目的 调查糖尿病肾脏疾病(DKD)患者高尿酸血症(HUA)的发生率和危险因素,并构建列线图预测模型以指导临 床实践。 方法 采用目的抽样法选取 2019 年 1 月至 2022 年 6 月南京市高淳人民医院诊断 DKD 的患者 219 例为训练集,入院 后根据 HUA 的定义将其分为 HUA 组(n = 102)和非 HUA 组(n = 117)。 按照相同标准选取 2022 年 7 月至 2023 年 7 月 105 例 DKD 患者为验证集。 记录患者的一般临床特征和近 3 个月的血生化平均值,分析 DN 患者发生 HUA 的危险因素,并建立列线 图预测模型。 结果 体质指数(BMI)(OR= 1. 782)、糖化血红蛋白(HbA1c)(OR= 2. 601)和高脂血症(OR = 1. 669)是发生 HUA 的危险因素,而估计肾小球滤过率(eGFR)(OR= 0. 606)是其保护因素。 建立列线图后计算训练集与验证集的一致性指数分 别为 0. 854 和 0. 802,校正曲线与理想曲线走势基本一致,受试者操作特征(ROC)曲线计算曲线下面积(AUC)分别为 0. 867 (95%CI = 0. 802~ 0. 923)和 0. 811(95%CI = 0. 745~ 0. 872),而且临床净获益值较高,表明该模型具有良好的预测能力。 结论 DKD 患者通常有较高的 HUA 患病率,高 BMI、高 HbA1c 和高脂血症是 HUA 的危险因素,高 eGFR 是保护因素。 构建列线图 模型对指导临床早期准确筛查 HUA 高风险群体具有较好的指导价值。

Objective To investigate the incidence and risk factors of hyperuricemia HUA in patients with diabetic kidney disease DKD then construct a nomogram predictive model to guide clinical practice. Method A retrospective summary was conducted on 219 DKD patients diagnosed in our hospital from January 2019 to June 2022 as training set. After admission they were divided into HUA group n = 102 and non-HUA group n = 117 according to the definition of HUA. Additionally 105 DKD patients from July 2022 to July 2023 were selected as validation set. The general clinical characteristics of patients and average blood biochemical values during the past 3 months were recorded then univariate and Logistic regression analysis was to analyze the risk factors to HUA in DKD patients and a nomogram predictive model was established. Result It showed that BMI OR = 1. 782 HbA1c OR = 2. 601 and hyperlipidemia OR = 1. 669 were risk factors to HUA while eGFR OR = 0. 606 was a protective factor. After establishing the nomogram the consistency indices of training set and validation set were calculated to be 0. 854 and 0. 802 respectively. The correction curve and ideal curve trends were basically consistent and the AUC calculated by ROC were 0. 867 95% CI = 0. 802 - 0. 923 and 0. 811 95%CI = 0. 745-0. 872 the clinical net benefit value was relatively high which all indicated that the model had good predictive ability. Conclusion DKD patients usually have a higher prevalence of HUA with high BMI high HbA1c and hyperlipidemia being risk factors while high eGFR as a protective factor. The construction of nomogram model has good value for guiding early and accurate screen of HUA high-risk groups in clinical practice.