新疆地区高尿酸血症患病现状及其与心脏代谢指数的相关性研究

doi:10.12114/j.issn.1007-9572.2023.0586

摘要/Abstract

摘要： 背景高尿酸血症（HUA）患病率逐年升高，而针对新疆地区的研究较少。因新疆地区人群有特殊的地域和饮食特点，故地域性研究是必要的。目的调查新疆维吾尔自治区年龄≥35岁人群HUA患病现状，并探讨不同民族、不同性别健康体检人群心脏代谢指数（CMI）与HUA的相关性，为该地区HUA患者制订个性化的预防措施提供参考依据。方法本研究为横断面研究，选取2021年10月—2022年10月在新疆医科大学第一附属医院参加健康体检的年龄≥35岁的9 429名体检者为研究对象。根据研究对象是否合并HUA将其分为HUA组（n=527）和非HUA组（n=8 902）；根据CMI值将研究对象分层为Q1（CMI≤0.34）、Q2（0.34<CMI≤0.56）、Q3（0.56<CMI≤0.99）、Q4（CMI>0.99）。通过查阅嘉禾病历系统收集研究对象的一般人口学资料（性别、年龄、民族）、既往病史（冠心病、高血压、糖尿病、脑卒中）、体格检查和实验室检查指标等并进行比较。采用多因素Logistic回归模型分析CMI对HUA发病风险的影响（模型Ⅰ调整年龄、性别和BMI，模型Ⅱ调整年龄、性别、既往史、尿素氮等），并按照性别（男/女）、民族（汉族/维吾尔族/哈萨克族）进行分层分析CMI与HUA的相关性。结果 9 429名体检者中HUA患者527例（5.58%），平均年龄（54.3±12.9）岁；其中男434例（82.4%）、女93例（17.6%）；汉族402例（76.3%）、维吾尔族82例（15.5%）、哈萨克族43例（8.2%）。HUA组与非HUA组脑卒中史、HDL-C水平比较，差异无统计学意义（P>0.05）；两组性别、年龄、民族、冠心病史、高血压史、糖尿病史、舒张压、收缩压、尿素氮、血尿酸（SUA）、肌酐、空腹血糖（FPG）、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、BMI、腰高比（WHtR）、CMI比较，差异有统计学意义（P<0.05）。多因素Logistic回归分析显示，调整相关混杂因素后，与Q1相比CMI为Q2、Q3、Q4时均会增加HUA的发病风险（OR=1.874、4.201、6.053，P<0.05），且CMI与HUA发病风险呈正相关（P趋势<0.001）。按照不同性别进行分层调整相关混杂因素后结果显示，与Q1相比，男性CMI为Q3、Q4时会增加HUA的发病风险（OR=3.168、4.273，P<0.05），女性CMI为Q2、Q3、Q4时会增加HUA的发病风险（OR=3.144、8.805、10.938，P<0.05），且CMI与HUA发病风险均呈正相关（P趋势<0.001）。按照不同民族进行分层调整相关混杂因素后结果显示，与Q1相比，汉族CMI为Q2、Q3、Q4时会增加HUA的发病风险（OR=1.924、4.522、6.681，P<0.05），哈萨克族CMI为Q2、Q3、Q4时会增加HUA的发病风险（OR=4.004、9.461、14.291，P<0.05），且CMI与HUA发病风险均呈正相关（P趋势<0.001）。结论新疆维吾尔自治区年龄≥35岁体检者HUA患病率为5.58%，HUA患者以男性和汉族为主。CMI升高会增加HUA的发病风险，在汉族与哈萨克族人群中更明显。

关键词: 高尿酸血症, 心脏代谢指数, 新疆维吾尔自治区, 哈萨克族, 横断面研究, Logistic模型

Abstract:

Background

The prevalence of hyperuricemia (HUA) is increasing year by year, and fewer studies have been conducted for the Xinjiang region. Because the population in Xinjiang has special regional and dietary characteristics, regional studies are necessary.

Objective

To investigate the current status of HUA among people aged≥35 years in Xinjiang Uygur Autonomous Region, and explore the correlation of cardiometabolic index (CMI) with HUA among healthy population undergoing health examinations of different ethnicities and genders, so as to provide a reference basis for the development of personalized preventive measures for HUA patients in the region.

Methods

This was a cross-sectional study, and 9 429 medical examiners aged≥35 years who participated in health checkups at the First Affiliated Hospital of Xinjiang Medical University from October 2021 to October 2022 were selected as the study subjects and divided into the HUA group (n=527) and the non-HUA group (n=8 902) according to the combination of HUA; and the study subjects were stratified into Q1 (CMI≤0.34) , Q2 (0.34<CMI≤0.56) , Q3 (0.56<CMI≤0.99) and Q4 (CMI>0.99) according to the CMI. General demographic information (gender, age, ethnicity) , past medical history (coronary heart disease, hypertension, diabetes mellitus, stroke) , physical examination and laboratory test indices of the study subjects were collected and compared by reviewing the medical record system. A multivariate Logistic regression model was used to analyze the effect of CMI on the risk of HUA (model Ⅰ adjusted for age, gender, gender and BMI; model Ⅱ adjusted for age, gender, past history, urea nitrogen, etc.) , and the correlation between CMI and HUA was analyzed bystratification according to gender (male/female) and ethnicity (Han/Uyghur/Kazak) .

