高尿酸血癥的治療課件

強(qiáng)效降酸,安全出擊強(qiáng)效降酸,安全出擊1主要內(nèi)容①高尿酸血癥概況高尿酸血癥與腎損害④高尿酸血癥的診治主要內(nèi)容2CKD的危險(xiǎn)因素eGFR<60mL/minAlbuminuriaper1.73mORAgechangeby10years174(159-191)108(102-115Sex(womenvsmen)166(117-237)142(117-171164(094-285)131(098-175)Historyofcardiovasculardisease2.51(1.24-5.10)1.40(0.14)Hypertension108(080-146)271(231-318)Diabetes200(135297)199(160248)93068017)08806811Urbanresidents(vsruralresidents)1.12(0.86-1-48)0.97(0-81-1-.16)全國(guó)流行病學(xué)調(diào)查發(fā)現(xiàn)高尿酸血癥是CKD的重要危險(xiǎn)因素(OR值930)ZhangL,WangEWangL,etal.TheLancet,2019,379(9818815-822CKD的危險(xiǎn)因素3HUA患病率區(qū)域變化示意圖70可意病亭高第543210987654321息病率低·沿海地區(qū)HA患病率高于內(nèi)陸地區(qū)南方地區(qū)HA患病率高于北方地區(qū)HUA患病率區(qū)域變化示意圖4上海社區(qū)人群CKD的危險(xiǎn)因素首次上海市橫斷面,多階段整群隨機(jī)抽樣調(diào)查(2596例)2019年上海城市社區(qū)人群cKD患病率11.8%回歸系數(shù)估計(jì)值OR高尿酸血癥11263.084<0.001腎結(jié)石l0722.9220.018貧血l.0102.74<0.001文盲0.7412.097<0.001糖尿病0.67819700.001絕經(jīng)婦女0.57717800.011腰圍異常0.4891.6310.045高血壓0.3811.4630.037年齡0.0601062<0.001NDT(2009)24:2117-2123上海社區(qū)人群CKD的危險(xiǎn)因素5高尿酸血癥(HUA)的潛在風(fēng)險(xiǎn)痛風(fēng)、腎功能損害只是HUA危害的冰山一角腦卒中糖尿病。心肌梗塞肌病血壓冠心病高尿酸血癥(HUA)的潛在風(fēng)險(xiǎn)6主要內(nèi)容高尿酸血癥概況②2高尿酸血癥與腎損害④高尿酸血癥的診治主要內(nèi)容7高尿酸血癥與腎損害不同尿酸水平人群慢性腎病的發(fā)生率慢性腎病%420811965.54st(=5.3mg'dl)2nd(5.4-6.4mgldl)3rd(.5-7.6mg/dIE7.7mg/dijNephrology(Carlton).2019V15N2:253-8高尿酸血癥與腎損害8高尿酸血癥與腎損害Table1EpidemiologyofuricacidandchronickidneydiseaseFirstauthorYearParticipantsMajorfindings09177570,USRDSHigheruricacidquartileconferred2.14foldincreasedriskofESRDObermayr201921457ViennaHealthUricacid>7me/dlincreasedriskofCKD1.74.foldinmenand3.12-foldinwomen(+Each1mg/dincreaseinuricacidincreasedriskofCKD7-11956403,OkinawaUricacid>8ma/dlincreasedCKDriskthree-foldinmenGereralHealthand10-foldinwomen(+)2009385Elevateduricacidassociatedwith2.63-foldincreasedriskofCKDinhypertensivewomen(20092596,RuijinHospital,ChinaLinearcomelationbetweenuricacidanddegreeofCKD(+Chen20095722,TaipeiUniversityHospitalUricacidassociatedwithprevalentCKDinelderly(+Park2009134,YonseiUniversityUricacid>7mg/dlcorrelateswithmorerapiddeclineinresidtrenalfunctioninperitonealdialysispatients(+2019227,MIKDstudyUncacidpredictedChonchol20195808CardiovascularUricacidstronglyassociatedwithprevalentbutweaklywithincidentCKD(-)See200928745,ChangGungUricacid>7.7mg/dIinmenand>6.6mg/dlinwomenonlyrealyassociatedwithprevalentrenalimpairment(-)Madere9840.InstitutoNacionaldeCKD3-4anduricacidcorrelatewithdeathbutnotCariologia,MexicowithESRD(-)高尿酸血癥與腎損害9RiskFactorsforEnd-StageRenalDisease25-YearFollow-LChi-yuanHsu,MD,MSc:CarlosIribarren,MD,PhD:CharlesE.McCulloch,PhDJeanneDarwinian,MPIanSGo.MDHsu2009177570.USRDSHgheruricacidquartileconfered214foldincreasedriskofESRDover25Quartile4(vsquartile1)4600149mgdlQuartile3(vsquartile1)/Uricacid35.10-5.99mg/dLartie2(vsquartile1)2418509mgd10104:17mgdLTT10000AdjustedHazardRato(95%ConfidenceInterval)forEnd-StageRenalDiseaseFigureAdjustedrelativerisksamongindependentriskfactorsforESRDRiskFactorsforEnd-StageRen10高尿酸血癥的治療課件11高尿酸血癥的治療課件12高尿酸血癥的治療課件13高尿酸血癥的治療課件14高尿酸血癥的治療課件15高尿酸血癥的治療課件16高尿酸血癥的治療課件17高尿酸血癥的治療課件18高尿酸血癥的治療課件19高尿酸血癥的治療課件20高尿酸血癥的治療課件21高尿酸血癥的治療課件22高尿酸血癥的治療課件23高尿酸血癥的治療課件24高尿酸血癥的治療課件25高尿酸血癥的治療課件26高尿酸血癥的治療課件27高尿酸血癥的治療課件28高尿酸血癥的治療課件29高尿酸血癥的治療課件30高尿酸血癥的治療課件31高尿酸血癥的治療課件32