老年患者血清尿酸水平影响因素及其在心血管疾病中的作用

Determinants of serum uric acid levels and risk for cardiovascular disease in elderly patients

目的 探讨老年患者血尿酸水平的影响因素及其在心血管疾病中的作用.方法 采用横断面调查研究方法,连续纳入符合观察条件的老年患者1 066例,进行人体测量和生活方式调查,检测血清尿酸（UA）、血脂、血糖、同型半胱氨酸（Hcy）、超氧化物歧化酶（SOD）等生化指标,通过回归分析了解血尿酸的影响因素及其与心血管疾病的关系.结果 老年患者高尿酸血症的发病率为21.9％,其中男性高尿酸血症的发病率为25.9％,女性高尿酸血症的发病率为18.7％.偏相关分析显示：血尿酸水平与Hcy （r=0.163,P=0.000）、体质量指数（BMI） （r=0.128,P=0.004）和三酰甘油（TG） （r=0.133,P=0.003）呈正相关;与高密度脂蛋白胆固醇（HDL-C）（r=-0.103,P=0.021）呈负相关.校正混杂因素后,多元回归分析显示：估计肾小球滤过率（eGFR） （β=-2.044,t=-10.544,P=0.000）、性别（β=42.065,t=4.700,P=0.000）、Hcy（β=1.367,t=3.714,P=0.000）、BMI （β=3.370,t=2.706,P=0.007）、TG（β=14.120,t=2.589,P=0.010）和SOD（β=-0.636,t=-3.079,P=0.002）是老年患者血尿酸水平的独立影响因素.多因素Logistic回归分析显示,轻度尿酸升高发生高血压的比值比（OR）,女性OR=1.925 （95％ CI=1.124～3.295）,男性OR=1.780 （95％ CI=1.010～3.136）;高尿酸水平可使女性冠心病患病风险增加（OR=1.710,95％ CI=1.157～2.526）;而使男性缺血性脑卒中的患病风险减少（OR=0.524,95％ CI=0.335～0.820）.结论 老年患者血尿酸水平受肾功能状态、性别、BMI以及血清Hcy、TG和SOD的影响;轻度尿酸升高增加高血压的患病风险;女性高尿酸水平增加冠心病的患病风险;男性高尿酸水平减少缺血性脑卒中的患病风险.

Objective To explore the determinants of serum uric acid （UA） levels and the relationship between UA and cardiovascular disease in elderly patients.Methods A cross-sectional design was used.A total of 1 066 elderly patients were consecutively recruited in the study.Anthropometric measurement and lifestyle survey were performed,and serum UA,lipid profile,glucose,homocysteine （Hcy） and superoxide dismutase （SOD） were measured.The determinants of serum UA levels and correlation between UA and cardiovascular disease were analyzed by regression.Results The prevalence of hyperuricemia was 21.9% （25.9% in men and 18.7% in women）.Partial correlation analysis showed the level of serum UA was positively correlated with Hcy （r=0.163,P=0.000）,body mass index （r=0.128,P=0.004） and triglyceride （r=0.133,P=0.003）,and negatively correlated with HDL-C （r=-0.103,P=0.021）.After adjustment for potential confounding factors,multivariate analysis showed eGFR （β =-2.044,t =-10.544,P =0.000）,gender （β =42.065,t=4.700,P=0.000）,Hcy （β=1.367,t=3.714,P=0.000）,BMI （β=3.370,t=2.706,P=0.007）,TG （β=14.120,t=2.589,P=0.010） and SOD （β=-0.636,t=-3.079,P=0.002） were independent determinants for UA levels in elderly patients.Logistic regression analysis indicated that mild elevation of UA levels was a risk factor of hypertension （OR=1.925,95% CI=1.124-3.295） in women and OR=1.780 （95% CI=1.010-3.136） in men].High UA levels increased the risk of coronary heart disease in women [OR=1.710 （95% CI=1.157-2.526）],but decreased the risk of ischemic stroke in men [OR=0.524 （95% CI=0.335-0.820）].Conclusions In elderly patients,serum UA levels were affected by renal function,gender,BMI and serum Hcy,TG and SOD.Mildly elevated UA levels increased the risk of hypertension.High UA levels increased the risk of coronary heart disease in women and decreased the risk of ischemic stroke in men.