上海市徐家汇街道老年人高尿酸血症、痛风患病状况及影响因素研究
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摘要
背景我国高尿酸血症(HUA)和痛风患病率逐年上升,HUA和痛风的患病分布具有地域性,分析辖区内居民的患病特征和影响因素可以指导社区防治,但上海市徐家汇街道尚未对辖区内居民的HUA和痛风患病率、患病人口分布等进行统计分析。目的了解上海市徐家汇街道老年人(≥65岁)的HUA和痛风患病状况,并探讨老年人患HUA的影响因素。方法以2016-04-19至2016-10-27、2017-09-04至2017-10-31在徐家汇街道社区卫生服务中心完成体检的2 047例老年人为研究对象。统计社区老年人的HUA、无症状HUA、痛风患病率,并分析其性别、年龄分布情况;采用多元逐步Logistic回归分析老年人患HUA的影响因素。结果老年人的HUA、无症状HUA、痛风患病率分别为24.33%(498/2 047)、23.35%(478/2 047)、5.13%(105/2 047)。男性的痛风患病率高于女性,无症状HUA患病率低于女性(P<0.05);男性、女性的HUA患病率比较,差异无统计学意义(P>0.05)。女性的HUA患病率随年龄增长而增加(P<0.05)。多元逐步Logistic回归分析结果显示,高龄、超重和肥胖、高三酰甘油血症(≥1.70mmol/L)、高ALT(>40 U/L)是老年人患HUA的危险因素(P<0.05)。痛风患者的高血压、糖尿病、脑血管病、冠心病、骨质疏松发生率高于血尿酸正常且无痛风者和无症状HUA患者(P<0.016 7)。结论徐家汇街道老年人的HUA和痛风患病率较高,患HUA的影响因素与既往研究类似。痛风患者的慢性合并症患病率较高,社区应加强对高危居民的管理及对痛风患者合并症的防治。
Background The prevalence of hyperuricemia(HUA) and gout in China has been increasing annually in recent years.Their distribution varies across regions.Investigating the disease characteristics and risk factors in a local area can guide the corresponding prevention and treatment services in community practice.There is no statistical analysis of HUA and gout prevalence and the distribution of such patients in Xujiahui Subdistrict,Shanghai.Objective To investigate the epidemiological characteristics and associated factors of HUA and gout in community-dwelling elderly people aged 65 and over from Xuhui Subdistrict,Shanghai.Methods From Xujiahui Subdistrict Community Health Center,we enrolled a total of 2 047 elderly physical examinees,some of whom were recruited between April 19 and October 27,2016,and others were recruited between September 4 and October 31,2017.We analyzed the prevalence,and sex and age distributions of HUA,asymptomatic HUA and gout in the participants,and determined the associated factors of HUA by using stepwise multiple Logistic regression.ResultsThe prevalence of HUA,asymptomatic HUA,and gout was 24.33%(498/2 047),23.35%(478/2 047) and 5.13%(105/2 047),respectively.Higher gout prevalence and lower asymptomatic HUA prevalence were found in male patients than in female patients(P<0.05).No significant difference was found for HUA between males and females(P>0.05).The HUA prevalence showed an increase with age(P<0.05) in female patients.Regression analysis indicated older age,overweight and obesity,high TG( ≥ 1.70 mmol/L),and high ALT(>40 U/L) were independent risk factors for HUA(P<0.05).The prevalence of hypertension,diabetes,cerebrovascular disease,coronary heart disease and osteoporosis in gout patients was much higher than in those with normal uric acid but without gout or in those with asymptomatic HUA(P<0.016 7).Conclusion The prevalence of HUA and gout in community-dwelling elderly people in Xujiahui Subdistrict is high,with similar HUA associated factors as found in previous studies,and the prevalence of chronic comorbidity of gout is also high,demanding for increased community-based risk management among high-risk residents,as well as prevention and treatment of comorbidity for gout patients.
Background The prevalence of hyperuricemia(HUA) and gout in China has been increasing annually in recent years.Their distribution varies across regions.Investigating the disease characteristics and risk factors in a local area can guide the corresponding prevention and treatment services in community practice.There is no statistical analysis of HUA and gout prevalence and the distribution of such patients in Xujiahui Subdistrict,Shanghai.Objective To investigate the epidemiological characteristics and associated factors of HUA and gout in community-dwelling elderly people aged 65 and over from Xuhui Subdistrict,Shanghai.Methods From Xujiahui Subdistrict Community Health Center,we enrolled a total of 2 047 elderly physical examinees,some of whom were recruited between April 19 and October 27,2016,and others were recruited between September 4 and October 31,2017.We analyzed the prevalence,and sex and age distributions of HUA,asymptomatic HUA and gout in the participants,and determined the associated factors of HUA by using stepwise multiple Logistic regression.ResultsThe prevalence of HUA,asymptomatic HUA,and gout was 24.33%(498/2 047),23.35%(478/2 047) and 5.13%(105/2 047),respectively.Higher gout prevalence and lower asymptomatic HUA prevalence were found in male patients than in female patients(P<0.05).No significant difference was found for HUA between males and females(P>0.05).The HUA prevalence showed an increase with age(P<0.05) in female patients.Regression analysis indicated older age,overweight and obesity,high TG( ≥ 1.70 mmol/L),and high ALT(>40 U/L) were independent risk factors for HUA(P<0.05).The prevalence of hypertension,diabetes,cerebrovascular disease,coronary heart disease and osteoporosis in gout patients was much higher than in those with normal uric acid but without gout or in those with asymptomatic HUA(P<0.016 7).Conclusion The prevalence of HUA and gout in community-dwelling elderly people in Xujiahui Subdistrict is high,with similar HUA associated factors as found in previous studies,and the prevalence of chronic comorbidity of gout is also high,demanding for increased community-based risk management among high-risk residents,as well as prevention and treatment of comorbidity for gout patients.
