【摘要】 目的 分析糖尿病肾脏疾病(DKD)患者临床资料，探讨血尿酸/白蛋白比值(sUAR)与DKD患者不良预后的关系。方法 2021年1月—2022年9月河南省人民医院诊治DKD患者340例，以入院次日sUAR中位数为界值分为低水平sUAR组(sUAR≤8.57μmol/g)170例和高水平sUAR组(sUAR>8.57μmol/g)170例。比较2组年龄、性别、糖尿病病程、高血压比率及入院次日血红蛋白、血白蛋白、血尿酸、尿白蛋白/肌酐比值自然对数(lnUACR)、sUAR、残余胆固醇、估算肾小球滤过率等临床资料。2组住院期间均给予控制血糖、血压、蛋白尿和调节血脂等治疗，出院后每3个月随访1次，随访至2023年12月，记录生存及不良预后事件发生情况；绘制Kaplan-Meier生存曲线，比较2组累积生存率；采用单因素及多因素Cox回归分析DKD患者不良预后的影响因素。结果 (1)高水平sUAR组糖尿病病程[14.00(6.00,20.00)年]长于低水平sUAR组[10.00(4.75,18.00)年](U=2.029,P=0.042),高血压比率(75.3%)高于低水平sUAR组(57.1%)(χ~2=12.628,P<0.001),纤维蛋白原[3.56(2.83,4.54)g/L]、三酰甘油[1.97(1.35,2.91)mmol/L]、残余胆固醇[0.78(0.56,1.12)mmol/L]、lnUACR[5.89(4.55,7.41)mg/g]、血尿素氮[7.94(6.05,11.75)mmol/L]、血肌酐[90.00(65.00,131.00)μmol/L]、血尿酸[406.50(355.50,454.75)]μmol/L、视黄醇结合蛋白[59.85(44.53,73.15)mg/L]、胱抑素C[1.35(0.96,1.88)mg/L]均高于低水平sUAR组[2.98(2.55,3.58)g/L、1.52(1.16,2.32)mmol/L、0.59(0.48,0.83)mmol/L、4.41(3.93,5.45)mg/g、6.07(4.88,7.46)mmol/L、56.00(48.00,68.25)μmol/L、305.00(271.00,344.25)μmol/L、44.40(37.43,53.25)mg/L、0.91(0.83,1.05)mg/L](U=3.515～12.077,P均<0.001),血红蛋白[(126.86±22.31)g/L]、血白蛋白[38.05(33.45,41.73)g/L]、估算肾小球滤过率[74.78(46.10,114.47)mL/(min·1.73m~2)]均低于低水平sUAR组[(138.26±19.97)g/L、41.90(38.58,45.30)g/L、126.56(103.58,149.99)mL/(min·1.73 m~2)](t=-4.968,U=-6.636、-9.234,P均<0.001),年龄、性别、体质量指数、血压、空腹血糖、糖化血红蛋白、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇与低水平sUAR组比较差异均无统计学意义(P>0.05)。(2)随访21(16,26)个月，低水平sUAR组不良预后事件发生率(13.5%)低于高水平sUAR组(45.3%)(χ~2=41.310,P<0.001),累积生存率(86.5%)高于高水平sUAR组(54.7%)(χ~2=45.928,P<0.001)。(3)sUAR(HR=1.274,95%CI:1.145～1.417,P<0.001)、高血压(HR=2.083,95%CI:1.168～3.716,P=0.013)、血红蛋白(HR=0.980,95%CI:0.967～0.992,P=0.002)、残余胆固醇(HR=1.700,95%CI:1.280～2.258,P<0.001)、lnUACR(HR=1.377,95%CI:1.160～1.636,P<0.001)是DKD患者不良预后的影响因素。结论 sUAR、残余胆固醇、lnUACR增高，血红蛋白降低及合并高血压的DKD患者不良预后的风险增大。更多还原

【Abstract】 Objective To analyze the clinical data of patients with diabetic kidney disease(DKD),and to investigate the relationship between serum uric acid to albumin ratio(sUAR) and the adverse prognosis.Methods Totally 340 DKD patients were diagnosed and treated in Henan Provincial People’s Hospital from January 2021 to September 2022,and were equally divided into low-level sUAR group(sUAR≤8.57 μmol/g) and high-level sUAR group(sUAR>8.57 μmol/g) based on the median sUAR tested the day after admission.The clinical data as age,gender,course of diabetes,proportion of hypertension,and the levels of hemoglobin,serum albumin,serum uric acid,and log-normalized urine albumin,to creatinine ratio(lnUACR),sUAR,remnant cholesterol,and estimated glomerular filtration rate were compared between two groups.Patients in both groups were treated with blood glucose control,blood pressure control,proteinuria control and blood lipid regulation during hospitalization.The follow-up survey was done