高尿酸血症和颈动脉粥样硬化随访研究

Follow-up study on hyperuricemia and carotid artery atherosclerosis

目的探讨高尿酸血症与颈动脉粥样硬化的关系。方法从2008年1月至2010年6月在我院体检符合高尿酸血症诊断的人员中选取63例作为高尿酸血症组,以同期体检血尿酸值正常的人员中选取63例作为非高尿酸血症组,连续跟踪观察5年,100例完成随访,其中高尿酸血症组46例,非高尿酸血症组54例。比较两组受检者基线时的性别、年龄、体重指数(BMI)、腰臀比(WHR)、体脂肪含量(Fat%)、收缩压(SBP)、舒张压(DBP)、血尿酸、空腹血糖(FBG)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C),观察以上各指标5年的变化,检测颈动脉粥样硬化情况。采用多因素Logistic回归分析颈动脉粥样硬化发生的影响因素。结果基线时两组受检者的BMI、WHR以及Fat%比较,差异均有统计学意义(P<0.05);而两组受检者的性别、年龄、SBP、DBP、FBG、TG、TC、LDL-C、HDL-C水平比较,差异均无统计学意义(P>0.05)。5年随访期间,高尿酸血症组血尿酸水平均高于非高尿酸血症组,差异均有统计学意义(P<0.05);高尿酸血症组与非高尿酸血症组各自组内的血尿酸水平变化不明显,差异均无统计学意义(P>0.05)。随访结束时高尿酸血症组颈动脉粥样硬化斑块形成18例(39.1%),非高尿酸血症组颈动脉粥样硬化斑块形成11例(20.4%),高尿酸血症组的粥样硬化斑块发生率明显高于非高尿酸血症组,差异有统计学意义(P<0.05)。多因素Logistic回归结果显示高尿酸血症组基线时血尿酸水平偏高(OR=0.049,95%CI=0.003~0.784)和Fat%超标(OR=0.277,95%CI=0.082~0.939)是颈动脉粥样硬化斑块形成的独立危险因素。结论高尿酸血症是颈动脉粥样硬化的危险因素;应早期加强高尿酸血症的干预,预防动脉粥样硬化疾病的发生。

Objective To investigate the relationship between hyperuricemia and carotid atherosclerosis.Methods From January 2008 to June 2010, 126 persons who underwent physical examination were chosen from Beijing Aerospace General Hospital, and divided into hyperuricemia group(n=63) and normal serum uric acid group(n=63). The change of blood uric acid level was followed for 5 years, and 46 cases in hyperuricemia group and 54 cases in normal serum uric acid group were followed up. The gender, age, body mass index(BMI), waist hip ratio(WHR), systolic blood pressure(SBP), diastolic blood pressure(DBP), blood uric acid, fasting blood glucose(FBG), triglyceride(TG), total cholesterol(TC), low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C)and Fat% were compared between the two groups, and the changes were observed in the following 5 years. The manifestation of carotid artery was examined by ultrasonography. The factors affecting the occurrence of carotid atherosclerosis were analyzed by using logistic regression analysis. Results The BMI, WHR and Fat% of hyperuricemia group were significantly higher than those in normal serum uric acid group(P<0.05). The differences of SBP, DBP, FBG, TG, TC,LDL-C, HDL-C between two groups were not statistically significant(P>0.05). During 5-year follow-up period, the blood uric acid level of hyperuricemia group was significantly higher than that of the normal serum uric acid group(P<0.05). There was no significant difference between the two groups in the change of uric acid level(P>0.05). 18 cases(39.1%) of carotid artery atherosclerotic in hyperuricemia group, compared with 11 patients(20.4%) of carotid artery atherosclerotic in normal serum uric acid group were observed, and the difference was of statistical significance(P<0.05).Multiple logistic regression showed that higher blood uric acid level(OR=0.049, 95% CI=0.003~0.784) and exceeding fat%(OR=0.277, 95%CI=0.082~0.939) appeared to be independent factors to carotid plaque. Conclusion Hyperuricemia is an independent risk factor to promote carotid atherosclerosis. Patients with hyperuricemia should control the level of serum uric acid to reduce the occurrence and development of atherosclerosis.