基线血尿酸水平与发生代谢综合征的相关性

Correlation between baseline serum uric acid and metabolic syndrome

目的研究天津市体检人群基线尿酸（UA）水平与2年后发生代谢综合征（MS）及其组分异常的相关性,为探讨MS组分的构成提供科学依据。方法采取历史回顾性队列研究方法,收集2011年和2013年均在天津市第一中心医院健康体检中心接受体检的3 825人的体检结果,包括体格检查（体重和血压）、生化指标测定结果（UA、甘油三酯、高密度脂蛋白胆固醇水平等）及用药史等。分析基线（2011年）UA水平与2013年发生MS及其组分异常的相关性,并运用工作特征曲线（ROC）确定基线UA预测MS发生的切点值。结果基线无MS的1 566人中2年内有141人新发生MS,累计发病率为9.0%,其中男性为12.0%,女性为4.5%。相关性分析结果显示,无论男女,基线UA水平与2013年随访时TG水平和BMI的相关程度最高（男性r值分别为0.209和0.243,女性r值分别为0.307和0.353）,有统计学意义（P〈0.01）。随着基线UA水平的升高,2013年男性肥胖、高甘油三酯血症发病率逐渐升高（P趋势值〈0.01）;同时,女性肥胖、高甘油三酯血症、高血压、低高密度脂蛋白血症和MS的发病率也逐渐升高（P趋势值〈0.01）。多元logistic回归分析显示,基线UA是肥胖（男性：OR=2.06,95%CI：1.37~3.08;女性：OR=2.55,95%CI：1.56~5.63）、高甘油三酯血症（男性：OR=2.63,95%CI：1.66~4.15;女性OR=3.91,95%CI：1.36~11.30）及女性MS（OR=2.01,95%CI：1.32~3.68）发生的独立预测因子。在女性中,ROC曲线确定基线UA预测MS发生的最佳切点值为285.15μmol/L。结论在天津市体检人群中,基线UA水平与2年后MS的发生及其组分异常密切相关,并且基线UA是女性发生MS的独立预测因子,建议把UA作为女性MS的组分之一。

Objective To investigate the relationship of baseline serum uric acid （UA） and occurrence metabolic syndrome （MS） in two years or cardinal features abnormality of MS, and to provide the base for cardinal features of MS in residents of Tianjin. Methods The historical cohort study was performed in 3 825 subjects who participated in health examination in the health examination center of Tianjin First Center Hospital in 2011 and 2013. Data about physical examination （blood pressure and weight）, biochemistry indexes （UA, TG and HDL-C ） and medical history were collected. The relationship between baseline serum UA in 2011 and occurrence of MS and its cardinal features in 2013 were analyzed, and the cut-off value of baseline UA level was estimated to predict the MS occurrence by the ROC curve. Results In 2013, 141 subjects suffered newly with MS among 1 566 without MS at baseline UA in 2011, and the cumulative incidence was 9.0% （12.0% for males and 4.5% for females）. Correlation analysis indicated that the baseline UA was correlated closely to TG levels and BMI in 2013 （males： r values were 0.209 and 0.243; females： r values were 0.307 and 0.353, P〈0.01 ）. The morbidities of male obesity and high TG in 2013 increased with baseline UA （P〈0.01）. Also the morbidities of female obesity and high TG, hypertension, low HDL-C and MS in 2013 increased with baseline UA （P〈0.01）. Multivariate regression logistic analysis showed that the baseline UA was an independent predictor for obesity （OR=2.06, 95%CI： 1.37-3.08 in males; OR=2.55, 95%CI： 1.56-5.63 in females）, high serum TG （OR=2.63, 95%CI： 1.66-4.15 in males; OR=3.91, 95%CI： 1.36-11.30 in females） and female MS （OR=2.01, 95%CI： 1.32-3.68）. In females, the optimal cut-off level of baseline UA for the prediction of MS occurrence was 285.15 μmol/L which was determined by the ROC curve. Conclusion The baseline UA level is closely related with occurrence of MS and its cardinal features in two years in the health examination population of Tianjin. The elevated baseline UA level is an independent predictor for MS occurrence and should be served as one of the components of MS in females.