尿酸排泄分数的影响因素分析
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摘要
目的探索尿液pH及血、尿生化指标对尿酸排泄分数的影响。方法收集2017年5月至2018年6月在山东大学齐鲁医院(青岛)保健科住院的患者285例,根据尿pH分为高尿pH组(pH≥6)156例与低尿pH组(pH<6)129例,对两组患者临床资料进行比较,应用多元线性回归分析评估尿酸排泄分数的影响因素。结果高尿pH组(pH≥6)与低尿pH组(pH<6)尿酸排泄分数差异有显著性[0.063(0.049,0.084)vs 0.050(0.043,0.070),P<0.01],经自然对数转换后,高尿pH组较低尿pH组尿酸排泄分数增加[(-2.76±0.41)vs(-2.92±0.38),P <0.01]。多元线性回归分析显示,肌酐清除率、尿糖、尿pH是尿酸排泄分数的独立影响因素。结论提高尿pH可增加尿酸排泄分数,促进尿酸排泄,肌酐清除率下降及尿糖升高均可增加尿酸排泄分数。
Objective To investigate the effect of urine pH and other biochemical factors on fractional uric acid excretion. Method Inpatients(n=285) were collected according to the established inclusion and exclusion criteria. Two groups were divided by pH <6 and pH≥6. The difference between clinical data from two groups was analyzed using t test, Chi-square test and non-parameter test according to the data type and distribution. A multivariate linear regression was used to analysis the factors in? uencing fractional uric acid excretion.Result The fractional uric acid excretion in the higher urine pH group(pH ≥ 6) and lower urine PH group(pH<6) was statistically different [0.063(0.049,0.084) vs 0.050(0.043,0.070), P<0.01]. The result of natural logarithmic conversion showed that the fractional uric acid excretion in the higher urinary pH group is greater than that in the lower urinary pH group [(-2.76±0.41) vs(-2.92±0.38), P<0.01];the result of multivariate linear regression analysis suggested that creatinine clearance rate, urinary sugar, urine pH are independent factors of the fractional uric acid excretion. Conclusion Growing urine pH can increase fractional uric acid excretion. Low creatinine clearance rate and high urinary sugar will also increase the excretion fraction of uric acid.
Objective To investigate the effect of urine pH and other biochemical factors on fractional uric acid excretion. Method Inpatients(n=285) were collected according to the established inclusion and exclusion criteria. Two groups were divided by pH <6 and pH≥6. The difference between clinical data from two groups was analyzed using t test, Chi-square test and non-parameter test according to the data type and distribution. A multivariate linear regression was used to analysis the factors in? uencing fractional uric acid excretion.Result The fractional uric acid excretion in the higher urine pH group(pH ≥ 6) and lower urine PH group(pH<6) was statistically different [0.063(0.049,0.084) vs 0.050(0.043,0.070), P<0.01]. The result of natural logarithmic conversion showed that the fractional uric acid excretion in the higher urinary pH group is greater than that in the lower urinary pH group [(-2.76±0.41) vs(-2.92±0.38), P<0.01];the result of multivariate linear regression analysis suggested that creatinine clearance rate, urinary sugar, urine pH are independent factors of the fractional uric acid excretion. Conclusion Growing urine pH can increase fractional uric acid excretion. Low creatinine clearance rate and high urinary sugar will also increase the excretion fraction of uric acid.
引文
[1]中华医学会内分泌学分会.高尿酸血症和痛风治疗的中国专家共识[J].中华内分泌代谢杂志,2013,29(11):913-920.
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[3]Maesaka JK,Fishbane S.Regulation of renal urate excretion:a critical review[J].Am J Kidney Dis,1998,32(6):917-933.
[4]Coe FL.Uric acid and calcium oxalate nephrolithiasis[J].Kidney Int,1983,24(3):392-403.
[5]Lipkowitz MS.Regulation of uric acid excretion by the kidney[J].Curr Rheumatol Rep,2012,14(2):179-188.
[6]Marangella M.Uric acid elimination in the urine.Pathophysiological implications[J].Contrib Nephrol,2005,147:132-148.
[7]Moriwaki Y,Yamamoto T,Takahashi S,et al.Spot urine uric acid to creatinine ratio used in the estimation of uric acid excretion in primary gout[J].J Rheumatol,2001,28(6):1306-1310.
[8]Vahlensieck EW,Bach D,Hesse A.Circadian rhythm of lithogenic substances in the urine[J].Urol Res,1982,10(4):195-203.
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[10]Fenske W,Stork S,Koschker AC,et al.Value of fractional uric acid excretion in differential diagnosis of hyponatremic patients on diuretics[J].J Clin Endocrinol Metab,2008,93(8):2991-2997.
[11]Andrade JA,Kang HC,Greffin S,et al.Serum uric acid and disorders of glucose metabolism:the role of glycosuria[J].Braz JMed Biol Res,2014,47(10):917-923.
[12]Stiburkova B,Bleyer AJ.Changes in serum urate and urate excretion with age[J].Adv Chronic Kidney Dis,2012,19(6):372-376.
[13]邢亚楠,彭勤建,杨冠华,等.体检人群高尿酸血症患病情况及相关因素分析[J].中国医药导报,2012,9(32):130-131.