every 3 months till December 2023.The survival and occurrence of adverse prognosis events were recorded.Kaplan-Meier survival curves were drawn,and the cumulative survival rate was compared between two groups.Univariate and multivariate Cox regression analyses were done to evaluate the influencing factors of adverse prognosis of DKD patients.Results(1) The course of diabetes was longer in high-level sUAR group [14.00(6.00,20.00) years] than that in low-level sUAR group[10.00(4.75,18.00) years](U=2.029,P=0.042).The proportion of hypertension was higher in high-level sUAR group(75.3%) than that in low-level sUAR group(57.1%)(χ~2=12.628,P<0.001).The levels of fibrinogen,triacylglycerol,remnant cholesterol,lnUACR,blood urea nitrogen,serum creatinine,serum uric acid,retinol-binding protein,and cystatin C were higher in high-level sUAR group [3.56(2.83,4.54) g/L,1.97(1,35,2.91) mmol/L,0.78(0.56,1.12) mmol/L,5.89(4.55,7.41) mg/g,7.94(6.05,11.75) mmol/L,90.00(65,00,131.00) μmol/L,406.50(355.50,454.75) μmol/L,59.85(44.53,73.15) mg/L,1.35(0.96,1.88) mg/L] than those in low-level sUAR group [2.98(2.55,3.58) g/L,1.52(1.16,2.32) mmol/L,0.59(0.48,0.83) mmol/L,4.41(3.93,5.45) mg/g,6.07(4.88,7.46) mmol/L,56.00( 48.00,68.25) μmol/L,305.00(271.00,344.25) μmol/L,44.40(37.43,53.25) mg/L, 0.91(0.83,1.05) mg/L](U=3.515-12.077,all P values <0.001).The levels of hemoglobin,serum albumin,and estimated glomerular filtration rate were lower in high-level sUAR group [(126.86±22.31) g/L, 38.05(33.45,41.73) g/L,74.78(46.10, 114.47) mL/(min·1.73 m~2)] than those in low-level sUAR group [(138.26±19.97) g/L,41.90(38.58,45.30) g/L,126,56(103.58,149.99) mL/(min·1.73 m~2)](t=-4.968,U=-6.636,U=-9.234;all P values <0.001).There were no significant differences in the age,gender,body mass index,blood pressure,fasting plasma glucose,glycosylated hemoglobin,total cholesterol,high-density lipoprotein cholesterol,and low-density lipoprotein cholesterol between two groups(P>0.05).(2) The median follow-up duration was 21(16,26) months.The incidence of adverse prognosis events was lower in low-level sUAR group(13.5%) than that in high-level sUAR group(45.3%)(χ~2=41.310,P<0.001),and the cumulative survival rate was higher in low-level sUAR group(86.5%) than that in high-level sUAR group(54.7%)(χ~2=45.928,P<0.001).(3) sUAR(HR=1.274,95% CI:1.145-1.417,P<0.001),hypertension(HR=2.083,95%CI:1.168-3.716,P=0.013), hemoglobin(HR=0.980,95%CI:0.967-0.92,P=0.002), remnant cholesterol(HR=1.700,95% CI:1.280-2.258,P<0.001),and lnUACR(HR=1.377,95%CI:1.160-1.636,P<0.001) were the influencing factors of adverse prognosis.Conclusion The sUAR,remnant cholesterol,elevated lnUACR,decreased hemoglobin and hypertension indicate a high risk of adverse prognosis of DKD patients.更多还原