上海市某社区老年人高尿酸血症现况调查及影响因素分析

Survey of hyperuricemia and related factors among elderly in a community of Shanghai

目的调查社区老年人高尿酸血症(HUA)的患病情况以及相关知识知晓情况,并分析HUA相关影响因素。方法收集选取2019年1月至2020年1月上海市闵行区古美社区6897名65岁以上老年人健康体检资料,包括一般资料、血尿生化指标及腹部B超结果等,分析比较HUA组与非HUA组上述指标的差异;采用多元logistic逐步回归分析HUA的影响因素。对HUA患者开展问卷调查,了解HUA相关知识知晓情况及相关健康行为执行情况等。结果6897名老年人中,HUA总体患病率为16.8%(1156例),男性为26.4%(842/3195),女性为8.5%(314/3702),且不同年龄组间男性患病率均明显高于女性(χ^(2)=215.65、134.56、42.34,均P<0.01),女性患病率随年龄增加而增高(χ^(2)=7.56,P=0.023)。HUA组体重指数、腰围、总胆固醇(TC)、甘油三酯(TG)、血肌酐(Scr)、丙氨酸转氨酶(ALT)、尿微量白蛋白和尿肌酐的比值(UACR)均高于非HUA组,估算的肾小球滤过率(eGFR)和高密度脂蛋白胆固醇(HDL)均低于非HUA组(均P<0.01);HUA组高血压、肾功能下降、超重或肥胖、腹型肥胖、脂肪肝、肾囊肿患病率均明显高于非HUA组(均P<0.01)。多因素分析显示,高水平的TG、LDL、腰围,合并高血压和脂肪肝为老年HUA的危险因素(OR=1.14、1.20、1.03、1.43、2.19,均P<0.01);而女性及高水平的eGFR、HDL及糖化血红蛋白(HbA1c)为保护因素(OR=0.32、0.94、0.65、0.78,均P<0.01)。1090例HUA患者接受问卷调查,结果显示,在体检结果发布后3个月知晓患病者占73.2%(798例),仅30.9%(337例)知晓HUA诊断标准,21.1%(230例)知晓HUA需终生随访复查,有56.3%(614例)、49.2%(536例)和47.9%(522例)认为HUA应少吃海鲜、肉汤和豆制品,17.0%(185例)目前饮酒,且痛风组的以上比例均高于非痛风组(P<0.05)。结论上海市古美社区老年人HUA患病率较高,且男性高于女性,女性患病率随年龄增加而增高。影响HUA的主要危险因素有高血压、腹型肥胖、高TG、高LDL、肾功能减退和脂肪肝。HUA相关知识知晓情况及健康行为执行情况不甚理想,尤其对于无痛风史的HUA患者,需加强健康教育。

Objective To investigate the prevalence of hyperuricemia(HUA),patients′awareness of HUA,and related factors among elderly in community.Methods The health check-up data of 6897 residents aged over 65 years in Gumei Community of Shanghai were collected from January 2019 to January 2020.There were 1156 subject with increased serum uric acid levels(HUA group)and 5741 with normal uric acid levels(non-HUA group).The differences of clinical indicators between HUA group and non-HUA group were analyzed and the risk factors of HUA was determined by multivariate logistic stepwise regression.A questionnaire survey on the knowledge of HUA and the adoption of relevant health behaviors was conducted among HUA patients.Results The overall prevalence was 16.8%(1156/6897)in this population.The prevalence in males was significantly higher than that in females[26.4%(842/3195)vs.8.5%(314/3702),P<0.001);and the prevalence in females increased with age(χ^(2)=7.56,P=0.023).Body mass index(BMI),waist circumference(WC),total cholesterol(TC),triglyceride(TG),serum creatinine,alanine aminotransferase(ALT)and albumin/urine creatinine ratio(UACR)in the HUA group were significantly higher than those in the non-HUA group,while estimated glomerular filtration rate(eGFR)and high-density lipoprotein(HDL)were lower than those in the non-HUA group(all P<0.01).The prevalence of hypertension,decreased renal function,overweight or obesity,abdominal obesity,fatty liver and renal cyst in HUA group was significantly higher than that in non-HUA group(all P<0.01).High values of TG,low-density lipoprotein(LDL),WC,hypertension and fatty liver were risk factors for HUA(OR=1.14,1.20,1.03,1.43,2.19;P<0.01);while female gender,eGFR,HDL and glycosylated hemoglobin A1c(HbA1c)were protective factors for HUA(OR=0.32,0.94,0.65,0.78;P<0.01).The questionnaire survey was conducted among 1090 HUA patients,and the results showed that 73.2%(798 cases)were aware of the disease after the health check-up results released;only 30.9%(337 cases)knew the diagnostic criteria of HUA,21.1%(230 cases)knew that HUA needed life-long follow-up care,56.3%(614 cases),49.2%(536 cases)and 47.9%(522 cases)thought that HUA should eat less seafood,broth and soya bean products,17.0%(185 cases)were atcohol drinker and the awareness rates of above questions in patients with gout were higher than those in patients without gout(P<0.05).Conclusion The study shows that the prevalence of HUA among the elderly in Gumei community of Shanghai is high,and the HUA related knowledge levels and health behavior performance are not ideal,especially for HUA patients without gout,therefore health education should be strengthened for elderly residents in the community.