上海社区中老年人群血尿酸/肌酐比值与代谢综合征关联性的流行病学调查

Epidemiological study on association of uric acid to creatinine ratio with metabolic syndrome in middle-aged and elderly populationin Shanghai

目的:探讨上海市嘉定区中老年人群血尿酸/肌酐比值(uric acid to creatinine ratio, UA/Cr)与代谢综合征(metabolic syndrome,MS)间关联性的流行病学趋势。方法:采取整群抽样的方法,对2014年上海市嘉定区6 570名40岁以上居民进行标准化问卷调查、体格检查、生化检测等。根据国际糖尿病联盟的标准定义MS。按照UA/Cr四分位数分组,采用多因素logistic回归模型,分析UA/Cr与MS间相关性,以明确UA/Cr是否可作为MS的独立风险因素。结果:本研究纳入6 414名研究对象,其中MS患者3 313例(52.7%)。血Cr水平为77(70～87) mmol/L,血UA水平为314(267～372) mmol/L,UA/Cr水平为4.01(3.46～4.65)。根据UA/Cr四分位数将研究人群分为4组,第1组UA/Cr <1.0,第2组1.0≤UA/Cr<1.5,第3组1.5≤UA/Cr<2.0,第4组UA/Cr≥2.0。从第1组到第4组,随着UA/Cr水平的增加,受试者的体质量指数(body mass index, BMI)、腰围、血压、三酰甘油、低密度脂蛋白胆固醇、总胆固醇、C反应蛋白及胰岛素抵抗水平逐渐增加(P<0.01);MS及其组分的患病率也呈现显著增加的趋势(P<0.01)。logistic回归分析显示,UA/Cr水平与MS、高血压病、中心性肥胖、高三酰甘油血症、低高密度脂蛋白血症及胰岛素抵抗呈正相关性,以第1组作为参照,第2、3、4组MS患病风险OR值及95%CI分别为1.15(0.96～1.38)、1.36(1.14～1.64)、1.96(1.62～2.37);高血压病为1.04(0.86～1.25)、1.22(1.01～1.48)、1.33(1.09～1.62);中心性肥胖为1.06(0.86～1.31)、1.26(1.02～1.56)、1.33(1.09～1.62);高三酰甘油血症为1.29(1.08～1.54)、1.74(1.46～2.07)、2.81(2.35～3.36);低高密度脂蛋白血症为0.93(0.77～1.13)、1.35(1.12～1.61)、1.50(1.25～1.80);胰岛素抵抗为0.96(0.77～1.19)、1.14(0.92～1.40)、1.81(1.48～2.22)(均P趋势<0.01)。结论:社区中老年人群UA/Cr与MS患病间呈独立正相关,UA/Cr可作为MS的早期生物标志物,为MS的早期发现、高危人群的干预及心血管疾病的逆转提供新的科学依据。

Objective: To undertake an epidemiological study onassociation between serum uric acid to creatinine ratio(UA/Cr) and metabolic syndrome(MS) in middle-aged and elderly populationin Shanghai. Methods: A cross-sectional study was conducted in 6 570 residents aged 40 years or older in Jiading District of Shanghai in 2014. All participants re-ceived standard questionnaire, anthropometric measurements, biochemical evaluation. MS was defined according to the in-ternational Diabetes Federation(IDF) criteria. Participants were divided into 4 groups according to the quartiles of UA/Cr,and the associations of UA/Cr with MA were investigated by multivariate logistic regression analysis. Results: A total of6 414 participants were included in this study, of which 33 135(52.7%) participants were diagnosed with MS. The blood Cr level was 77(70-87) mmol/L, bloodUA level was 314(267-372) mmol/L, UA/Cr level was 4.01(3.46-4.65). The UA/Cr of 1 stquartile group was <1.0, the 2 ndquartile group was 1.0≤ to<1.5, the 3 rdquartile group was 1.5≤ to<2.0, the 4 th quartile group was ≥2.0. From 1 stUA/Cr quartile to 4 thUA/Cr quartile, the body mass index(BMI), waist circumference,blood pressure, serum triglyceride, total cholesterol, low-density lipoproteincholesterol, HOMA-IR level, and serum C-reactive protein level increased with the increase of UA/Cr level(P <0.01);the prevalence of MS and its components also showed a trend of increase(P<0.01). The multivariate logistic regression analysis revealed that serum UA/Cr was positively associated with MS, hypertension, dyslipidemia, hyperglycemia, central obesity, and insulin resistance. Compared with 1 st quartile group, the risk of MS in 2 nd quartile group, 3 rdquartile group and 4 thquartile group 4 were 1.15(0.96-1.38),1.36(1.14-1.64),1.96(1.62-2.37);the risk of hypertension were 1.04(0.86-1.25), 1.22(1.01-1.48), 1.33(1.09-1.62);the risk of central obesity were 1.06(0.86-1.31),1.26(1.02-1.56), 1.33(1.09-1.62);the risk of high TG were 1.29(1.08-1.54), 1.74(1.46-2.07), 2.81(2.35-3.36);the risk of low HDL were 0.93(0.77-1.13),1.35(1.12-1.61), 1.50(1.25-1.80);the risk of insulin resistance were 0.96(0.77-1.19),1.14(0.92-1.40), 1.81(1.48-2.22)(all P<0.01). Conclusions: Serum UA/Cr is significantly associated with MS in middle-aged and elderly populationin Shanghai. Serum UA/Cr could serve as a biomarker of MS, which contributes to early detection and thereby the intervention of metabolic syndrome and its associated diseases.