中青年美国人血清尿酸与心血管自主神经功能之间关联的基于社区的横断面研究

A community-based cross-sectional study of the association between serum uric acid and cardiovascular autonomic function in young and middle-aged Americans

目的探讨中青年美国人群中血清尿酸(SUA)与心血管自主神经系统功能之间的关系。方法检索美国全国健康和营养检查调查数据库的数据,收集1999-2004年完成心肺运动测试患者资料,采用心肺运动测试中的心率恢复(HRR)评价心血管自主神经功能,HRR1或HRR2为受试者在心肺运动中达到峰值或症状限制时的最大心率与心肺运动测试后恢复1或2 min时的心率差值。通过多元线性回归分析研究SUA与HRR1或HRR2之间的关系。结果共2968例受试者最终纳入研究,年龄18~49岁,平均(29.02±9.73)岁,平均HRR1为(11.19±7.15),平均HRR2为(29.61±11.55),平均SUA水平为(5.14±1.35)mg/dl。本研究发现在调整潜在混杂因素后,SUA与HRR1或HRR2呈负相关。多变量调整平滑曲线表明HRR1和HRR2随着SUA水平的增加而降低,上述关联在根据协变量分层的分层分析中仍存在。结论中青年美国人群尿酸和心血管自主神经功能障碍有明确相关,应重视高尿酸患者的自主神经功能评估。

Objective To investigate the relationship between serum uric acid(SUA)and cardiovascular autonomic nervous system function in young and middle-aged Americans.Methods The data of patients who completed cardiopulmonary exercise test from 1999 to 2004 were retrieved from the National Health and Nutrition Examination Survey database.The cardiovascular autonomic function was evaluated by heart rate recovery(HRR)in cardiopulmonary exercise test.HRR1 or HRR2 is the difference between the subject's maximum heart rate at peak or symptom limitation during cardiopulmonary exercise and the heart rate at 1 or 2 min after recovery from the cardiopulmonary exercise test.Multiple linear regression analysis was used to investigate the relationship between SUA and HRR1 or HRR2.Results A total of 2968 subjects were included in the study,ranging in age from 18 to 49 years,with an average age of(29.02±9.73)years.The mean HRR1 was(11.19±7.15),the mean HRR2 was(29.61±11.55),and the mean SUA level was(5.14±1.35)mg/dl.This study found that after adjusting for potential confounders,SUA was negatively associated with HRR1 or HRR2.The multivariable adjusted smoothing curve showed that HRR1 and HRR2 decreased with increasing SUA levels,and the above association persisted in stratified analyses based on covariate stratification.Conclusion There is a clear correlation between uric acid and cardiovascular autonomic dysfunction in young and middle-aged Americans,and attention should be paid to the evaluation of autonomic nervous function in patients with high uric acid.