血清尿酸水平对代谢性疾病影响的研究

Study on the effect of serum uric acid on metabolic disorders

目的评价血清尿酸对多种代谢性疾病发生的预测价值。方法研究对象来自天津医科大学总医院健康管理中心。针对2型糖尿病、高血压、高脂血症、非酒精性脂肪肝的4种代谢性疾病患者，开展4个队列分析，样本量分别为56915、47387、31431、35203人；分别平均随访（3.56±2.32）、（3.31±2.24）、（2.70±1.95）、（2.90±1.76）年。基线和随访期检测所有相关变量，包括实验室检查、生活方式问卷和体格检查。血清尿酸五分位水平和2型糖尿病、高血压、高血脂、非酒精性脂肪肝发生率之间的关系通过Cox比例风险回归模型进行分析。结果随访期内2型糖尿病、高血压、高脂血症和非酒精性脂肪肝发病率分别为3.5%、17.6%、33.4%、15.7%。调整了混杂因素后，随着血清尿酸浓度的增高，2型糖尿病发生的风险比（95%可信区间）分别为1.00、0.82（0.70，0.95）、0.80（0.69，0.92）、0.77（0.67，0.88）和0.83（0.72，0.95）（倾向性P值=0.02）。而血清尿酸水平升高分别与高血压、高脂血症和非酒精性脂肪肝的高发生风险有关：相比于最低水平尿酸组，最高水平血尿酸发生高血压、高脂血症和非酒精性脂肪肝的风险比（95%置信区间）分别为1.17（1.09，1.25）、1.20（1.13，1.28）和1.56（1.43，1.70）（倾向性P值均〈0.01）。结论血清尿酸水平对高血压、高脂血症和非酒精性脂肪肝的发生具有阳性预测价值，而对于2型糖尿病具有阴性预测价值。

ObjectiveTo evaluate the prediction value of serum uric acid level in the occurrence of multiple metabolic disorders.MethodsThe subjects are from the Health Management Centre, Tianjin Medical University General Hospital. Four kinds of metabolic diseases, namely type 2 diabetes mellitus, hypertension, hyperlipidemia, and nonalcoholic fatty liver disease （NAFLD）, were analyzed by four-cohort analysis. Sample sizes were 56 915, 47 387, 31 431, and 35 203. The average follow-up time for each cohort was （3.56±2.32）, （3.31±2.24）, （2.70±1.95）, （2.90±1.76） years, respectively. In each cohort, the population was divided into two groups, depending on the occurrence of type 2 diabetes, hypertension, hyperlipidemia, and NAFLD during follow-up. All relevant variables were tested for baseline and follow-up, including laboratory tests, lifestyle questionnaire, and physical examination. Statistical analysis by Cox proportional hazard regression model was performed for the relationships between the fifth percentile of the distribution of serum uric acid levels and incidence of type 2 diabetes, hypertension, hyperlipidemia, and NAFLD.ResultsDuring the follow-up period, the incidence of type 2 diabetes, hypertension, hyperlipidemia, and NAFLD were 3.5%, 17.6%, 33.4%, and 15.7%, respectively. After adjustment for confounding factors, with the increase in serum uric acid level, the hazard ratios （95%CI） of type 2 diabetes were 1.00, 0.82 （0.70, 0.95）, 0.80 （0.69, 0.92）, 0.77 （0.67, 0.88）, and 0.83 （0.72, 0.95） （P=0.02）. Meanwhile, higher risk of hypertension, hyperlipidemia, and NAFLD were associated with elevated serum uric acid level. In the group with the highest serum uric acid level in each cohort, the hazard ratio （95%CI） of hypertension, hyperlipidemia, and NAFLD were 1.17 （1.09, 1.25）, 1.20 （1.13, 1.28）, and 1.56 （1.43, 1.70）, respectively （P〈 0.01）, as compared to the group with the lowest level.ConclusionSerum uric acid levels have a positive predictive value for the occurrence of hypertension, hyperlipidemia, and NAFLD, but have a negative predictive value for type 2 diabetes.