Results

There were 527 (5.58%) HUA patients among 9 429 medical examiners, with an average age of (54.3±12.9) years; 434 (82.4%) were male and 93 (17.6%) were female; 402 (76.3%) of them were Han nationality, 82 (15.5%) were Uyghurs, and 43 (8.2%) were Kazakhs. In the comparison between the HUA group and non-HUA group, there was no statistically significant difference in stroke history and HDL-C levels (P>0.05) ; the differences in gender, age, ethnicity, history of coronary heart disease, hypertension and diabetes, diastolic blood pressure (DBP) , systolic blood pressure (SBP) , urea nitrogen (UN) , blood uric acid (SUA) , creatinine, fasting plasma glucose (FPG) , triacylglycerol (TG) , total cholesterol (TC) , low-density lipoprotein cholesterol (LDL-C) , BMI, waist-to-height ratio (WHtR) , and CMI were statistically significant (P<0.05) . Multivariate Logistic regression analysis showed that after adjusting for relevant confounders, the risk of HUA was increased when CMI was Q2, Q3, and Q4 compared to Q1 (OR=1.874, 4.201, 6.053; P<0.05) , and CMI was positively associated with the risk of HUA (P_trend<0.001) . Stratified by gender after adjusting for relevant confounders, the results showed that compared with Q1, a CMI of Q3, Q4 increased the risk of HUA in men (OR=3.168, 4.273; P<0.05) , and a CMI of Q2, Q3, and Q4 increased the risk of HUA in women (OR=3.144, 8.805, 10.938; P<0.05) , and CMI was positively associated with the risk of HUA (P_trend<0.001) . The results after adjusting for relevant confounders stratified by different ethnic groups showed that compared with Q1, the risk of HUA was increased at CMIs of Q2, Q3, and Q4 in Han nationality (OR=1.924, 4.522, 6.681; P<0.05) , and at CMIs of Q2, Q3, and Q4 in Kazakhs (OR=4.004, 9.461, 14.291; P<0.05) , and CMI was positively associated with the risk of HUA development in all cases (P_trend<0.001) .

Conclusion

The prevalence of HUA among medical examiners aged≥35 years in Xinjiang Uygur Autonomous Region was 5.58%, and HUA patients were predominantly male and Han nationality. Elevated CMI increases the risk of HUA, which is more pronounced in Han and Kazakh populations.

Key words: Hyperuricemia, Cardiometabolic index, Xinjiang, Kazak nationality, Cross-sectional studies, Logistic models

李幸,杨毅宁. 新疆地区高尿酸血症患病现状及其与心脏代谢指数的相关性研究[J]. 中国全科医学, 2024, 27(09): 1095-1101. DOI: 10.12114/j.issn.1007-9572.2023.0586.
LI Xing,YANG Yining. Prevalence of Hyperuricemia and Its Correlation with Cardiometabolic Index in Xinjiang Region[J]. Chinese General Practice, 2024, 27(09): 1095-1101. DOI: 10.12114/j.issn.1007-9572.2023.0586.

图/表 5

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组别	人数	性别[名（%）]		年龄（岁）	民族[名（%）]			冠心病史[名（%）]
组别	人数	男	女	年龄（岁）	汉族	维吾尔族	哈萨克族	冠心病史[名（%）]
非HUA组	8 902	3 955（44.4）	4 947（55.6）	52.5±11.6	3 812（42.8）	3 226（36.2）	1 864（21.0）	2 330（26.2）
HUA组	527	434（82.4）	93（17.6）	54.3±12.9	402（76.3）	82（15.5）	43（8.2）	247（46.9）
检验统计量值		287.616^a		11.603	225.456^a			107.293^a
P值		<0.001		<0.001	<0.001			<0.001
组别	高血压史[名（%）]	糖尿病史[名（%）]	脑卒中史[名（%）]	舒张压（mmHg）	收缩压（mmHg）	尿素氮（mmol/L）	SUA （mmol/L）	肌酐（mmol/L）
非HUA组	2 533（28.5）	564（6.3）	406（4.6）	86±17	136±22	5.0±1.6	264.0±70.3	72.3±26.0
HUA组	233（44.2）	46（8.7）	31（5.9）	92±17	141±21	5.6±1.8	473.0±50.4	91.9±25.2
检验统计量值	59.602^a	4.709^a	1.966^a	64.154	28.644	69.273	4 522.912	284.221
P值	<0.001	0.030	0.161	<0.001	<0.001	<0.001	<0.001	<0.001
组别	FPG （mmol/L）	TG [M（Q₁，Q₃），mmol/L]	TC （mmol/L）	HDL-C [M（Q₁，Q₃），mmol/L]	LDL-C （mmol/L）	BMI （kg/m²）	WHtR	CMI [M（Q₁，Q₃）]
非HUA组	5.2±1.7	1.2（0.9，1.8）	4.6±1.1	1.2（1.0，1.5）	2.9±0.9	25.9±4.2	0.5±0.1	0.6（0.3，1.0）
HUA组	5.4±1.4	2.0（1.4，3.0）	5.1±1.1	1.2（1.0，1.5）	3.2±1.0	27.5±3.7	0.6±0.1	1.0（0.6，1.6）
检验统计量值	9.473	302.721^b	70.463	1.463^b	68.11	72.106	20.482	208.615^b
P值	0.002	<0.001	<0.001	0.226	<0.001	<0.001	<0.001	<0.001

