陈怡渝,程琳,黄朝晖,高勤,何常
CHEN Yiyu,CHENG Lin,HUANG Zhaohui,GAO Qin,HE Chang

• 1:贵州医科大学附属医院风湿免疫科
• 2:贵州医科大学临床医学院
• 3:贵州医科大学
• 4:贵州医科大学附属医院病理科

摘要(Abstract)：

目的 探讨微小病变型肾病(MCD)患者的血尿酸(UA)/血肌酐(Cr)比值与其临床指标、肾脏病理的相关性。方法 选取肾穿刺活检确诊为MCD的患者109例，按照UA/Cr大小分为低UA/Cr组(n=54)和高UA/Cr组(n=55),收集2组患者的临床资料，采用酶法、Jaffe法检测患者住院首日静脉血生化指标及24 h尿蛋白定量(24 h-UP)、浆膜腔积液情况以及肾脏病理特征，采用多重线性回归分析MCD患者UA/Cr水平的影响因素。结果 高UA/Cr组MCD患者的纤维蛋白原(FIB)、D-二聚体(D-D)、UA、肾小球滤过率(eGFR)水平高于低UA/Cr组，Cr水平低于低UA/Cr组，差异有统计学意义(P<0.05);高UA/Cr组MCD患者肾小球肥大比例高于低UA/Cr组，差异有统计学意义(P<0.05);多重线性回归模型结果示，MCD患者肾小管萎缩/间质纤维化与UA/Cr呈负相关(β=-0.332,95%CI为-1.798～-0.515,P=0.001),FIB与UA/Cr呈正相关(β=0.263,95%CI为0.067～0.379,P=0.006)。结论 UA/Cr水平可反映MCD患者高凝状态、血栓形成及肾小管间质损害风险。
Objective To investigate the correlation of serum uric acid(UA)/serum creatinine(Cr) ratio with clinical indicators and renal pathology in patients with minimal change nephropathy(MCD). Methods A total of 109 patients diagnosed as MCD via renal biopsy were selected and categorized into low UA/Cr group(n=54) and high UA/Cr group(n=55) based on their UA/Cr levels. Clinical data from two groups of patients were collected. Enzymatic method and Jaffe method were used to examine venous blood biochemical indicators of the patients on the first day of hospitalization, 24-hour urinary protein quantification(24 h-UP), serosal fluid accumulation and renal pathological characteristics on the first day of hospitalization. Multiple linear regression analysis was used to analyze the influencing factors of UA/Cr levels in the patients with MCD. Results The levels of FIB, D-dimer(D-D), UA, and estimated glomerular filtration(eGFR) rate were higher in high UA/Cr group than those in low UA/Cr group, while Cr level was lower than that in low UA/Cr group(P<0.05). The proportion of glomerular hypertrophy was significantly higher in the patients with MCD in high UA/Cr group than that in low UA/Cr group(P<0.05). Multiple linear regression model analysis showed that renal tubular atrophy/interstitial fibrosis of the patients with MCD was negatively correlated with UA/Cr(β=-0.332, 95% CI was from-1.798 to-0.515, P=0.001), while FIB was positively correlated with UA/Cr(β=0.263, 95% CI was from 0.067 to 0.379, P=0.006).Conclusion UA/Cr level can serve as an indicator for assessing the risk of hypercoagulability, thrombosis and tubulointerstitial damage in the patients with MCD.

关键词(KeyWords)： 肾病综合征;血尿酸/血肌酐;微小病变型肾病;高凝状态;肾小管萎缩/间质纤维化;肾脏病理
nephrotic syndrome;serum uric acid/serum creatinine;minimal change nephropathy;hypercoagulability;renal tubular atrophy/interstitial fibrosis;renal pathology

Abstract:

Keywords:

基金项目(Foundation): 贵州省卫生健康委科学技术基金项目(gzwkj2022-002)

