唐山地区儿童青少年血尿酸分布特征及相关危险因素分析

Distribution of Serum Uric Acid and Risk Factors of Hyperuricemia in Children and Adolescents in Tangshan

背景高尿酸血症在儿童中的发病率逐年增高,且其是心血管疾病的独立危险因素,与代谢综合征及其组分密切相关,若不及早干预,会影响儿童日后的生活质量。而河北省唐山市具有独特的地域及饮食结构特点,但国内尚未见唐山地区儿童青少年血尿酸(UA)分布特征及相关危险因素的研究。目的调查河北省唐山市儿童青少年UA分布特征,分析UA与其相关危险因素的关系,为进一步开展高尿酸血症相关疾病的早期诊断、预防提供理论依据。方法随机选取2012-01-01至2017-12-31于唐山市人民医院儿科就诊治疗的1 039例4~15岁儿童青少年为研究对象,在征得家长知情同意后,共有1 000例接受血样采集纳入该研究。获得其一般体格资料、留取血液标本测得UA、总胆固醇(TC)、三酰甘油(TG)、血糖(GLU)。按性别、年龄等人群分布特征,分别描述UA水平分布特征,分析UA相关危险因素。结果不同性别UA水平比较,差异有统计学意义(t=5.90,P<0.001)。不同年龄UA水平比较,差异有统计学意义(P<0.05);男、女不同年龄UA水平比较,差异均有统计学意义(P<0.05)。高尿酸血症总检出率为13.5%(135/1 000),男、女高尿酸血症检出率分别为12.3%(69/560)、15.0%(66/440)。不同性别高尿酸血症检出率比较,差异无统计学意义(χ^2=1.514,P=0.219)。不同年龄高尿酸血症检出率比较,差异有统计学意义(P<0.05);男、女不同年龄间高尿酸血症检出率比较,差异有统计学意义(P<0.05)。相关性分析结果显示,男生UA水平与年龄(r=0.39)、体质指数(BMI)(r=0.33)、收缩压(r=0.28)、舒张压(r=0.20)、TC(r=0.12)、TG(r=0.21)呈正相关,与腰围身高比(WHtR)(r=-0.25)呈负相关(P<0.05);女生UA水平与BMI(r=0.17)、TG(r=0.21)、GLU(r=0.11)呈正相关(P<0.05)。多元线性回归分析结果显示,年龄[β=9.42,95%CI(6.96,11.89),P<0.001]、BMI[β=4.07,95%CI(2.49,5.66),P<0.001]、TG[β=21.77,95%CI(12.09,31.45),P<0.001]是男生UA水平的影响因素,BMI[β=3.56,95%CI(1.50,5.62),P=0.001]、WHtR[β=243.25,95%CI(52.17,434.34),P=0.013]、TG[β=32.25,95%CI(17.80,46.70),P<0.001]是女生UA水平的影响因素。多因素Logistic回归分析结果显示,年龄[OR=1.46,95%CI(1.30,1.64),P<0.001]、BMI[OR=2.03,95%CI(1.16,3.53),P=0.013]、TG[OR=1.49,95%CI(1.09,2.04),P=0.013]是男生高尿酸血症的影响因素,TG[OR=1.93,95%CI(1.21,3.07),P=0.006]是女生高尿酸血症的影响因素。结论唐山地区儿童青少年UA水平存在性别差异,男生UA水平高于女生,男生UA水平自9岁开始有增高趋势;但不同性别高尿酸血症检出率无统计学差异。BMI、TG是本地区儿童青少年UA水平的影响因素;而年龄、BMI、TG是本地区儿童青少年高尿酸血症的影响因素。

Background Hyperuricemia is an independent factor for cardiovascular diseases,and is also closely related to metabolic syndrome and its components.The incidence of hyperuricemia in children is increasing year by year,which can impair their quality of life without early intervention.At present,there are no domestic studies about the distribution of serum uric acid(UA)and risk factors of hyperuricemia in children and adolescents in Tangshan,Hebei Province,a district with its unique geographical and dietary characteristics.Objective To investigate the distribution characteristics of UA and the risk factors of hyperuricemia in children and adolescents in Tangshan,Hebei Province,providing a theoretical basis for early diagnosis and prevention of hyperuricemia-related diseases.Methods We randomly selected 1 039 children and adolescents in the age group of 4-15 years from Department of Pediatrics,Tangshan People’s Hospital,during January 1,2012 to December 31,2017,and finally enrolled 1 000 of them who received blood sampling for biochemical analysis after obtaining written informed consent from their parents.We obtained their general physical data,and biochemical data[UA,total cholesterol(TC),triglyceride(TG),and glucose(GLU)].We analyzed the distribution characteristics of UA by sex and age,and the risk factors for hyperuricemia.Results The level of UA differed significantly among the participants by sex(t=5.90,P<0.001)and age.And it varied obviously among the same sex groups by age(P<0.05).The detection rates of hyperuricemia in all the participants,male and female participants were 13.5%(135/1 000),12.3%(69/560),and 15.0%(66/440),respectively.The detection rate of hyperuricemia varied significantly by age(P<0.05),but not by sex(χ~2=1.514,P=0.219).The detection rate of hyperuricemia differed significantly in the same-sex groups by age(P<0.05).Correlation analysis showed that UA level in males was positively correlated with age(r=0.39),BMI(r=0.33),systolic pressure(r=0.28),diastolic pressure(r=0.20),TC(r=0.12)and TG(r=0.21),negative correlated with WHtR(r=-0.25)(P<0.05),while in females,it was positively correlated with BMI(r=0.17),TG(r=0.21)and GLU(r=0.11)(P<0.05).Multiple linear regression analysis showed that age[β=9.42,95%CI(6.96,11.89),P<0.001],BMI[β=4.07,95%CI(2.49,5.66),P<0.001],TG[β=21.77,95%CI(12.09,31.45),P<0.001]were the influencing factors of SUA level in males;BMI[β=3.56,95%CI(1.50,5.62),P=0.001],WHtR[β=243.25,95%CI(52.17,434.34),P=0.013],and TG[β=32.25,95%CI(17.80,46.70),P<0.001]were the influencing factors of SUA level in females.Multivariate Logistic regression analysis showed that age[OR=1.46,95%CI(1.34,1.64),P<0.001],BMI[OR=2.03,95%CI(1.16,3.53),P=0.013],TG[OR=1.49,95%CI(1.09,2.04),P=0.013]were the influencing factors of hyperuricemia in males,and TG[OR=1.93,95%CI(1.21,3.07),P=0.006]was an influential factor of hyperuricemia in females.Conclusion There is a significant sex difference in UA level among children and adolescents in Tangshan.UA level in males is higher than that of females.UA level increased significantly from the age of 9 years in males.There is no significant sex difference in the detection rate of hyperuricemia.BMI and TG are the influencing factors of UA level in children and adolescents.And age,BMI and TG are the influencing factors of hyperuricemia.