摘要
背景近年来儿童高尿酸血症(HUA)患病率升高,但临床重视程度不够,国内尚未建立公认的儿童血尿酸水平参考值,缺乏儿童HUA的诊断标准。目的探讨医院就诊患儿中血尿酸水平的分布特征、HUA的检出率。设计横断面调查。方法纳入2022年7月至2023年7月在郑州大学附属儿童医院行血尿酸检测的门诊及住院患儿,尿酸检测时年龄>28日龄且病历系统中有明确的疾病诊断。HUA诊断标准:男性和女性外周血尿酸水平分别为≥420μmol·L^(-1)和≥360μmol·L^(-1);血尿酸≥540μmol·L^(-1)为重度HUA。主要结局指标血尿酸水平及HUA检出率。结果38317例有血尿酸检测结果的患儿进入分析,男22534例、女15783例。①总体血尿酸中位数为259.3(211.1,316.1)μmol·L^(-1),男孩和女孩差异有统计学意义[262.7(213.0,322.3)μmol·L^(-1) vs 255.0(208.3,308.5)μmol·L^(-1),Z=10.365,P<0.001]。男孩血尿酸水平随年龄增加逐渐升高;女孩血尿酸水平在14岁前随年龄增加而升高,从14岁起逐渐下降,17岁起再次升高;除~8岁和~10岁外其他年龄段男孩的血尿酸水平均高于女孩。②共检出HUA 3719例(9.7%),男、女孩HUA检出率分别为7.7%(1730例)和12.6%(1989例),差异有统计学意义(χ^(2)=256.882,P<0.001)。男孩HUA检出率随年龄的增加而升高,~17岁达到峰值45.8%;女孩HUA检出率在~13岁前(25.7%)随年龄增加呈升高趋势,之后逐渐下降;男孩在~13岁前的HUA检出率低于女孩,~14岁后高于女孩。③重度HUA 284例(0.7%),男、女孩检出率分别为1.0%(222/22534)和0.4%(62/15783),差异有统计学意义(χ^(2)=44.269,P<0.001)。重度HUA在HUA患儿中的比例:除~7岁和~17岁外,其他年龄段男孩均高于女孩。④HUA检出率和重度HUA检出率均以内分泌系统疾病患儿最高(15.3%和1.8%),HUA检出率最高的病种为肥胖症(46.3%,320/691)。结论儿童HUA临床并不少见,儿童血尿酸水平有明显的年龄和性别差异,我国亟待建立不同年龄和不同性别儿童的血尿酸参考值,并在此基础上制定儿童HUA的诊断标准,以加强对HUA患儿的临床管理。
Background In recent years,the prevalence of hyperuricemia(HUA)in children has increased,yet it has not received adequate clinical attention.There is currently no established reference value for blood uric acid levels in children in China,and diagnostic criteria for pediatric HUA are lacking.Objective To explore the distribution characteristics of blood uric acid levels and the detection rate of HUA among children attending the hospital.Design Cross-sectional survey.Methods Children who underwent blood uric acid testing at Children's Hospital Affiliated to Zhengzhou University from July 2022 to July 2023 were included.Eligible subjects were aged>28 days at the time of uric acid testing and had a clear disease diagnosis in their medical records.HUA was defined as peripheral blood uric acid levels of≥420μmol·L^(-1) for males and≥360μmol·L^(-1) for females;levels≥540μmol·L^(-1) were classified as severe HUA.Main outcome measures Serum uric acid level and the detection rate of HUA.Results Among 38,317 children with blood uric acid test results,22,534 were male and 15,783 were female.The overall median blood uric acid level was 259.3(211.1,316.1)μmol·L^(-1),with a statistically significant difference between boys and girls[262.7(213.0,322.3)μmol·L^(-1) vs.255.0(208.3,308.5)μmol·L^(-1),Z=10.365,P<0.001].Blood uric acid levels in boys gradually increased with age,while girls'levels increased until age 14,then gradually declined and increased again after age 17;in all age groups except around ages 8 and 10,boys had higher blood uric acid levels than girls.A total of 3,719 cases of HUA were detected(9.7%),with detection rates of 7.7%(1,730 cases)in boys and 12.6%(1,989 cases)in girls,showing a statistically significant difference(χ^(2)=256.882,P<0.001).The detection rate of HUA in boys increased with age,peaking at 45.8%around age 17;for girls,the detection rate increased until about age 13(25.7%)and then gradually declined.Before age 13,the HUA detection rate was lower in boys than in girls,but higher after age 14.There were 284 cases of severe HUA(0.7%),with detection rates of 1.0%(222/22,534)in boys and 0.4%(62/15,783)in girls,showing a statistically significant difference(χ^(2)=44.269,P<0.001).The proportion of severe HUA among children with HUA was higher in boys than girls in all age groups except around ages 7 and 17.The highest detection rates of HUA and severe HUA were observed in children with endocrine system diseases(15.3%and 1.8%,respectively),with the highest detection rate in the obesity category(46.3%,320/691).Conclusion Pediatric HUA is clinically common,with significant age and gender differences in blood uric acid levels.It is urgent to establish reference values for blood uric acid in children of different ages and genders in China and to develop diagnostic criteria for pediatric HUA to enhance the clinical management of affected children.
作者
赵艺璇
袁淑娴
林一凡
魏怡
鲁帅
卫海燕
ZHAO Yixuan;YUAN Shuxian;LIN Yifan;WEI Yi;LU Shuai;WEI Haiyan(Children's Hospital Affiliated to Zhengzhou University,Henan Children's Hospital,Zhengzhou 450018,China)
出处
《中国循证儿科杂志》
CSCD
北大核心
2024年第4期302-306,共5页
Chinese Journal of Evidence Based Pediatrics
基金
十四五“生育健康及妇女儿童健康保障”重点专项:2021YFC2701900
郑州大学天健先进生物医学实验室重点研发专项,儿童青少年肥胖代谢性疾病发生机制、精准诊治与转化研究:2023⁃ZZLC⁃1108⁃003。
关键词
高尿酸血症
儿童青少年
流行特征
肥胖
Hyperuricemia
Children and adolescents
Epidemiological characteristics
Obesity
