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中国循证儿科杂志

中国循证儿科杂志 ›› 2024, Vol. 19 ›› Issue (4): 302-306.DOI: 10.3969/j.issn.16735501.2024.04.007

• 论著 • 上一篇    下一篇

郑州市单中心儿童高尿酸血症的横断面调查

赵艺璇,袁淑娴,林一凡,魏怡,鲁帅,卫海燕   

  1. 郑州大学附属儿童医院，河南省儿童医院 郑州，450018


  • 收稿日期:2024-05-23 修回日期:2024-06-08 出版日期:2024-08-25 发布日期:2024-10-31
  • 通讯作者: 卫海燕

Epidemiological characteristics and etiological analysis of hyperuricemia in children and adolescents in a 3A hospital

ZHAO Yixuan, YUAN Shuxian, LIN Yifan, WEI Yi, LU Shuai, WEI Haiyan    

  1. Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou 450018, China
  • Received:2024-05-23 Revised:2024-06-08 Online:2024-08-25 Published:2024-10-31
  • Contact: WEI Haiyan

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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≥420 μmol·L-1和≥360 μmol·L-1 ；血尿酸≥540 μmol·L-1为重度HUA。 主要结局指标：血尿酸水平及HUA检出率。 结果：38 317例有血尿酸检测结果的患儿进入分析，男22 534例、女15 783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 3 719例（9.7%），男、女孩HUA检出率分别为7.7%（1 730例）和12.6%（1 989例），差异有统计学意义（χ2=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%（222/22 534）和0.4%（62/15 783），差异有统计学意义（χ2=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。

关键词: 高尿酸血症, 儿童青少年, 流行特征, 肥胖

Abstract: 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 ≥420 μmol·L-1 for males and ≥360 μmol·L-1 for females; levels ≥540 μmol·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 (χ2=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 (χ2=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.

Key words: Hyperuricemia, Children and adolescents, Epidemiological characteristics, Obesity