高血尿酸增加高血压靶器官损害的性别差异

Gender Differences in Serum Uric Acid and Target Organ Damage in Patients With Hypertension

目的:探讨中国农村高血压患者高血尿酸增加高血压靶器官损害是否存在性别差异。方法:本研究为横断面研究,通过阶段性随机整群抽样入选河南信阳7个社区4 163例40～75岁高血压患者,进行问卷、体检、生化检查等确定合并危险因素及血尿酸和血肌酐水平,进行心脏超声检查明确左心室肥厚情况。结果:男性血肌酐升高者(>115μmol/L)显著高于女性(>107μmol/L)(5.2%vs.1.5%,P<0.001),左心室肥厚者显著低于女性(33.8%vs.41.9%,P<0.001),差异均有统计学意义。男、女性血肌酐升高者较血肌酐正常者血尿酸水平显著升高(均P<0.001),差异有统计学意义。女性左心室肥厚者血尿酸水平显著高于无左心室肥厚者[(264.5±70.1)vs.(250.6±66.5)μmol/L,P<0.001],差异有统计学意义,但在男性中无显著差异(P>0.05)。Logistic回归分析调整多个危险因素后发现与血尿酸水平Ⅰ分位组比较,血尿酸水平Ⅳ分位组显著增加男性血肌酐升高危险(OR,15.8,95%CI:3.3～77.2),而在女性未治疗高血压患者中显著增加左心室肥厚危险(OR,1.51,95%CI:1.13～2.03)。结论:高血尿酸增加高血压靶器官损害存在性别差异,在女性中显著增加左心室肥厚危险,在男性中增加肾脏损害。

Objective：To investigate the community based cross-section study for assessing the association of serum uric acid level with target organ damage in patients with hypertension of different gender. Methods：A total of 4163 hypertension patients were studied by using a multistage cluster sampling method. The subjects including 1373 male and 2790 female,aged 40-75 years from 7 communities of Xinyang County. Cardiovascular risk factors, demographic and biochemical parameters including serum creatinine and uric acid levels were examined. Left ventricular hypertrophy was assessed by echocardiography. Results：Male had higher prevalence of elevated serum creatinine value （ 〉 115 μmol/L）than female （ 〉 107 μmol/L）, （5.2% vs. 1.5% , P 〈 0. 001 ）, while female showed higher prevalence of left ventricular hypertrophy than male （41.9% vs. 33.8% ,P 〈0. 001 ）. Both male and female with elevated serum ereatinine presented increased level of serum uric acid than the subjects with normal creatinine （P 〈 0. 001 respectively）. Serum uric acid was significantly higher in female with left ventricul ar hypertrophy than those without it （ 264. 5 ± 70. 1 vs. 250. 6 ± 66. 5 μmol/L, P 〈 0. 001 ）, but not in male patients （ P 〉 0. 05 ）. After adjustment for conventional risk factors with multiple logistic regression analysis, serum uric acid in the highest quarter was independently associated with the risk of elevated serum creatinine in male （ OR, 15.8,95% CI ： 3.3-77. 2 ）, it also showed the higher risk of left ventricular hypertrophy in untreated female patients（ OR, 1.51,95% CI：1. 13-2. 03 ）. Conclusion：Gender difference existed in the association of serum uric acid with target organ damage in hypertension patients.