组别	人数	性别[名（%）]		年龄（岁）	民族[名（%）]			冠心病史[名（%）]
组别	人数	男	女	年龄（岁）	汉族	维吾尔族	哈萨克族	冠心病史[名（%）]
非HUA组	8 902	3 955（44.4）	4 947（55.6）	52.5±11.6	3 812（42.8）	3 226（36.2）	1 864（21.0）	2 330（26.2）
HUA组	527	434（82.4）	93（17.6）	54.3±12.9	402（76.3）	82（15.5）	43（8.2）	247（46.9）
检验统计量值		287.616^a		11.603	225.456^a			107.293^a
P值		<0.001		<0.001	<0.001			<0.001
组别	高血压史[名（%）]	糖尿病史[名（%）]	脑卒中史[名（%）]	舒张压（mmHg）	收缩压（mmHg）	尿素氮（mmol/L）	SUA （mmol/L）	肌酐（mmol/L）
非HUA组	2 533（28.5）	564（6.3）	406（4.6）	86±17	136±22	5.0±1.6	264.0±70.3	72.3±26.0
HUA组	233（44.2）	46（8.7）	31（5.9）	92±17	141±21	5.6±1.8	473.0±50.4	91.9±25.2
检验统计量值	59.602^a	4.709^a	1.966^a	64.154	28.644	69.273	4 522.912	284.221
P值	<0.001	0.030	0.161	<0.001	<0.001	<0.001	<0.001	<0.001
组别	FPG （mmol/L）	TG [M（Q₁，Q₃），mmol/L]	TC （mmol/L）	HDL-C [M（Q₁，Q₃），mmol/L]	LDL-C （mmol/L）	BMI （kg/m²）	WHtR	CMI [M（Q₁，Q₃）]
非HUA组	5.2±1.7	1.2（0.9，1.8）	4.6±1.1	1.2（1.0，1.5）	2.9±0.9	25.9±4.2	0.5±0.1	0.6（0.3，1.0）
HUA组	5.4±1.4	2.0（1.4，3.0）	5.1±1.1	1.2（1.0，1.5）	3.2±1.0	27.5±3.7	0.6±0.1	1.0（0.6，1.6）
检验统计量值	9.473	302.721^b	70.463	1.463^b	68.11	72.106	20.482	208.615^b
P值	0.002	<0.001	<0.001	0.226	<0.001	<0.001	<0.001	<0.001

变量	赋值
HUA	是=1，否=0
性别	男=1，女=0
年龄	实测值
民族	汉族=1，维吾尔族=2，哈萨克族=3
冠心病史	是=1，否=0
高血压史	是=1，否=0
糖尿病史	是=1，否=0
舒张压	实测值
收缩压	实测值
尿素氮	实测值
SUA	实测值
肌酐	实测值
FPG	实测值
TG	实测值
TC	实测值
LDL-C	实测值
BMI	实测值
WHtR	实测值
CMI	Q1=1，Q2=2，Q3=3，Q4=4

变量	赋值
HUA	是=1，否=0
性别	男=1，女=0
年龄	实测值
民族	汉族=1，维吾尔族=2，哈萨克族=3
冠心病史	是=1，否=0
高血压史	是=1，否=0
糖尿病史	是=1，否=0
舒张压	实测值
收缩压	实测值
尿素氮	实测值
SUA	实测值
肌酐	实测值
FPG	实测值
TG	实测值
TC	实测值
LDL-C	实测值
BMI	实测值
WHtR	实测值
CMI	Q1=1，Q2=2，Q3=3，Q4=4

变量CMI	β	SE	Wald χ²值	OR（95%CI）	P值
未调整模型（以Q1为参照）
Q2	0.471	0.187	6.355	1.602（1.114~2.324）	0.012
Q3	1.313	0.166	62.948	3.718（2.710~5.192）	<0.001
Q4	1.732	0.160	117.874	5.654（4.175~7.814）	<0.001
模型Ⅰ（以Q1为参照）
Q2	0.315	0.186	2.873	1.371（0.955~1.983）	0.090
Q3	1.055	0.167	39.829	2.872（2.085~4.020）	<0.001
Q4	1.381	0.164	70.644	3.981（2.908~5.546）	<0.001
模型Ⅱ（以Q1为参照）
Q2	0.628	0.191	10.850	1.874（1.294~2.737）	<0.001
Q3	1.435	0.186	59.861	4.201（2.941~6.093）	<0.001
Q4	1.801	0.209	73.977	6.053（4.043~9.189）	<0.001