不同体脂指标对高尿酸血症发生风险的预测价值

The predictive value of different body fat indexes on the risk of hyperuricemia

目的探讨不同体脂指标[体重指数(BMI)、腰围(WC)、腰高比(WHtR)、内脏脂肪指数(VAI)、脂质聚集指数(LAP)]与高尿酸血症(HUA)的相关性,评估不同体脂指标对HUA发生风险的预测价值。方法连续纳入于2018年9月至2019年5月在中日友好医院体检中心进行体检的708例受试者,其中HUA患者189例,非HUA受试者519例。比较2组患者WHtR、WC、BMI、LAP、VAI及相关理化指标差异。采用Spearman相关分析评估不同体脂测量指标与血尿酸(SUA)水平的相关性。根据VAI、LAP、WC、WHtR、BMI四分位数水平对受试者进行分组,采用二元logistic回归分析比较不同四分位数分组中各体脂指标对HUA发生风险的影响;分别绘制不同性别LAP、VAI、WHtR、WC、BMI预测HUA发生的受试者工作特征(ROC)曲线。结果WHtR、WC、BMI、VAI、LAP与SUA水平呈正相关。二元logistic回归结果显示,在校正各危险因素后,V4组HUA发生风险为V1组的5.47倍,L4组HUA发生风险为L1组的6.13倍,W4组HUA发生风险为W1组的4.06倍,H4组HUA发生风险为H1组的3.64倍,B4组HUA发生风险为B1组的3.77倍,且差异均有统计学意义(P<0.001)。ROC曲线结果显示,男性LAP、VAI、WHtR、WC、BMI预测HUA发生风险的ROC曲线下面积(AUC)分别为0.662、0.663、0.604、0.605、0.615,临界值分别为46.370、2.155、0.528、91.750 cm、28.230 kg/m^(2);女性LAP、VAI、WHtR、WC、BMI预测HUA发生风险的AUC分别为0.792、0.741、0.761、0.762、0.751,临界值分别为47.538、2.385、0.553、90.250 cm、26.750 kg/m^(2)。WHtR、WC、BMI、VAI的男性与女性AUC比较,差异有统计学意义(P<0.05);LAP的男性与女性AUC比较,差异无统计学意义(P>0.05)。结论VAI、LAP、WC、WHtR、BMI与HUA发生风险均呈正相关。不同体脂指标对HUA的发生均有一定的预测价值。并且WHtR、WC、BMI、VAI对女性HUA的预测准确性更高。

Objective To explore the correlation between body fat index(BMI),waist circumference(WC),waist to height ratio(WHtR),visceral fat index(VAI),lipid aggregation index(LAP)and hyperuricemia(HUA),and to evaluate the predictive value of different body fat indexes on the risk of HUA.Methods A total of 708 subjects who underwent physical examination in the Physical Examination Center of China-Japan Friendship Hospital from September 2018 to May 2019 were enrolled consecutively,including 189 HUA patients and 519 non-HUA subjects.The differences of WHtR,WC,BMI,LAP,VAI and related physical and chemical indexes were compared between 2 groups.Spearman correlation analysis was used to evaluate the correlation between different body fat measurements and serum uric acid(SUA)levels.Then the subjects were grouped according to the quartile levels of VAI,LAP,WC,WHtR and BMI,and the effects of body fat indexes in different quartile groups on the risk of HUA were compared by binary Logistic regression analysis.The receiver operating characteristic(ROC)curves of LAP,VAI,WHtR,WC and BMI for predicting the occurrence of HUA were analysed respectively.Results WHtR,WC,BMI,VAI,LAP were positively correlated with SUA level.Binary logistic regression results showed that after adjusting for all risk factors,the risk of HUA in V4 group was 5.47 times that in V1 group,that in L4 group was 6.13 times that in L1 group,and that in W4 group was 4.06 times that in W1 group.The risk ofHUAin H4 group was 3.64 times higher than that in H1 group,and that in B4 group was 3.77 times higher than that in B1 group,with statistical significance(P<0.001).ROC curve results showed that the area under ROC curve(AUC)of LAP,VAI,WHtR,WC and BMI for predicting the risk of HUA were 0.662,0.663,0.604,0.605 and 0.615,respectively.The critical values were 46.370,2.155,0.528,91.750 cm,28.230 kg/m^(2),respectively.The area under AUC of LAP,VAI,WHtR,WC and BMI for predicting the risk of HUA were 0.792,0.741,0.761,0.762 and 0.751,with critical values of 47.538,2.385,0.553 and 90.250 cm,26.750 kg/m^(2),respectively.There were statistically significant differences between male and female AUC in WHtR,WC,BMI and VAI(P<0.05).There was no statistically significant difference in AUC between LAP men and women(P>0.05).Conclusions VAI,LAP,WC,WHtR and BMI were positively correlated with the risk of HUA.Different body fat indexes have certain predictive value for the occurrence of HUA.Moreover,WHtR,WC,BMI and VAI are more accurate in predicting FEMALE HUA.