引文
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[2]LIU R,HAN C,WU D,et al.Prevalence of hyperuricemia and gout in mainland China from 2000 to 2014:a systematic review and meta-analysis[J].Bio Med Research International,2015:762820.DOI:10.1155/2015/762820.
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[9]KRISHNAN E,KWOH C K,SCHUMACHER H R,et al.Hyperuricemia and incidence of hypertension among men without metabolic syndrome[J].Hypertension,2007,49(2):298-303.DOI:10.1161/01.HYP.0000254480.64564.b6.
[10]TANIGUCHI Y,HAYASHI T,TSUMURA K,et al.Serum uric acid and the risk for hypertension and type 2 diabetes in Japanese men:the Osaka Health Survey[J].Journal of Hypertension,2001,19(7):1209-1215.DOI:10.1097/00004872-200107000-00005.
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[12]NISKANEN L K,LAAKSONEN D E,NYYSS?NEN K,et al.Uric acid level as a risk factor for cardiovascular and all-cause mortality in middle-aged men:a prospective cohort study[J].Archives of Internal Medicine,2004,164(14):1546-1551.DOI:10.1001/archinte.164.14.1546.
[13]ALDERMANMH,COHENH,MADHAVANS,etal.Serum uric acid and cardiovascular events in successfully treated hypertensive patients[J].Hypertension,1999,34(1):144-150.DOI:10.1161/01.HYP.34.1.144.
[14]FANG J,ALDERMAN M H.Serum uric acid and cardiovascular mortality the NHANESⅠepidemiologic follow-up study,1971—1992.NationalHealthandNutritionExamination Survey[J].JAMA,2000,283(18):2404-2410.DOI:10.1001/jama.283.18.2404.
[15]TALAAT K M,EL-SHEIKH A R.The effect of mild hyperuricemia on urinary transforming growth factor beta and the progression of chronic kidney disease[J].American Journal of Nephrology,2007,27(5):435-440.DOI:10.1159/000105142.
[16]中华医学会内分泌学分会.高尿酸血症和痛风治疗的中国专家共识[J].中华内分泌代谢杂志,2013,29(11):913-920.DOI:10.3760/cma.j.issn.1000-6699.2013.11.001.Chinese Society of Endocrinology.Chinese expert consensus on hyperuricemia and gout treatment[J].Chinese Journal of Endocrinology and Metabolism,2013,29(11):913-920.DOI:10.3760/cma.j.issn.1000-6699.2013.11.001.
[17]WALLACE S L,ROBINSON H,MASI A T,et al.Preliminary criteria for the classification of the acute arthritis of primary gout[J].Arthritis and Rheumatism,1977,20(3):895-900.DOI:10.1002/art.1780200320.
[18]中华人民共和国卫生部疾病控制司.中国成人超重和肥胖症预防控制指南[M].北京:人民卫生出版社,2006.
[19]王吉耀.内科学[M].3版.北京:人民卫生出版社,2015.
[20]ALBERTIKG,ZIMMETPZ.Definition,diagnosisand classification of diabetes mellitus and its complications.Part 1:diagnosis and classification of diabetes mellitus provisional report of a WHO consultation[J].Diabetic Medicine,1998,15(7):539-553.
[21]陈灏珠.实用内科学[M].北京:人民卫生出版社,2005.
[22]杜蕙,陈顺乐,王元.上海市黄浦区社区高尿酸血症与痛风流行病学调查[J].中华风湿病学杂志,1998,2(2):75-78.DOI:10.3760/j.issn.1007-7480.1998.02.005.DU H,CHEN S L,WANG Y.Epidemiological investigation of hyperuricemia and gout in Huangpu District of Shanghai[J].Chinese Journal of Rheumatology,1998,2(2):75-78.DOI:10.3760/j.issn.1007-7480.1998.02.005.
[23]尹潍.老年人高尿酸血症及痛风的特点[J].中华老年医学杂志,2003,22(6):331-332.DOI:10.3760/j.issn.0254-9026.2003.06.006.YIN W.The investigation and multivariable statistical analysis of hyperuricemia in 1 500 elderly people[J].Chinese Journal of Geriatrics,2003,22(6):331-332.DOI:10.3760/j.issn.0254-9026.2003.06.006.
[24]王宏儒,鲍晓荣.上海市社区老年人高尿酸血症及相关危险因素调查分析[J].中国中西医结合肾病杂志,2017,18(10):869-872.DOI:10.3969/j.issn.1009-587X.2017.10.008.WANG H R,BAO X R.Morbidity and risk factors of hyperuricemia in elderly people from a Shanghai community[J].Chinese Journal of Integrated Traditional and Western Nephrology,2017,18(10):869-872.DOI:10.3969/j.issn.1009-587X.2017.10.008.
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