血尿酸水平与高血糖关系的前瞻性队列研究

Relationship between serum uric acid level and hyperglycemia: a prospective cohort study

目的:探讨血尿酸水平与高血糖的相关性。方法:构建中南大学湘雅医院职工体检队列,2011年1月1日至12月31日期间,选取无高血糖的3937例本院职工作为研究对象,通过问卷调查、体格检查、血脂、血糖、肾功能等实验室检查收集基线资料。2012年1月1日至2018年12月31日间,每年体检时进行随访,共随访7年。根据血尿酸水平分为尿酸<360μmol/L、360≤尿酸<420μmol/L、420≤尿酸<480μmol/L、尿酸≥480μmol/L四组,分别计算总体人群及不同性别四组间高血糖累积发病率。以是否发生高血糖作为结局指标,尿酸水平为观察指标,尿酸<360μmol/L为参照组,性别、年龄、体质指数、吸烟、高血压、血脂异常为混杂因素,调整混杂因素前后分别构建Cox回归模型,分析总人群、男性人群、女性人群不同尿酸水平与高血糖发病的关系。结果:总人群中各组高血糖7年累积发病率分别为15.7%、34.0%、38.8%、43.8%(Z=148.94,P<0.01),其中男性职工各组7年累积发病率分别为23.4%、29.9%、34.7%、35.8%(Z=11.17,P<0.01);女性职工各组7年累积发病率分别为14.2%、42.5%、52.2%、65.0%(Z=141.84,P<0.01)。以尿酸<360μmol/L为参照,调整了性别、年龄、体质指数、吸烟、高血压、血脂异常的影响后,总人群中,360≤尿酸<420μmol/L、420≤尿酸<480μmol/L、尿酸≥480μmol/L三组高血糖的发病风险是参照组的1.73(1.39~2.15)、1.86(1.42~2.45)、1.95(1.34~2.85)倍(均P<0.05);女性职工中,360≤尿酸<420μmol/L、420≤尿酸<480μmol/L、尿酸≥480μmol/L三组高血糖的发病风险是参照组的2.18(1.62~2.94)、3.41(2.24~5.20)、3.02(1.69~5.40)倍(均P<0.01)。结论:随着血尿酸水平增高,医务人员高血糖发病风险增高,这一趋势主要表现在女性医务人员中。

Objective To investigate the correlation between serum uric acid level and hyperglycemia.Methods A medical examination cohort of the staff of our hospital was constructed.From February 1st,2011,to December 31st,2011,3937 staff members without hyperglycemia were selected,and baseline data were collected through a questionnaire survey,physical examination,measurement of blood lipid and blood glucose,assessment of kidney function,and other laboratory tests.The subjects were followed up during the annual physical examination for 7 years,from January 1st,2012,to December 31st,2018.They were divided into four groups according to serum uric acid level:uric acid<360μmol/L,360≤uric acid<420μmol/L,420≤uric acid<480μmol/L,and uric acid≥480μmol/L.With the occurrence of hyperglycemia as the outcome indicator;uric acid level as the observation index;uric acid<360μmol/L as the control group;and gender,age,body mass index,smoking,hypertension,dyslipidemia as confounding factors,Cox regression was performed before and after adjusting confounding factors to analyze the relationship between different uric acid levels and the incidence of hyperglycemia in the entire sample,in the male staff,and in the female staff.Results The 7-year cumulative incidence of hyperglycemia in the four groups were 15.7%,34.0%,38.8%,and 43.8%,respectively(Z=148.94,P<0.01).In the male staff,the 7-year cumulative incidence rates in the four groups were 23.4%,29.9%,34.7%,and 35.8%,respectively(Z=11.17,P<0.01).In the female staff,the 7-year cumulative incidence rates in the four groups were 14.2%,42.5%,52.2%,and 65.0%,respectively(Z=141.84,P<0.01).After adjusting for gender,age,body mass index,smoking,hypertension,and dyslipidemia,the risk of hyperglycemia in the 360≤uric acid<420μmol/L,420≤uric acid<480μmol/L,and uric acid≥480μmol/L groups were 1.73(1.39-2.15),1.86(1.42-2.45),and 1.95(1.34-2.85)times higher than that in the control group(all P<0.05).Among female staff,the risk of hyperglycemia in the 360≤uric acid<420μmol/L,420≤uric acid<480μmol/L,and uric acid≥480μmol/L groups were 2.18(1.62-2.94),3.41(2.24-5.20),and 3.02(1.69-5.40)times,respectively,and were also higher than those in the control group(all P<0.01).Conclusion With the increase of serum uric acid level,the risk of hyperglycemia in medical staff increases,which is mainly manifested in female staff.