不同尿酸濃度對慢性血液透析病人之長期預後影響

Effect of Different Serum Uric Acid on Long-Term Prognosis of Chronic Hemodialysis Patients

本研究目的在探討尿酸濃度對慢性血液透析病人的長期預後之影響。觀察 423 位 血液透析病人，時間最長為 54 個月，依尿酸數值高低分成四等份（＜6.82、6.82≦ 尿酸<7.71、7.71≦尿酸＜8.62 和≧8.62 mg/dL）。結果：第一組之血清前白蛋白、 尿素氮、肌酸酐、常態蛋白質分解率及血鉀皆較其他三組顯著性偏低（p＜0.001）， 累積存活率亦較其他三組顯著性差（p＜0.05）。在第一組的多變項迴歸分析中發 現糖尿病合併症（OR：2.12）、低濃度之尿素氮（OR：0.928）、肌酸酐（OR： 0.808）與三酸甘油酯（OR：0.996）皆呈有意義相關。結論：正常尿酸值的血液透 析病人相對會有較低濃度的白蛋白、尿素氮、肌酸酐、常態蛋白質分解率而死亡風險 卻比高尿酸血症患者來得高。因此，此篇研究認為高尿酸血症透析病人有較好的臨床 表徵與長期預後。

This study was conducted to evaluate the clinical features and long-term prognosis of the hemodialsyis patients with different levels of serum uric acid. The maximal observation period was 54 months. A total of 423 hemodialysis patients were divided into 4 quartiles according to the predialysis serum uric acid concentration (＜6.82, 6.82≦uric acid＜ 7.70, 7.71≦uric acid＜8.61, ≧8.62 mg/dL). Results: Group＜patients also had the lowest levels of prealbumin, BUN, Cr, nPCR and potassium (p＜0.001). The patients of group＜ had the lower cumulative survival rate than the groups II, III, and IV patients (p＜0.05). Multiple logistic regression analyses showed that the patients of group＜were correlated with diabetes (OR: 2.12), BUN (OR: 0.928), creatinine (OR: 0.808) and triglyceride (OR: 0.996). Conclusion: Hemodialysis patients with normal serum uric acid had lower levels of albumin, BUN, creatinine and nPCR. They were associated with high mortality rate than those with higher serum uric acid levels. Hyperuricemia HD patients seem to have best clinical features and long term survival.