摘要
目的 探讨随机尿尿酸/肌酐(UA/Cr)在克拉玛依地区高尿酸血症(HUA)患者分型诊断中的应用价值.方法 选取2022年4月—2023年5月克拉玛依市中西医结合医院(市人民医院)HUA患者126例(HUA)组、健康体检者124名(对照组).检测所有研究对象总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FBG)、血清尿素(SU)、血清尿酸(SUA)、血清肌酐(SCr)、尿尿酸(UUA)、尿肌酐(UCr)水平.采用Spearman分析评价HUA组随机尿UA/Cr与24 h尿尿酸排泄量(UUE)和肾脏尿酸排泄分数(FEUA)的相关性.采用受试者工作特征(ROC)曲线评价随机尿UA/Cr判断HUA患者分型的效能.结果 HUA组和对照组性别、年龄、TC、HDL-C、SU、肾小球滤过率(eGFR)差异均无统计学意义(P>0.05).HUA组体重指数、TG、FBG、SUA、SCr均显著高于对照组(P<0.05),HUA组尿pH值显著低于对照组(P<0.05).肾脏排泄不良型与肾脏负荷过多型UUA、UUE、FEUA、随机尿UA/Cr比较差异均有统计学意义(P<0.05).肾脏排泄不良型UUA、UUE、随机尿UA/Cr均低于混合型(P<0.05).HUA组随机尿UA/Cr与UUE、FEUA均呈正相关(r值分别为0.778 4、0.708 6,P<0.05).随机尿UA/Cr判断FEUA 5.5%的临界值为0.297,敏感性为92.5%,特异性为64.4%,曲线下面积(AUC)为0.804.随机尿UA/Cr判断HUA UUE≤600 mg·d-1·(1.73 m2)-1的临界值为0.302,敏感性为87.6%,特异性为100.0%,AUC为0.979.肾脏排泄不良型随机尿UA/Cr分型临界值为<0.297;肾脏负荷过多型随机尿UA/Cr分型临界值为>0.302;其他型随机尿UA/Cr分型临界值为≥0.297且≤0.302;混合型无法依据统计学结果筛选.结论 随机尿UA/Cr对克拉玛依地区HUA分型有一定参考价值.
Abstract
Objective To evaluate the value of random urine uric acid/creatinine(UA/Cr)in the classification of hyperuricemia(HUA)patients in Karamay.Methods Totally,126 patients with HUA and 124 healthy subjects in Karamay Hospital of Integrated Traditional Chinese and Western Medicine(People's Hospital)from April 2022 to May 2023 were enrolled.The total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),fasting blood glucose(FBG),serum urea(SU),serum uric acid(SUA),serum creatinine(SCr),urinary uric acid(UUA)and urinary creatinine(UCr)were determined.The correlation between random urine UA/Cr and 24 h urine uric acid excretion(UUE)and fractional excretion of uric acid(FEUA)in HUA group was analyzed by Spearman analysis.Receiver operating characteristic(ROC)curve was used to evaluate the efficiency of random urine UA/Cr in HUA group.Results There was no statistical significance in gender,age,TC,HDL-C,SU and estimated glomerular filtration rate(eGFR)between HUA group and control group(P>0.05).Body mass index,TG,FBG,SUA and SCr in HUA group were higher than those in control group(P<0.05),while urinary pH value in HUA group was lower than that in control group(P<0.05).There was statistical significance for UUA,UUE,FEUA and random urine UA/Cr between renal excretion poor type and renal overload type(P<0.05).The UUA,UUE and random urine UA/Cr of renal excretion poor type were lower than those of mixed type(P<0.05).In HUA group,random urine UA/Cr was positively correlated with UUE and FEUA(r were 0.778 4 and 0.708 6,P<0.05),respectively.The ROC curve for random urine UA/Cr predictive typing in HUA group was drawn with FEUA 5.5%as the cut-offpoint.The cut-offvalue of random urine UA/Cr predictive typing was 0.297,the sensitivity was 92.5%,the specificity was 64.4%,and the area under curve(AUC)was 0.804.With UUE≤600 mg·d-1·(1.73 m2)-1 as the cut-offpoint,the ROC curve for random urine UA/Cr predictive typing was drawn in HUA group.The cut-offvalue of random urine UA/Cr predictive typing was 0.302,the sensitivity was 87.6%,the specificity was 100.0%,and the AUC was 0.979.For renal excretion poor type,random urine UA/Cr typing cut-offvalue was<0.297;for renal overload type,the cut-offvalue of random urine UA/Cr typing was>0.302;for other types,the cut-offvalue of random urine UA/Cr typing was≥0.297 and≤0.302;mixed type could not be screened according to statistical results.Conclusions Random urine UA/Cr can provide reference for the classification of HUA in Karamay.
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