高血压人群不同胰岛素抵抗指数与高尿酸血症的相关性

Associations Between Insulin Resistance Indexes and Hyperuricemia in Hypertensive Population

目的 探讨高血压人群不同胰岛素抵抗(IR)指数与高尿酸血症(HUA)的相关性。方法 2018年7至8月在江西省婺源县开展高血压普查,进行问卷调查、体格测量和生化检测。应用Logistic回归分析IR代谢指数(METS-IR)、甘油三酯葡萄糖乘积(TyG)指数、TyG-体重指数(BMI)、TyG-腰围(WC)、内脏脂肪指数(VAI)、甘油三酯(TG)/高密度脂蛋白胆固醇(HDL-C)、脂质蓄积指数(LAP)等IR评估指数与HUA的关系,通过惩罚样条法进行曲线拟合,并采用受试者工作特征曲线下面积(area under the curve, AUC)比较各指数与HUA的相关性。结果 14 220例高血压患者平均年龄(63.8±9.4)岁,其中男性6 713例,女性7 507例。尿酸平均水平为(418.9±120.6)mmol/L,HUA检出率为44.4%。与尿酸正常组比较,HUA组的男性、目前饮酒、目前吸烟、糖尿病和服用各类降压药物的比例较高,年龄、舒张压、WC、BMI、同型半胱氨酸、总胆固醇、TG、低密度脂蛋白胆固醇、尿素氮、肌酐、天冬氨酸转氨酶、丙氨酸转氨酶、总蛋白、血清白蛋白、总胆红素、直接胆红素以及METS-IR、TyG、TyG-BMI、TyG-WC、VAI、TG/HDL-C、LAP值较大,而收缩压和HDL-C值较小(P均<0.05)。多因素Logistic回归分析显示,控制其他因素后,METS-IR(OR=1.049,95%CI=1.038~1.060,P<0.001)、TyG(OR=1.639,95%CI=1.496~1.797,P<0.001)、TyG-BMI(OR=1.008,95%CI=1.006~1.010,P<0.001)、TyG-WC(OR=1.003,95%CI=1.002~1.004,P<0.001)、lnVAI(OR=1.850,95%CI=1.735~1.973,P<0.001)、ln(TG/HDL-C)(OR=1.862,95%CI=1.692~2.048,P<0.001)、lnLAP(OR=1.503,95%CI=1.401~1.613,P<0.001)均与HUA独立相关。曲线关系拟合显示,METS-IR、TyG、TyG-BMI、TyG-WC、lnVAI、ln(TG/HDL-C)及lnLAP与HUA发生风险均呈正相关(P均<0.001),TyG指数AUC明显高于其他指数(P均<0.05)。结论 高血压人群中IR指数升高与HUA发生风险存在关联,其中TyG指数与HUA关联性较强。

Objective To explore the relationship between insulin resistance(IR)indexes and hyperuricemia(HUA)among the people with hypertension.Methods From July to August in 2018,hypertension screening was carried out in Wuyuan county,Jiangxi province,and the data were collected through questionnaire survey,physical measurement,and biochemical test.Logistic regression was performed to analyze the relationship between HUA and IR indexes including metabolic score for IR(METS-IR),triglyceride-glucose(TyG)index,TyG-body mass index(BMI),TyG-waist circumference(WC),visceral adiposity index(VAI),triglyceride(TG)/high-density lipoprotein cholesterol(HDL-C),and lipid accumulation product(LAP).The penalty spline method was used for the curve fitting between IR indexes and HUA.The area under the receiver operating characteristic curve(AUC)was employed to reveal the correlation between each index and HUA.Results The 14220 hypertension patients included 6713 males and 7507 females,with the average age of(63.8±9.4)years old,the average uric acid level of(418.9±120.6)mmol/L,and the HUA detection rate of 44.4%.The HUA group had higher proportions of males,current drinking,current smoking,diabetes,and using antihypertensive drugs,older age,higher diastolic blood pressure,WC,BMI,homocysteine,total cholesterol,TG,low-density lipoprotein cholesterol,blood urea nitrogen,creatinine,aspartate aminotransferase,alanine aminotransferase,total protein,albumin,total bilirubin,direct bilirubin,METS-IR,TyG,TyG-BMI,TyG-WC,VAI,TG/HDL-C,and LAP,and lower systolic blood pressure and HDL-C than the normal uric acid group(all P<0.05).Multivariate Logistic regression showed that METS-IR(OR=1.049,95%CI=1.038-1.060,P<0.001),TyG(OR=1.639,95%CI=1.496-1.797,P<0.001),TyG-BMI(OR=1.008,95%CI=1.006-1.010,P<0.001),TyG-WC(OR=1.003,95%CI=1.002-1.004,P<0.001),lnVAI(OR=1.850,95%CI=1.735-1.973,P<0.001),ln(TG/HDL-C)(OR=1.862,95%CI=1.692-2.048,P<0.001),and lnLAP(OR=1.503,95%CI=1.401-1.613,P<0.001)were associated with the risk of HUA.Curve fitting indicated that METS-IR,TyG,TYG-BMI,TYG-WC,lnVAI,ln(TG/HDL-C),and lnLAP were positively correlated with HUA(all P<0.001),and the AUC of TyG index was higher than that of other IR indexes(all P<0.05).Conclusion Increased IR indexes,especially TyG,were associated with the risk of HUA among people with hypertension.