선평균년령(68.3±9.7)세.3년후혈뇨산수평여기선혈뇨산수평상비차이무통계학의의(P＞0.05).조정년령、성별、당뇨병、BMI화혈압등인소후,다원선성회귀분석결과현시:혈뇨산기선치매증고100 μmol/L,eGFR기선치하강4.40 ml· min-1·(1.73 m2)-1[95％ CI:-6.25～-2.55,P＜0.01].근거3년후혈뇨산수평변화정황분위뇨산하강조화뇨산승고조,량조eGFR기선치적차이무통계학의의(P＞0.05),3년후뇨산승고조eGFR교뇨산하강조강저[(70.63±21.54)비(79.62±21.16) ml· min-1 · (1.73m2)-1,P＜ 0.01].조정증령、성별、당뇨병、혈압、강압약물강도적분、혈지변화등인소후,다원이분류logistic회귀분석결과현시:인혈뇨산기선치승고도치3년후eGFR하강초과10 ml· min-1· (1.73 m2)-1적풍험비위2.11(95％CI:1.24 ～ 3.59,P＜0.01);여뇨산하강조상비,3년후뇨산승고조eGFR하강적풍험비위2.60(95％CI:1.67～ 4.07,P＜0.01).결론 혈뇨산기선치고적노년고혈압병환자,수방3년후eGFR교뇨산하강조강저,환만성신장병적풍험증고;3년후혈뇨산수평하강적환자,신공능감퇴적정도교경.제시혈뇨산수평하강유조우연완노년고혈압환자적신공능악화.
Objective To explore the relationship of serum uric acid level with estimated glomerular filtration rate (eGFR) of elderly patients with hypertention based on a retrospective cohort study.Method The subjects included 465 cases who had a readmission after 3 years of follow-up in an original cohort of 1648 patients with diagnosis of essential hypertension in Fujian Provincial Hospital from August 2007 to September 2009.Multiple regression analysis was performed to examine the effect of serum uric acid level on renal function.Results Four hundred and sixty-five subjects were followed up for an average of 3.9 years.Mean patient age was 68.3 ± 9.7 years.There was no significant difference in uric acid between the baseline and 3 years later (P ＞ 0.05).Multiple regression analysis showed that after adjustment for age,gender,diabetes,body mass index,blood pressure etc,each 100 μmol/L-higher uric acid at baseline was associated with 4.40 ml· min-1· (1.73m2)-1 decrease in eGFR[95％ confidence interval (CI):-6.25--2.55,P ＜ 0.01].According to the alteration of the serum uric acid,all patients were divided into the group with decreased uric acid and the group with increase uric acid.The eGFR was lower in patients with increased uric acid than that in patients with decreased uric acid 3 years later [(70.63±21.54) ml· min-1 · (1.73m2)-1 vs (79.62±21.16) ml· min-1· (1.73 m2)-1,P ＜ 0.01] and there was no significant difference at baseline between the two groups (P ＞ 0.05).Multiple logistic regression analysis showed that after adjusting for aging,gender,diabetes,alteration of blood pressure etc,baseline uric acid was associated with a higher risk for eGFR decreasing more than 10 ml· min-1· (1.73 m2)-1 3 years later [hazard ratio (HR)=2.11,95％CI:1.24-3.59,P ＜ 0.01]; increased uric acid 3 years later resulted in a higher risk for renal function deterioration (HR=2.60,95％ CI:1.67-4.07,P ＜ 0.01).Conclusions Elderly hypertensive patients with baseline hyperuricemia have a lower eGFR,resulting an increased risk of chronic kidney disease.While the patients with declined uric acid had a lesser imparied renal function.It suggests that the improvement of uric acid may help to slow down the deterioration of renal function in elderly hypertensive patients.