血尿酸水平与血脂异常关系的交叉滞后分析

Cross⁃lagged analysis of the relationship between serum uric acid and dyslipidemia

目的研究血尿酸(serum uric acid,SUA)水平升高与血脂质之间的关系,为预防控制血脂异常和高尿酸血症提供依据。方法2017年4―7月在江苏省盐城市盐都区,采用多级分层随机抽样方法,对≥18岁常住居民进行基线调查,于2022年对该队列人群进行随访;采用交叉滞后模型,探讨SUA水平与血脂之间的关系,包括总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low⁃density lipoprotein cholesterol,LDL⁃C)、三酰甘油(triglyceride,TG)、高密度脂蛋白胆固醇(high⁃density lipoprotein cholesterol,HDL⁃C),并且针对性别进行分层分析,探究SUA水平与血脂异常的关系是否存在性别差异。结果共有1347名符合条件的对象纳入研究。基线TC到随访SUA的路径系数在一般人群(β=3.402,P=0.048)和男性(β=7.214,P=0.012)中差异均有统计学意义;基线SUA到随访TC的路径系数差异无统计学意义(P=0.958)。基线TG到随访SUA的路径系数在一般人群(β=2.357,P=0.011)和男性(β=3.425,P=0.011)中差异均有统计学意义;基线SUA到随访TG的路径系数差异无统计学意义(P=0.188)。基线SUA到随访HDL⁃C的路径系数在一般人群(β=0.002,P<0.001)、男性(β=0.001,P<0.001)和女性(β=0.003,P<0.001)中差异均有统计学意义;基线HDL⁃C到随访SUA的路径系数差异无统计学意义(P=0.461)。基线SUA到随访LDL⁃C的路径系数在一般人群(β=0.002,P<0.001)、男性(β=0.004,P<0.001)和女性(β=0.001,P=0.015)中差异均有统计学意义;基线LDL⁃C到随访SUA的路径系数差异无统计学意义(P=0.436)。结论SUA与血脂水平之间相互影响,TC、TG水平升高可能导致SUA水平升高,从而可能导致LDL⁃C水平升高和HDL⁃C水平降低。

Objective To study the relationship between elevated serum uric acid levels and serum lipids,and to provide evidence for the prevention and control of dyslipidemia and hyperuricemia.Methods A multi⁃level stratified random sampling method was used to conduct a baseline survey among permanent residents aged 18 and above in Yandu District,Yancheng City,Jiangsu Province from April to July 2017.And the cohort was followed up in 2022.The Cross⁃lag model was used to investigate the rela⁃tionship between serum uric acid(SUA)level and blood lipid,including serum total cholesterol(TC),low⁃density lipoprotein cholesterol(LDL⁃C),triglyceride(TG),and high⁃density lipoprotein cholesterol(HDL⁃C).In addition,gender stratified analysis was conducted to explore whether there were gender differences in the relationship between SUA level and dyslipidemia.Results A total of 1347 eligible subjects were included in the study.The path coefficients from baseline TC to follow⁃up SUA were statisti⁃cally significant in the general population(β=3.402,P=0.048)and men(β=7.214,P=0.012).The path coefficients from baseline SUA to follow⁃up TC were not statistically significant(P=0.958).The path coefficients from baseline TG to follow⁃up SUA were statistically significant in the general population(β=2.357,P=0.011)and men(β=3.425,P=0.011).The path coefficients from baseline SUA to follow⁃up TG were not statistically significant(P=0.188).The path coefficients from baseline SUA to follow⁃up HDL⁃C were statistically significant in the general population(β=0.002,P<0.001),men(β=0.001,P<0.001),and women(β=0.003,P<0.001).The path coefficients from baseline HDL⁃C to follow⁃up SUA were not statistically significant(P=0.461).The path coefficients of baseline SUA to follow⁃up LDL⁃C were statistically significant in the general population(β=0.002,P<0.001),men(β=0.004,P<0.001),and women(β=0.001,P=0.015).The path coefficients from baseline LDL⁃C to follow⁃up SUA were not statistically significant(P=0.436).Conclusions Serum uric acid and lipid levels interact with each other.The increase of TC and TG levels may lead to an increase in SUA level,the increase of SUA level may lead to an increase in LDL⁃C level,and the increase in SUA level may lead to a decrease in HDL⁃C level.