台灣成年工作者高尿酸血症在修飾後代謝症候群之角色及作為腎絲球過濾率下降之預測因子

Role of Hyperuricemia in Modified Metabolic Syndrome as a Predictor of Declined Estimated Glomerular Filtration Rate in Taiwanese Workers

阮北辰(Pei-Chen Juan) ； 林亞萱(Ya-Hsuan Lin) ； 陳昭源(Jau-Yuan Chen) ； 蔡依紋(Yi-Wen Tsai)

《中華職業醫學雜誌》 29卷4期 (2022/10) Pp. 253-263

摘要

目的：代謝症候群是全球重要的公共衛生議題，過去許多研究顯示與慢性腎疾病具有相關性，而高尿酸血症則是常見卻易被忽視的健康問題，由於其造成氧化壓力及血管內皮功能障礙的特性，被發現與多種心血管疾病相關，也是引起慢性腎臟病的重要危險因子。本研究的目的為探討以高尿酸血症修飾後的代謝症候群，是否能更適當地做為早期腎絲球過濾率下降的預測因子。方法：本研究為回顧性、橫斷性，以2013至2014年間參與台灣北部某醫院及其南部院區體檢中心的公司年度健檢成年人共22603位為收錄對象。將尿酸值用四分位法及性別分組，尿酸值大於該性別的第三分位數者定義為尿酸過高，將腎絲球過濾率下降定為小於60mL／min／1.73m^2，另以尿酸過高取代代謝症候群定義裡高密度脂蛋白過低的子項，成為修飾後代謝症候群的診斷標準，與原始代謝症候群相同，符合三項危險因子即達診斷。以多變項羅吉斯迴歸分析診斷原始及修飾後代謝症候群對於腎絲球過濾率下降之勝算比（Odds ratio，OR）。而後分別依兩種標準用危險因子數量各分成三組（具危險因子0到2項為組別1、3項為組別2、4到5項為組別3），使用Kruskal-Wallis做事後檢定，分析原始和修飾後代謝症候群相關風險因子數量與腎絲球過濾率之間的關係。結果：結果發現代謝症候群及高尿酸血症在腎絲球過濾率下降的組別有較高盛行率。校正年紀及性別後，多變項羅吉斯迴歸分析顯示原始及修正後代謝症候群，皆與腎絲球過濾率下降呈顯著正相關，且修正後代謝症候群對於腎絲球過濾率下降有較高勝算比（OR：2.946，95％ CI：2.273-3.818，p＜0.001 vs OR＝2.557，95％ CI：1.940-3.370，p＜0.001）。事後檢定顯示，符合修飾後代謝症候群危險因子越多，其腎絲球過濾率越低，且各組間皆有顯著差異（組別1 vs 2，p＜0.001；組別1 vs 3，p＜0.001；組別2 vs 3，p＝0.005），而原始代謝症候群則否（組別1 vs 2，p＜0.001；組別1 vs 3，p＜0.001；組別2 vs 3，p＝0.459）。結論：本研究顯示用高尿酸血症修飾後的代謝症候群，對健檢勞工的腎絲球過濾率下降更具顯著相關。未來可將目標放在修正後代謝症候群的應用，以及降尿酸藥物治療在預防慢性腎臟病是否有幫助。

關鍵字

代謝症候群 ； 高尿酸血症 ； 腎絲球過濾率下降 ； 慢性腎臟病

並列摘要

Background and Purpose: Metabolic syndrome (MetS) is found to be strongly correlated with chronic kidney disease (CKD). Hyperuricemia is related to several cardiovascular conditions because of its oxidative stress and endothelial dysfunction, which also play an important role in pathogenesis of renal dysfunction. The purpose of this study is to investigate the contribution of hyperuricemia in various ranges of estimated glomerular filtration rate (eGFR), and to see if modified metabolic syndrome (modified MetS) which is substituted one of the criterion for hyperuricemia can predict impaired renal function more properly. Methods:In this retrospective cross-sectional study, 22,603 workers were recruited during 2013-2014 in Taiwan. Upper quartile of serum urate level, based on gender, was defined as hyperuricemia. MetS was defined by National cholesterol education program adult treatment panel III Asian version. Declined eGFR was defined as an eGFR＜60mL/min/1.73m2. We substituted the component of low high-density lipoprotein in MetS with hyperuricemia as modified MetS criteria. Multivariate logistic regression model was established to evaluate the relationship between modified MetS, as compared with original MetS, and declined eGFR. Numbers of MetS and modified MetS associated risk factors were further categorized into 3 groups: group 1=presence of 0-2 factors, group 2=presence of 3 factors, group 3=presence of 4-5 factors. We conducted Kruskal-Wallis with post-Hoc test to analyze the relationship between original and modified MetS associated risk factors and eGFR levels. Results: MetS prevalence was 9.2% and 29.7% in normal renal function and declined eGFR groups. Percentage of hyperuricemia was 25.3% and 59.1% in normal renal function and declined eGFR groups. After adjusting for age and gender, the odds ratio for declined eGFR was higher of modified MetS diagnostic criteria as compared with original MetS (OR=2.946, 95% CI: 2.273-3.818, p＜0.001 vs OR=2.557, 95% CI: 1.940-3.370, p＜0.001 respectively). In addition, the median eGFR levels were significantly different in post hoc analysis between each groups of the modified MetS stratification (p＜0.001, p for trend is for Kruskal-Wallis test, p＜0.001 for group 1 vs 2, and group 1 vs 3; p=0.005 for group 2 vs 3), while the difference of eGFR was statistically significant only between group 1 and the rest of the groups of the original MetS associated risk factors (p＜0.001 for group 1 vs 2, and group 1 vs 3; p=0.459 for group 2 vs 3). Conclusions: Our results provided the considerable influence of serum uric acid and its role in MetS associated risk factors in association with decline of eGFR levels and risk of CKD. Further studies should aim to verify the application of modified MetS and the consequences of uricosuric treatment in role of CKD prevention strategy.

並列關鍵字

Metabolic syndrome ； hyperuricemia ； declined glomerular filtration rate ； chronic kidney disease