血尿酸水平变化对臂踝动脉脉搏波传导速度的影响

Impact of uric acid variation on brachial-ankle pulse wave velocity

目的探讨血尿酸水平变化与臂踝动脉脉搏波传导速度（baPWV）的关系。方法在2006-2007年参加健康体检的开滦集团职工101 510人中随机分层抽取5852人作为研究对象,进行统一问卷调查、血液生化检查,符合入选标准的（年龄≥40岁、既往无缺血性脑卒中、短暂性脑缺血发作、心肌梗死者）5440人纳入研究队列。依据2006-2007年度、2010-2011年度两次血尿酸数据将观察对象分为4组：2006-2007年度和2010-2011年度健康体检血尿酸均在正常水平者为Q1组（n=3845）;2006-2007年度健康体检为高尿酸血症（HUA）,至2010-2011年度健康体检血尿酸水平正常者为Q2组（n=252）;2006-2007年度健康体检血尿酸正常,至2010-2011年度健康体检为HUA者为Q3组（n=285）;2006-2007年度和2010-2011年度健康体检均为HUA者为Q4组（n=206）。采用多因素线性回归模型分析不同年度血尿酸水平与baPWV的关系,多因素Logistic回归模型分析血尿酸变化对baPWV≥14m/s占比的影响。结果 2010-2011年度健康体检时Q2、Q3、Q4组baPWV水平[（17.03±3.96）、（16.61±4.04）、（18.22±4.76）比（15.48±3.79）m/s;均P〈0.01]和baPWV≥14 m/s的占比（76.2%、70.5%、83.5%比58.2%;均P〈0.01）高于Q1组。不同年度血尿酸与baPWV的多因素线性回归分析结果显示,校正年龄、收缩压等因素后,2006-2007年度血尿酸每增加1μmol/L,2010-2011年度baPWV增加0.17cm/s;2010-2011年度血尿酸每增加1μmol/L,2010-2011年度baPWV增加0.11cm/s。影响baPWV≥14m/s的占比的多因素Logistic回归分析显示：校正了年龄、收缩压等因素后,与Q1组相比,Q2、Q3、Q4组检出baPWV≥14m/s的OR值分别为1.49（95%CI1.02-2.18）、1.47（95%CI1.04-2.06）、1.61（95%CI1.02-2.55）。结论尿酸波动可能是baPWV增加的危险因素,因此建议尿酸持续维持在正常水平。

Objective To examine the impact of uric acid variation on braehial-ankle pulse wave velocity （baPWV）. Methods Initially, 5852 participants were selected with a stratified random sampling method from 101 510 workers of Tangshan Kailuan company who underwent health examinations. Participants were qualified if they aged 40 years or older and had no previous histories of isehemic stroke, transient ischemic attack and myocardial infarction, and a total of 5440 of them were left for final analysis. According to uric acid levels of two health examinations from 2006 to 2007 and 2010 to 2011, we divided all qualified participants into four groups： group 1 （participants with continued normal uric acid level, n=3845）, group 2 （participants with hyperuricaemia from 2006 to 2007 and uric acid below normal level from 2010 to 2011, n=252）, group 3 （participants without hyperuricaemia from 2006 to 2007 and with hyperuricaemia from 2010 to 2011, n=285） and group 4 （participants with hyperuricaemia from 2006 to 2007, as well as from 2010 to 2011, n= 206）. Multiple linear regression and multivariate Logistic regression analyses were used to examine the impact of uric acid variation on baPWV. Results The mean level of baPWV [（17.03±3.96）, （16.61±4.04）, （18.22±4.76） vs （15.48±3.79）m/s] and the percentage of baPWV ≥14 m/s from 2010 to 2011 （76.2%, 70.5%, 83.5± vs 68.2%） in groups 2, 3 and 4 were significantly higher than that in group 1 （all P±0.01 ）. In multiple linear regression analysis, baPWV was positively associated with uric acid after adjusting for confounders, with an increase of uric acid by 1 μmol/L from 2006 to 2007 leading to an increase of baPWV by 0.17 cm/s from 2010 to 2011, and an increase of uric acid by 1 μmol/L from 2010 to 2011 leading to an increase of baPWV by 0. 11 cm/s from 2010 to 2011. Multiple logistic regression analysis revealed that after adjus ring for age, systolic blood pressure and the other risk factors, the odds of baPWV abnormality was 1.49 （95% CI 1.02-2.18, 1.47 （95% CI 1.04-2.06） and 1.61 （950/00 CI 1.02-2.55） in groups 2, 3 and 4 when compared with group 1, respectively. Conclusion Uric acid variation is a risk factor for increased baPWV, reinforcing to keep uric acid within its normal level.