An evaluation of longitudinal changes in serum uric acid levels and associated risk of cardio-metabolic events and renal function decline in gout.
An evaluation of longitudinal changes in serum uric acid levels and associated risk of cardio-metabolic events and renal function decline in gout.
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DOI：
10.1371/journal.pone.0193622
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Kim SC
中科院分区：
文献类型：
--
作者：
Desai RJ;Franklin JM;Spoendlin-Allen J;Solomon DH;Danaei G;Kim SC
痛风患者有很高的合并症负担，包括糖尿病（DM）、慢性肾脏疾病（CKD）和心血管疾病（CVD）。我们试图评估血清尿酸（SUA）水平随时间变化与痛风患者发生糖尿病、心血管疾病和肾功能下降的风险之间的关系。一项观察性队列研究在2004年至2015年期间对美国私人医疗保险计划的参保者进行了研究。痛风患者纳入的指标日期为SUA测量≥6.8 mg/dl。感兴趣的暴露是从基线开始的SUA水平的累积变化。使用边际结构模型，计算基线混杂因素（年龄、性别、合并症、联合用药）和时变混杂因素（血清肌酐、血尿素氮、糖化血红蛋白）的稳定逆概率权重，得出糖尿病、心血管疾病和肾功能下降（肾小球滤过率降低≥30%）的风险比（HR）和95%可信区间（CI）。在26341例痛风患者中，平均年龄为62岁，75%为男性，中位基线SUA为8.6 mg/dl（四分位数范围为7.7 - 9.5）。糖尿病的发病率为1.63(1.51-1.75)/100人年（95% CI），心血管疾病为0.77(0.70-0.84)，肾功能下降为4.32（4.14-4.49）。在该人群中，每降低3 mg/dl的SUA，平均对应于达到<6 mg/dl的目标水平，调整后的HR （95% CI）为DM的1.04 (0.92-1.17)，CVD的1.07(0.89-1.29)，肾功能下降的0.85（0.78-0.92）。痛风患者SUA的降低可能与肾功能下降的风险降低有关，但与DM或CVD无关。
Gout patients have a high burden of co-morbid conditions including diabetes mellitus (DM), chronic kidney disease (CKD), and cardiovascular disease (CVD). We sought to evaluate the association between changes in serum uric acid (SUA) levels over time and the risk of incident DM, CVD, and renal function decline in gout patients. An observational cohort study was conducted among enrollees of private health insurance programs in the US between 2004 and 2015. Gout patients were included on the index date of a SUA measurement ≥6.8 mg/dl. The exposure of interest was cumulative change in SUA levels from baseline. Hazard ratios (HR) and 95% confidence intervals (CI) for incident DM, incident CVD, and renal function decline (≥30% reduction in glomerular filtration rate) were derived using marginal structural models with stabilized inverse probability weights accounting for baseline confounders (age, gender, co-morbidities, co-medications) and time-varying confounders (serum creatinine, blood urea nitrogen, glycated hemoglobin). Among 26,341 patients with gout, the average age was 62, 75% were men, and the median baseline SUA was 8.6 mg/dl (interquartile range 7.7 to 9.5). The incidence rates/100 person-years (95% CI) were 1.63 (1.51–1.75) for DM, 0.77 (0.70–0.84) for CVD, and 4.32 (4.14–4.49) for renal function decline. The adjusted HR (95% CI) per 3 mg/dl reduction in SUA, corresponding on average to achieving the target level of <6 mg/dl in this population, was 1.04 (0.92–1.17) for DM, 1.07 (0.89–1.29) for CVD, and 0.85 (0.78–0.92) for renal function decline. Reduction in SUA in patients with gout may be associated with a reduced risk of renal function decline, but not with DM or CVD.
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DOI：
10.1002/art.22466
发表时间：
2007-02-15
期刊：
ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH
影响因子：
--
作者：
Choi, Hyon K.;Ford, Earl S.;Curhan, Gary
通讯作者：
Curhan, Gary
影响因子：
13.6
作者：
Kleber, Marcus E.;La Delgado, Gracie;Maerz, Winfried
通讯作者：
Maerz, Winfried
影响因子：
5
作者：
Cole, Stephen R.;Hernan, Miguel A.
通讯作者：
Hernan, Miguel A.
影响因子：
--
作者：
Kim, Seo Young;Guevara, James P.;Kim, Kyoung Mi;Choi, Hyon K.;Heitjan, Daniel F.;Albert, Daniel A.
通讯作者：
Albert, Daniel A.
影响因子：
27.4
作者：
Annemans L;Spaepen E;Gaskin M;Bonnemaire M;Malier V;Gilbert T;Nuki G
通讯作者：
Nuki G