CKM综合征视角下尿酸白蛋白比值在心血管疾病中的研究进展

Research Progress of Uric Acid-to-Albumin Ratio in Cardiovascular Disease from the Perspective of CKM Syndrome

摘要: 目的：心血管–肾脏–代谢(CKM)综合征的提出将代谢异常、慢性肾脏病与心血管疾病整合为统一的疾病谱系，对新型整合性生物标志物的探索提出了新要求。尿酸/白蛋白比值(UAR)作为一种简便的血清学复合指标，理论上可捕捉CKM进程中“代谢失衡→氧化损伤→靶器官损害”的关键环节。本文旨在系统梳理UAR在心血管疾病领域的研究进展。方法：系统检索PubMed、CNKI、万方等数据库，纳入UAR与冠心病、心房颤动、心脏瓣膜病、心力衰竭及慢性肾脏病合并心血管疾病相关的原创性研究，对关键证据进行归纳与评价。结果：在冠心病领域，UAR与冠脉病变严重程度及PCI术后无复流显著相关(荟萃分析OR = 3.04)；在心房颤动领域，双队列研究证实UAR每增加一个标准差，1年全因死亡风险增加约16%，且能为CHA₂DS₂-VASc评分提供增量预测价值；在心脏瓣膜病领域，术前血清UAR是成人心脏瓣膜术后急性肾损伤的独立危险因素(OR = 1.467)，基于UAR构建的列线图模型AUC达0.779；在心力衰竭领域，UAR可独立预测心衰患者短期死亡或再入院(HR = 1.594)；在慢性肾脏病腹膜透析患者中，UAR亦是心脑血管事件的独立预测因子(HR = 1.042)。结论：UAR在多个心血管疾病场景中均显示出与预后相关的预测价值，但当前研究普遍存在截断值不统一、以回顾性单中心设计为主的局限。未来需在前瞻性队列中进一步验证UAR的预测价值，并探索其作为CKM早期筛查工具的可行性。

Abstract: Objective: The proposal of Cardiovascular-Kidney-Metabolic (CKM) syndrome integrates metabolic abnormalities, chronic kidney disease, and cardiovascular disease into a unified disease spectrum, highlighting the urgent need for novel integrated biomarkers. The uric acid-to-albumin ratio (UAR), a simple serological composite indicator, incorporates both uric acid (reflecting oxidative stress and metabolic burden) and albumin (reflecting antioxidant defense and nutritional status). Theoretically, UAR can capture the key cascade of “metabolic imbalance → oxidative damage → target organ damage” in the CKM continuum. This review aims to systematically summarize the research progress of UAR in the field of cardiovascular disease. Methods: We systematically searched PubMed, CNKI, Wanfang, and other databases for original studies investigating the association between UAR and coronary artery disease, atrial fibrillation, valvular heart disease, heart failure, and chronic kidney disease with cardiovascular complications. Key evidence was summarized and critically evaluated. Results: In coronary artery disease, UAR was significantly associated with the severity of coronary lesions and the no-reflow phenomenon after PCI (pooled OR = 3.04 in meta-analysis). In atrial fibrillation, a two-cohort study demonstrated that each standard deviation increase in UAR was associated with an approximately 16% increase in 1-year all-cause mortality, and UAR provided incremental predictive value beyond the CHA₂DS₂-VASc score. In valvular heart disease, preoperative serum UAR was identified as an independent risk factor for acute kidney injury after cardiac valve surgery (OR = 1.467), and a nomogram incorporating UAR achieved an AUC of 0.779. In heart failure, UAR independently predicted short-term death or readmission (HR = 1.594). In patients with chronic kidney disease undergoing peritoneal dialysis, UAR was an independent predictor of cardiovascular and cerebrovascular events (HR = 1.042). Conclusion: UAR demonstrates consistent prognostic value across multiple cardiovascular disease settings. However, current evidence is limited by heterogeneous cutoff values and predominantly retrospective, single-center designs. Future prospective cohort studies are warranted to validate the predictive value of UAR and to explore its feasibility as an early screening tool for CKM syndrome.