摘要
目的探讨血尿酸水平与免疫球蛋白A肾病(immunoglobulin A nephropathy,IgAN)患者动脉粥样硬化和心血管事件的相关性。方法选择2020年1月1日至2021年12月31日在深圳市南山区人民医院接受肾活检证实为IgAN的146例患者作为研究对象。根据尿酸水平的三分位数将患者分为T1水平组(≤220μmol/L)、T2水平组(220μmol/L~260μmol/L)和T3组(≥260μmol/L)。通过冠状动脉造影术定量分析血流储备分数。本研究的终点是主要心血管事件(major adverse cardiovascular events,MACE),包括冠状动脉疾病、卒中、外周动脉疾病和心血管死亡。根据患者是否发生MACE分为非MACE组和MACE组。结果在随访期间,有23例IgAN患者发生MACE事件。与非MACE组患者相比,MACE组的慢性肾脏病3~4期例数(19例比62例)、肌酐水平[117.00(109.00,138.00)μmol/L比136.00(121.00,169.00)μmol/L]、尿酸水平[(263.66±91.69)μmol/L比(371.45±156.58)μmol/L]、直径狭窄比例[46.00(40.00,52.00)%比51.00(43.00,59.00)%]显著增加,差异具有统计学意义(P<0.05),估算肾小球滤过率水平[57.00(44.00,83.00)mL·min^(-1)·(1.73 m^(2))-1比39.00(33.00,51.00)mL·min^(-1)·(1.73 m^(2))^(-1)]、最小管腔直径[1.43(1.21,1.66)mm比1.16(0.90,1.53)mm]显著降低,差异具有统计学意义(P<0.05)。多因素Cox回归模型显示,血尿酸(HR=4.137,95%CI:1.135~15.084)是IgAN患者发生MACE事件的独立影响因素(P<0.05)。受试者工作特征曲线分析显示,血尿酸水平在截止值为247μmol/L时,曲线下面积为0.733(95%CI:0.623~0.843),敏感度为87.0%,特异度为56.9%。Kaplan-Maier分析显示,血尿酸高水平组随访期间MACE事件发生率为27.4%(20/73),血尿酸低水平组MACE事件发生率为4.1%(3/73),组间比较差异具有统计学意义(Log-Rank=15.233,P<0.001)。结论血尿酸水平与IgAN患者的动脉粥样硬化发展和MACE事件的发生相关。在IgAN患者中较高的血尿酸水平有助于预测MACE事件的发生。
Objective To explore the correlation of serum uric acid level with atherosclerosis and cardiovascular events in patients with immunoglobulin A nephropathy(IgAN).Methods A total of 146 IgAN patients confirmed by renal biopsy in Shenzhen Nanshan People's Hospital from January 1,2020 to December 31,2021 were selected as the research objects.Patients were divided into T1 level group(≤220μmol/L),T2 level group(220μmol/L-260μmol/L)and T3 group(≥260μmol/L)according to the trinket of uric acid level.The fractional flow reserve(FFR)was quantitatively analyzed by coronary angiography.The end point of this study was the major adverse cardiovascular events(MACEs),including coronary artery disease,stroke,peripheral artery disease and cardiovascular death.Patients were divided into non-MACE group and MACE group according to whether MACE occurred or not.Results During the follow-up period,MACEs were reported in 23 IgAN patients.Compared with the non-MACE group,the number of stage 3-4 CKD cases(19 vs 62),creatinine level[117.00(109.00,138.00)μmol/L vs.136.00(121.00,169.00)μmol/L],uric acid level(263.66±91.69μmol/L vs.371.45±156.58μmol/L)and diameter stenosis ratio[46.00(40.00,52.00)%vs.51.00(43.00,59.00)%]in MACE group increased significantly(P<0.05),while eGFR level[57.00(44.00,83.00)mL·min^(-1)·(1.73 m^(2))^(-1)vs.39.00(33.00,51.00)mL·min^(-1)·(1.73 m^(2))^(-1)]and minimum lumen diameter[1.43(1.21,1.66)mm vs.1.16(0.90,1.53)mm]decreased significantly(P<0.05).Multivariate Cox re⁃gression model showed that uric acid(HR=4.137,95%CI:1.135-15.084)was an independent influenc⁃ing factor for the occurrence of MACE events in IgAN patients(P<0.05).Receiver operating character⁃istic(ROC)curve analysis showed that when the cutoff value of uric acid was 247μmol/L,the area under the curve(AUC)was 0.733(95%CI:0.623-0.843),the sensitivity was 87.0%and the specificity was 56.9%.Kaplan-Maier analysis showed that the incidence of MACEs in the high uric acid group was 27.4%(20/73),and that in the low uric acid group was 4.1%(3/73),showing a significant difference(Log-Rank=15.233,P<0.001).Conclusions Uric acid level is related to the development of atheroscle⁃rosis and the occurrence of MACEs in IgAN patients.Higher uric acid level in IgAN patients is helpful to predict the occurrence of MACEs.
作者
钟晓琴
王莉
马坤启
胡娇娇
祝胜郎
彭红云
Zhong Xiao-qin;Wang Li;Ma Kun-qi;Hu Jiao-jiao;Zhu Sheng-lang;Peng Hong-yun(Department of Nephrology,Shenzhen Nanshan People's Hospital,Shenzhen 518000,China)
出处
《临床肾脏病杂志》
2025年第9期761-767,共7页
Journal of Clinical Nephrology
基金
广东省卫生健康委员会科研项目(C2021102)
深圳市科技计划项目(JCYJ20230807115904009)。
关键词
尿酸
免疫球蛋白A肾病
动脉粥样硬化
血流储备分数
主要心血管不良事件
Uric acid
Immunoglobulin A nephropathy
Atherosclerosis
Fractional flow re⁃serve
Major cardiovascular adverse events