[14]Kanbara A,Seyama I.Effect of urine pH on uric acid excretion by manipulating food materials[J].Nucleosides Nucleotides Nucleic Acids,2011,30(12):1066-1071.
[15]Kanbara A,Hakoda M,Seyama I.Urine alkalization facilitates uric acid excretion[J].Nutr J,2010,9:45.
[16]郭赫,倪青.高尿酸血症与痛风的诊断与中医药治疗策略[J].中国临床医生杂志,2018,46(11):1268-1270.
[17]Coe FL,Strauss AL,Tembe V,et al.Uric acid saturation in calcium nephrolithiasis[J].Kidney Int,1980,17(5):662-668.
[18]Roch-Ramel F,Werner D,Guisan B.Urate transport in brushborder membrane of human kidney[J].Am J Physiol,1994,266(5Pt 2):F797-F805.
[19]Sulikowska B,Manitius J,Odrowaz-Sypniewska G,et al.Uric acid excretion and dopamine-induced glomerular filtration response in patients with IgA glomerulonephritis[J].Am J Nephrol,2008,28(3):391-396.
[20]Garcia Puig J,Mateos Anton F,Munoz Sanz A,et al.Renal handling of uric acid in normal subjects by means of the pyrazinamide and probenecid tests[J].Nephron,1983,35(3):183-186.
[21]Chino Y,Samukawa Y,Sakai S,et al.SGLT2 inhibitor lowers serum uric acid through alteration of uric acid transport activity in renal tubule by increased glycosuria[J].Biopharm Drug Dispos,2014,35(7):391-404.
[2]Fathallah-Shaykh SA,Cramer MT.Uric acid and the kidney[J].Pediatr Nephrol,2014,29(6):999-1008.
[3]Maesaka JK,Fishbane S.Regulation of renal urate excretion:a critical review[J].Am J Kidney Dis,1998,32(6):917-933.
[4]Coe FL.Uric acid and calcium oxalate nephrolithiasis[J].Kidney Int,1983,24(3):392-403.
[5]Lipkowitz MS.Regulation of uric acid excretion by the kidney[J].Curr Rheumatol Rep,2012,14(2):179-188.
[6]Marangella M.Uric acid elimination in the urine.Pathophysiological implications[J].Contrib Nephrol,2005,147:132-148.
[7]Moriwaki Y,Yamamoto T,Takahashi S,et al.Spot urine uric acid to creatinine ratio used in the estimation of uric acid excretion in primary gout[J].J Rheumatol,2001,28(6):1306-1310.
[8]Vahlensieck EW,Bach D,Hesse A.Circadian rhythm of lithogenic substances in the urine[J].Urol Res,1982,10(4):195-203.
[9]Matzkies F,Berg G,Madl H.The uricosuric action of protein in man[J].Adv Exp Med Biol,1980,122A:227-231.
[10]Fenske W,Stork S,Koschker AC,et al.Value of fractional uric acid excretion in differential diagnosis of hyponatremic patients on diuretics[J].J Clin Endocrinol Metab,2008,93(8):2991-2997.
[11]Andrade JA,Kang HC,Greffin S,et al.Serum uric acid and disorders of glucose metabolism:the role of glycosuria[J].Braz JMed Biol Res,2014,47(10):917-923.
[12]Stiburkova B,Bleyer AJ.Changes in serum urate and urate excretion with age[J].Adv Chronic Kidney Dis,2012,19(6):372-376.
[13]邢亚楠,彭勤建,杨冠华,等.体检人群高尿酸血症患病情况及相关因素分析[J].中国医药导报,2012,9(32):130-131.
[14]Kanbara A,Seyama I.Effect of urine pH on uric acid excretion by manipulating food materials[J].Nucleosides Nucleotides Nucleic Acids,2011,30(12):1066-1071.
[15]Kanbara A,Hakoda M,Seyama I.Urine alkalization facilitates uric acid excretion[J].Nutr J,2010,9:45.
[16]郭赫,倪青.高尿酸血症与痛风的诊断与中医药治疗策略[J].中国临床医生杂志,2018,46(11):1268-1270.
[17]Coe FL,Strauss AL,Tembe V,et al.Uric acid saturation in calcium nephrolithiasis[J].Kidney Int,1980,17(5):662-668.
[18]Roch-Ramel F,Werner D,Guisan B.Urate transport in brushborder membrane of human kidney[J].Am J Physiol,1994,266(5Pt 2):F797-F805.
[19]Sulikowska B,Manitius J,Odrowaz-Sypniewska G,et al.Uric acid excretion and dopamine-induced glomerular filtration response in patients with IgA glomerulonephritis[J].Am J Nephrol,2008,28(3):391-396.
[20]Garcia Puig J,Mateos Anton F,Munoz Sanz A,et al.Renal handling of uric acid in normal subjects by means of the pyrazinamide and probenecid tests[J].Nephron,1983,35(3):183-186.
[21]Chino Y,Samukawa Y,Sakai S,et al.SGLT2 inhibitor lowers serum uric acid through alteration of uric acid transport activity in renal tubule by increased glycosuria[J].Biopharm Drug Dispos,2014,35(7):391-404.