Division of Nephrology, Department of Medicine, Fatih University School of Medicine, Ankara, Turkey.
Am J Nephrol. 2011;33(4):325-31. doi: 10.1159/000324916. Epub 2011 Mar 10.
Cardiovascular disease is prevalent in chronic kidney disease (CKD). Uric acid is increased in subjects with CKD and has been linked with cardiovascular mortality in this population. However, no study has evaluated the relationship of uric acid with angiographically proven coronary artery disease (CAD) in this population. We therefore investigated the link between serum uric acid (SUA) levels and (i) extent of CAD assessed by the Gensini score and (ii) inflammatory parameters, including C-reactive protein (CRP) and pentraxin-3, in patients with mild-to-moderate CKD.
In an unselected population of 130 patients with estimated glomerular filtration rate (eGFR) between 90 and 30 ml/min/1.73 m(2), we measured SUA, serum pentraxin-3, CRP, urinary protein-to-creatinine ratio, lipid parameters and the severity of CAD as assessed by coronary angiography and quantified by the Gensini lesion severity score.
The mean serum values for SUA, pentraxin-3 and CRP in the entire study population were 5.5 ± 1.5 mg/dl, 6.4 ± 3.4 ng/ml and 3.5 ± 2.6 mg/dl, respectively. The Gensini scores significantly correlated in univariate analysis with gender (R = -0.379, p = 0.02), uric acid (R = 0.42, p = 0.001), pentraxin-3 (R = 0.54, p = 0.001), CRP (R = 0.29, p = 0.006) levels, eGFR (R = -0.33, p = 0.02), proteinuria (R = 0.21, p = 0.01), and presence of hypertension (R = 0.37, p = 0.001), but not with smoking status, diabetes mellitus, and lipid parameters. After adjustments for traditional cardiovascular risk factors, only uric acid (R = 0.21, p = 0.02) and pentraxin-3 (R = 0.28, p = 0.01) remained significant predictors of the Gensini score.
SUA and pentraxin-3 levels are independent determinants of severity of CAD in patients with mild-to-moderate CKD. We recommend a clinical trial to determine whether lowering uric acid could prevent progression of CAD in patients with CKD.
心血管疾病在慢性肾脏病（CKD）患者中较为常见。CKD 患者的尿酸水平升高，且与该人群的心血管死亡率相关。然而，尚无研究评估该人群中尿酸与经血管造影证实的冠状动脉疾病（CAD）之间的关系。因此，我们研究了血清尿酸（SUA）水平与（i）通过 Gensini 评分评估的 CAD 程度和（ii）炎症参数（包括 C 反应蛋白[CRP]和五聚素-3）之间的关系，纳入了肾小球滤过率（eGFR）为 90-30ml/min/1.73m²的轻至中度 CKD 患者。
在 130 例估计肾小球滤过率（eGFR）在 90-30ml/min/1.73m²之间的未选择患者人群中，我们测量了 SUA、血清五聚素-3、CRP、尿蛋白与肌酐比值、血脂参数以及通过冠状动脉造影评估和定量的 Gensini 病变严重程度评分的 CAD 严重程度。
在整个研究人群中，SUA、五聚素-3 和 CRP 的平均血清值分别为 5.5±1.5mg/dl、6.4±3.4ng/ml 和 3.5±2.6mg/dl。单变量分析显示，Gensini 评分与性别（R=-0.379，p=0.02）、尿酸（R=0.42，p=0.001）、五聚素-3（R=0.54，p=0.001）、CRP（R=0.29，p=0.006）水平、eGFR（R=-0.33，p=0.02）、蛋白尿（R=0.21，p=0.01）和高血压（R=0.37，p=0.001）相关，但与吸烟状态、糖尿病和血脂参数无关。在调整了传统心血管危险因素后，仅尿酸（R=0.21，p=0.02）和五聚素-3（R=0.28，p=0.01）仍是 Gensini 评分的显著预测因子。
SUA 和五聚素-3 水平是轻至中度 CKD 患者 CAD 严重程度的独立决定因素。我们建议进行临床试验以确定降低尿酸是否可预防 CKD 患者 CAD 的进展。
