高尿酸血症的治疗课件

强效降酸,安全出击强效降酸,安全出击1主要内容①高尿酸血症概况高尿酸血症与肾损害④高尿酸血症的诊治主要内容2CKD的危险因素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)全国流行病学调查发现高尿酸血症是CKD的重要危险因素(OR值930)ZhangL,WangEWangL,etal.TheLancet,2019,379(9818815-822CKD的危险因素3HUA患病率区域变化示意图70可意病亭高第543210987654321息病率低·沿海地区HA患病率高于内陆地区南方地区HA患病率高于北方地区HUA患病率区域变化示意图4上海社区人群CKD的危险因素首次上海市横断面,多阶段整群随机抽样调查(2596例)2019年上海城市社区人群cKD患病率11.8%回归系数估计值OR高尿酸血症11263.084<0.001肾结石l0722.9220.018贫血l.0102.74<0.001文盲0.7412.097<0.001糖尿病0.67819700.001绝经妇女0.57717800.011腰围异常0.4891.6310.045高血压0.3811.4630.037年龄0.0601062<0.001NDT(2009)24:2117-2123上海社区人群CKD的危险因素5高尿酸血症(HUA)的潜在风险痛风、肾功能损害只是HUA危害的冰山一角脑卒中糖尿病。心肌梗塞肌病血压冠心病高尿酸血症(HUA)的潜在风险6主要内容高尿酸血症概况②2高尿酸血症与肾损害④高尿酸血症的诊治主要内容7高尿酸血症与肾损害不同尿酸水平人群慢性肾病的发生率慢性肾病%420811965.54st(=5.3mg'dl)2nd(5.4-6.4mgldl)3rd(.5-7.6mg/dIE7.7mg/dijNephrology(Carlton).2019V15N2:253-8高尿酸血症与肾损害8高尿酸血症与肾损害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(-)高尿酸血症与肾损害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高尿酸血症的治疗课件11高尿酸血症的治疗课件12高尿酸血症的治疗课件13高尿酸血症的治疗课件14高尿酸血症的治疗课件15高尿酸血症的治疗课件16高尿酸血症的治疗课件17高尿酸血症的治疗课件18高尿酸血症的治疗课件19高尿酸血症的治疗课件20高尿酸血症的治疗课件21高尿酸血症的治疗课件22高尿酸血症的治疗课件23高尿酸血症的治疗课件24高尿酸血症的治疗课件25高尿酸血症的治疗课件26高尿酸血症的治疗课件27高尿酸血症的治疗课件28高尿酸血症的治疗课件29高尿酸血症的治疗课件30高尿酸血症的治疗课件31高尿酸血症的治疗课件32