医院职工高尿酸血症与高血压相关性的前瞻性队列研究

Association between hyperuricemia and hypertension in hospital employees:a prospective cohort study

目的分析医院职工高尿酸血症与高血压之间的相关性。方法构建中南大学湘雅医院4027名职工体检队列,于2011年2月1日至2012年1月29日进行基线健康体检和问卷调查,排除502例不符合入选条件的受检者,于2012年2月1日至2018年12月31日根据年度体检结果对3525例受检者进行随访。根据基线尿酸检查结果将研究对象分为尿酸正常组(3232例)和高尿酸血症组(293例),以基线时是否存在高尿酸血症作为观察指标,7年内是否发生高血压作为结局指标,年龄、性别、体质指数、肌酐、低密度脂蛋白胆固醇、三酰甘油、高密度脂蛋白胆固醇、空腹血糖、婚姻、文化程度、岗位、吸烟、饮酒、锻炼情况作为混杂因素,构建5个Cox回归模型,计算其HR值、调整HR值和95%CI,分析高尿酸血症与高血压发生的关系。结果随访(6.19±1.25)年,共随访21831人年。总人群高血压7年累积发病率16.5%,其中女性12.5%,男性30.1%,尿酸正常组14.1%,高尿酸血症组42.0%;总人群高血压发病密度26.6/1000人年,其中女性19.6/1000人年,男性53.8/1000人年,尿酸正常组22.4/1000人年,高尿酸血症组85.6/1000人年。未调整任何混杂变量时,总人群、女性人群、男性人群高尿酸血症组发生高血压的风险均高于尿酸正常组[HR=3.86、5.69、1.60(95%CI:3.17~4.72、4.36~7.43、1.18~2.16)](均P<0.05);逐步调整混杂因素后,这种相关性仅表现在女性人群中[调整HR=1.91(95%CI:1.08~3.36)](P<0.05),男性人群差异无统计学意义(P>0.05)。结论女性医院职工高尿酸血症是高血压发生的独立危险因素。

Objective To investigate the correlation between hyperuricemia and hypertension in hospital employees.Methods A cohort was constructed from staff participating health checkups at the Xiangya Hospital of Central South University,baseline health examinations and questionnaires were conducted from February 1,2011,to January 29,2012;502 participants were excluded according to the nadir criteria,and 3525 participants were followed-up from February 1,2012,to December 31,2018,according to the results of annual employee checkups.The participants were divided into the normal uric acid(3232 cases)and hyperuricemia groups(293 cases)according to the baseline examination results.The presence of hyperuricemia was used as an observation index and occurrence of hypertension within 7 years was used as an outcome indicator.Age,sex,body mass index,creatinine,LDL cholesterol,triacylglycerol,HDL cholesterol,fasting glucose,marriage,education,job position,smoking,alcohol consumption,and exercise status were used as confounding factors to construct five Cox regression models and calculate their HR values,adjusted HR values,and 95%CI to analyze the relationship between hyperuricemia and the occurrence of hypertension in the overall population and female and male populations.Results The follow-up of the study participants was conducted for a period of(6.19±1.25)years,with a total of 21831 person-years of follow-up.The 7-year cumulative prevalence of hypertension was 16.5%in the total population,12.5%in the female population,30.1%in the male population,14.1%in the normal uric acid group,and 42.0%in the hyperuricemia group.The prevalence density of hypertension was 26.6,19.6,53.8,and 22.4 per 1000 person-years in the total,female,male,and normouricemic groups,respectively.Without adjusting for any confounding variables,the risk of hypertension was higher in the total population,female population,and male population in the hyperuricemia group than in the normal uric acid group[HR=3.86,5.69,1.60,(95%CI:3.17-4.72,4.36-7.43,1.18-2.16)](all P<0.05);after gradually adjusting for confounders,this correlation was only manifested in the female population[adjusted HR=1.91(95%CI:1.08-3.36)](all P<0.05),and the difference was not statistically significant in the male population(P>0.05).Conclusion Among female hospital employees,hyperuricemia is an independent risk factor for the development of hypertension.