代谢健康型肥胖与高滤过和估算肾小球滤过率轻度降低的风险均升高相关：横断面研究中血清尿酸的作用。
Metabolically healthy obesity is associated with higher risk of both hyperfiltration and mildly reduced estimated glomerular filtration rate: the role of serum uric acid in a cross-sectional study.
机构信息
Department of Endocrine and Metabolic Diseases, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, 185 Juqianjie Road, Changzhou, 213000, Jiangsu, China.
Department of Nephrology, Nanjing Drum Tower Hospital Group Suqian Hospital, Suqian, 223800, Jiangsu, China.
出版信息
J Transl Med. 2023 Mar 23;21(1):216. doi: 10.1186/s12967-023-04003-y.
BACKGROUND
The impact of metabolically healthy obesity (MHO) on kidney dysfunction remains debatable. Moreover, few studies have focused on the early stages of kidney dysfunction indicated by hyperfiltration and mildly reduced eGFR. Thus, we aimed to investigate the association between the MHO and early kidney dysfunction, which is represented by hyperfiltration and mildly reduced estimated glomerular filtration rate (eGFR), and to further explore whether serum uric acid affects this association.
METHODS
This cross-sectional study enrolled 1188 residents aged ≥ 40 years old from Yonghong Communities. Metabolically healthy phenotypes were categorized based on Adult Treatment Panel III criteria. Obesity was defined as body mass index (BMI) ≥ 25 kg/m. Mildly reduced eGFR was defined as being in the range 60 < eGFR ≤ 90 ml/min/1.73m. Hyperfiltration was defined as eGFR > 95th percentile after adjusting for sex, age, weight, and height.
RESULTS
Overall, MHO accounted for 12.8% of total participants and 24.6% of obese participants. Compared to metabolically healthy non-obesity (MHNO), MHO was significantly associated with an increased risk of mildly reduced eGFR (odds ratio [OR] = 1.85, 95% confidence interval [CI] 1.13-3.01) and hyperfiltration (OR = 2.28, 95% CI 1.03-5.09). However, upon further adjusting for uric acid, the association between the MHO phenotype and mildly reduced eGFR was reduced to null. Compared with MHNO/non-hyperuricemia, MHO/non-hyperuricemia was associated with an increased risk of mildly reduced eGFR (OR = 2.04, 95% CI 1.17-3.58), whereas MHO/hyperuricemia was associated with an observably increased risk (OR = 3.07, 95% CI 1.34-7.01).
CONCLUSIONS
MHO was associated with an increased risk of early kidney dysfunction, and the serum uric acid partially mediated this association. Further prospective studies are warranted to clarify the causality.
背景
代谢健康肥胖（MHO）对肾功能障碍的影响仍存在争议。此外，很少有研究关注由超滤和轻度降低的估算肾小球滤过率（eGFR）所代表的肾功能障碍的早期阶段。因此，我们旨在探讨 MHO 与早期肾功能障碍的关系，这种关系表现为超滤和轻度降低的估计肾小球滤过率（eGFR），并进一步探讨血清尿酸是否会影响这种关系。
方法
这项横断面研究纳入了来自永宏社区的 1188 名年龄≥40 岁的居民。代谢健康表型根据成人治疗小组 III 标准进行分类。肥胖定义为体重指数（BMI）≥25kg/m。轻度降低的 eGFR 定义为 eGFR 在 60<eGFR≤90ml/min/1.73m 范围内。超滤定义为在调整性别、年龄、体重和身高后，eGFR>95 百分位。
结果
总体而言，MHO 占总参与者的 12.8%，占肥胖参与者的 24.6%。与代谢健康非肥胖（MHNO）相比，MHO 与轻度降低的 eGFR 风险增加显著相关（比值比[OR] = 1.85，95%置信区间[CI] 1.13-3.01）和超滤（OR = 2.28，95% CI 1.03-5.09）。然而，在进一步调整尿酸后，MHO 表型与轻度降低的 eGFR 之间的关联降低到无统计学意义。与 MHNO/非高尿酸血症相比，MHO/非高尿酸血症与轻度降低的 eGFR 风险增加相关（OR = 2.04，95% CI 1.17-3.58），而 MHO/高尿酸血症与明显增加的风险相关（OR = 3.07，95% CI 1.34-7.01）。
结论
MHO 与早期肾功能障碍的风险增加相关，血清尿酸部分介导了这种关联。需要进一步的前瞻性研究来阐明因果关系。
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