作者(Author): 陈怡渝,程琳,黄朝晖,高勤,何常
CHEN Yiyu,CHENG Lin,HUANG Zhaohui,GAO Qin,HE Chang

DOI: 10.19367/j.cnki.2096-8388.2024.10.015

参考文献(References)：

• [1] PRVERMA P R,PATIL P.Nephrotic syndrome:a review [J].Cureus,2024,16(2):53923.
• [2] Kidney Disease:Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group.KDIGO 2021 clinical practice guideline for the management of glomerular diseases [J].Kidney International,2021,100 (4):S153-S160.
• [3] HAN Y,CAO Y,HAN X,et al.Hyperuricemia and gout increased the risk of long-term mortality in patients with heart failure:insights from the national health and nutrition examination survey[J].Journal of Translational Medicine,2023,21(1):463.
• [4] GHERGHINA M E,PERIDE I,TIGLIS M,et al.Uric acid and oxidative stress-relationship with cardiovascular,metabolic,and renal impairment [J].International Journal of Molecular Sciences,2022,23(6):3188.
• [5] 中国民族卫生协会重症代谢疾病分会，高尿酸血症相关疾病诊疗多学科共识专家组，邹和建，等.中国高尿酸血症相关疾病诊疗多学科专家共识(2023年版)[J].中国实用内科杂志，2023,43(6):461-480.
• [6] TAO J,SHEN X,LI J,et al.Serum uric acid to creatinine ratio and metabolic syndrome in postmenopausal Chinese women [J].Medicine (Baltimore),2020,99 (17):19959.
• [7] YAO C,GU L,WANG T,et al.The association between serum uric acid to creatinine ratio and renal disease progression in type 2 diabetic patients in Chinese communities [J].Journal of Diabetes and its Complications,2019,33(7):473-476.
• [8] HAN R,DUAN L,ZHANG Y,et al.Serum uric acid is a better indicator of kidney impairment than serum uric acid-to-creatinine ratio and serum uric acid-to-high-density lipoprotein ratio:a cross-sectional study of type 2 diabetes mellitus patients [J].Diabetes,Metabolic Syndrome and Obesity:Targets and Therapy,2023,16:2695-2703.
• [9] DING Z,FAN Y,YAO C,et al.The association between the serum uric acid to creatinine ratio and all-cause mortality in elderly hemodialysis patients [J].BMC Nephrology,2022,23(1):177.
• [10]余卫，张在竹.医学领域年龄人群划分标准浅析[J].中国医学科学院学报，2023,45(2):285-289.
• [11]全国eGFR课题协作组.MDRD方程在我国慢性肾脏病患者中的改良和评估[J].中华肾脏病杂志，2006(10):589-595.
• [12]张慧颖.B超在胸腔积液中的应用价值探讨[J].当代医学，2014,20(2):121-122.
• [13]陈科锦，封光华，贾忠.腹腔积液的B型超声诊断进展[J].医学研究杂志，2010,39(1):116-118.
• [14]周福梅.心包积液的病因及超声诊断分析[J].中西医结合心脑血管病杂志，2012,10(3):363-364.
• [15]程琳，陈怡渝，郑兰兰，等.多因素Logistic分析原发性肾病综合征微小病变青年患者浆膜腔积液的危险因素[J].川北医学院学报，2023,38(9):1250-1255.
• [16]WAHEED Y,YANG F,SUN D.Role of asymptomatic hyperuricemia in the progression of chronic kidney disease and cardiovascular disease [J].The Korean Journal of Internal Medicine,2021,36(6):1281-1293.
• [17]周晶晶，陈育青，刘颖，等.血尿酸/血肌酐比值对肾小管间质损害程度的评估价值[J].北京医学，2012,34(4):253-256.
• [18]郑晓庆，杨立宏，王彩虹.不同血浆白蛋白水平肾病综合征患者的凝血状态研究[J].中国实用医药，2024,19(6):77-80.
• [19]DANIELLA D,KANDARINI Y,MAHADITA G W.Risk factors for acute kidney injury in covid-19 patients:a systematic review [J].Open Access Macedonian Journal of Medical Sciences,2021,9:118-123.
• [20]谭玥，毕亚艳.血清尿酸在心血管疾病中的作用机制研究进展[J].疑难病杂志，2022,21(1):90-93.
• [21]GEORGOULIS M,MIKHAILIDIS D P,PANAGIOTAKOS D B.Are serum uric acid levels predictors of cardiovascular risk?An update [J].Current Opinion in Cardiology,2023,38(4):337-343.

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