摘要目的 探讨IgA肾病(IgAN)患者高尿酸血症的相关因素.方法 回顾性选取2016年1月至2018年10月在安徽医科大学附属省立医院肾脏内科行肾活检诊断为IgAN的患者为研究对象.依据血尿酸值将IgAN患者分为高尿酸血症组和正常血尿酸组,比较分析两组患者的一般临床指标及肾脏病理资料的差别,采用Logistic回归模型分析IgAN患者高尿酸血症的相关因素.结果 共纳入125例IgAN患者,其中男63例,女62例;年龄(35.70±11.16)岁;高尿酸血症患病率为44.0％(55/125).与正常血尿酸组比,高血尿酸组的血尿素氮、血肌酐、慢性肾脏病(CKD)3期及以上比例、小动脉管壁增厚比例、纤维性新月体/小球总数、肾间质纤维化发生比例、肾小管萎缩比例、肾小球球性硬化比例及炎性细胞浸润比例均较高,而估算肾小球滤过率(eGFR)水平较低,差异均有统计学意义(均P<0.05).多因素Logistic回归分析显示血肌酐是IgAN患者高血尿酸血症的独立相关因素(OR=1.034,95％CI 1.005～1.064,P=0.021).结论 IgAN伴高尿酸血症患者肾小球、肾小管及间质病变严重,血肌酐水平是IgAN患者高血尿酸血症的独立相关因素.高尿酸血症可能在IgAN疾病发展过程中发挥重要作用,因此控制血尿酸水平可能有助于改善IgAN患者预后.

abstractsObjective To investigate the influencing factors of hyperuricemia in patients with IgA nephropathy (IgAN). Methods A retrospective study was performed in patients with renal biopsy diagnosed as IgAN in the Department of Nephrology, Provincial Hospital of Anhui Medical University from January 2016 to October 2018. According to the blood uric acid level, they were divided into two groups: patients with hyperuricemia and patients without hyperuricemia. The general clinical indicators and renal pathological data were compared between the two groups. Logistic regression model was used to analyze the influencing factors of hyperuricemia in IgAN patients. Results A total of 125 IgAN patients with age of (35.70±11.16) years old were enrolled, including 63 males and 62 females. The morbidity of hyperuricemia was 44.0％(55/125). Compared with the normal blood uric acid group, the blood urea nitrogen, serum creatinine and the proportion of chronic kidney disease (CKD) stage 3 - 5, small arterial wall thickening, fibrous crescents/globules, renal interstitial fibrosis, renal tubular atrophy, glomerular sclerosis and inflammatory cell infiltration in the hyperuric acid group were higher, while the level of estimated glomerular filtration rate (eGFR) was lower. And the differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that the level of serum creatinine was an independent related factor of hyperuricemia in IgAN patients (OR=1.034, 95％ CI 1.005-1.064, P=0.021). Conclusions IgAN patients with hyperuricemia presented more severe glomerular, tubular and interstitial lesions, and the level of serum creatinine is an independent related factor of hyperuricemia in IgAN patients. High uric acid level may have an important influence on the progression of IgAN, so good control of serum uric acid may improve the prognosis of patients with IgAN.