浦兴社区老年人体质指数、腰围、颈围与高尿酸血症的关系研究
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摘要
背景社区慢性病防治是一种综合管理,包括高尿酸血症(HUA)的防治。HUA相关危险因素较多,如肥胖、代谢异常性疾病、心脑血管疾病以及慢性肾脏病等。然而,以往肥胖与HUA的相关性研究显示的结果不同。目的探讨浦兴社区老年人体质指数(BMI)、腰围、颈围与HUA的关系。方法选取2015年4—6月于上海市浦东新区浦兴社区卫生服务中心参加老年人免费体检的65～99岁的老年人4 364例,调查BMI、腰围、颈围以及HUA其他相关因素[吸烟、饮酒、高血压史、糖尿病史、尿酸、空腹血糖、总胆固醇、三酰甘油、尿素、肌酐、总胆红素、丙氨酸氨基转移酶(ALT)、估算肾小球滤过率(eGFR)]。男性及绝经后女性血清尿酸>420μmol/L定义为HUA诊断标准。根据HUA检出情况分为高尿酸组(n=610)与尿酸正常组(n=3 754),比较两组的一般情况。根据BMI将研究对象分为低体质量、正常体质量、超重与肥胖,根据腰围四分位数分为A1(男<82.2 cm,女<78.0 cm)、A2(男82.2～<88.5 cm,女78.0～<85.0 cm)、A3(男88.5～<94.0 cm,女85.0～<92.0 cm)、A4(男≥94.0 cm,女≥92.0 cm);根据颈围四分位数分为B1(男<35.0 cm,女<31.0 cm)、B2(男35.0～<37.0 cm,女31.0～<33.0 cm)、B3(男37.0～<38.0 cm,女33.0～<35.0 cm)、B4(男≥38.0 cm,女≥35.0 cm);分析不同性别HUA检出率与年龄、BMI、腰围、颈围的关系。采用多因素Logistic回归分析BMI、腰围、颈围与HUA的相关性。结果高尿酸组年龄、高血压史、BMI、腰围、颈围、收缩压、舒张压、尿酸、三酰甘油、尿素、肌酐、总胆红素、ALT、eGFR、超重和肥胖发生率、腹型肥胖发生率、颈围超标发生率、高血压发生率、eGFR下降发生率与尿酸正常组比较,差异有统计学意义(P<0.05)。男、女性HUA检出率均随年龄增长逐渐升高(P<0.05);男、女性HUA检出率均随着BMI、腰围、颈围升高而升高(P值均<0.05)。BMI、腰围、颈围分别建模,调整性别、年龄、吸烟情况、饮酒情况、总胆固醇、三酰甘油、总胆红素、ALT、高血压发生情况、糖尿病发生情况后,进行多因素Logistic回归分析,结果显示,BMI、腰围、颈围与HUA均有相关性(P值均<0.05)。BMI每增加1个标准差(3.4 kg/m~2),HUA检出风险升高42%;腰围每增加1个标准差(9.5 cm),HUA检出风险升高38%;颈围每增加1个标准差(3.3 cm),HUA检出风险升高29%。进一步相互调整3项肥胖指标后,进行多因素Logistic回归分析,结果显示,BMI与HUA有相关性(P<0.05)。此外,男性、三酰甘油、eGFR下降、高血压、糖尿病与HUA有相关性(P<0.05)。结论 BMI、腰围、颈围与HUA均有相关性,但调整相关因素后,仅BMI与HUA有相关性,因此与腰围或颈围相比,BMI可能与老年人HUA的关系更密切。
Background The prevention and treatment of chronic diseases[including hyperuricemia(HUA)]in communities are a kind of comprehensive management for such diseases.Many factors,such as obesity,metabolic disorders,cardiovascular disease,cerebrovascular disease,and chronic kidney disease are associated with the risk of increased HUA.However,previous studies linking obesity to HUA have shown different results.Objective To assess the association between diverse measures of obesity[body mass index(BMI),waist circumference(WC) and neck circumference(NC)]and HUA in the elderly in Puxing Community.Methods Elderly(65-99 years old) people(n=4 364) were recruited from the Puxing Community,Pudong New District,Shanghai.All of them participated in the free physical examination delivered by the Puxing Community Health Center during April to June,2015.A cross-sectional survey was used to collected the data concerning BMI,WC and NC,and other factors associated with HUA[history of smoking and drinking,hypertension,diabetes,levels of uric acid(UA)fasting plasma glucose(FPG),total cholesterol(TC),triacylglycerol(TG),urea,creatinine(Cr),total bilirubin,ALT and estimated glomerular filtration rate(eGFR)].They were divided into high sUA group(n=610) and normal UA group(n=3 754) according to the level of UA(UA>420 μmol/L in men and postmenopausal women was defined as the diagnostic criterion for HUA).And personal characteristics of both groups were compared.By BMI,the participants were stratified into underweight,normal weight,overweight,and obesity.On the basis of the quartile of WC,they were assigned to A1(WC<82.2 cm for men,<78.0 cm for women),A2(82.2 cm ≤ WC<88.5 cm for men,78.0 cm ≤ WC<85.0 cm for women),A3(88.5 cm ≤ WC<94.0 cm for men,85.0 cm ≤ WC<92.0 cm for women),A4(WC ≥ 94.0 cm for men,≥ 92.0 cm for women).They were also divided into 4 groups according to the quartile of NC,B1(NC<35.0 cm for men,<31.0 cm for women),B2(35.0 cm ≤ NC<37.0 cm for men,31.0 cm ≤ NC<33.0 cm for women),B3(37.0 cm ≤ NC<38.0 cm for men,33.0 cm ≤ NC<35.0 cm for women),B4(NC ≥ 38.0 cm for men, ≥ 35.0 cm for women).The relationships of HUA prevalence with BMI,WC and NC were analyzed by sex.Multivariable Logistic regression analyses were also performed to investigate the relationships of HUA prevalence with BMI,WC and NC.Results The average age,history of hypertension,BMI,WC,NC,systolic and diastolic blood pressure,UA,TG,urea,SCr,total bilirubin,ALT and eGFR,prevalence of overweight and obesity,abdominal obesity,increased NC,hypertension,and decreased eGFR were significant different between high UA group and normal UA group(all P<0.05).The prevalence of HUA significantly increased with the growth of age,BMI,WC,and NC in both men and women(P<0.05).After adjusting for sex,age,smoking,drinking,TC,TG,total bilirubin,ALT,hypertension,and diabetes,multivariate Logistic regression analyses of the models established with the BMI,WC and NC data showed that BMI,WC and NC were all associated with HUA(P<0.001).The prevalence of HUA increased by 42%,38%,29%,respectively,with every 1-standard deviation(3.4 kg/m~2) increase in BMI,every 1-standard deviation(9.5 cm) increase in WC,and every 1-standard deviation(3.3 cm) increase in NC.After further adjusting for WC and NC,multivariable Logistic regression analyses found that BMI was associated with HUA(P<0.05).In addition,male,TG,decreased eGFR,hypertension and diabetes were associated with HUA(P<0.05).Conclusion BMI,WC and NC were all associated with HUA.But after adjusting for the latter two,BMI was found to be associated with HUA.Compared with WC and NC,BMI might have a stronger association with HUA.
Background The prevention and treatment of chronic diseases[including hyperuricemia(HUA)]in communities are a kind of comprehensive management for such diseases.Many factors,such as obesity,metabolic disorders,cardiovascular disease,cerebrovascular disease,and chronic kidney disease are associated with the risk of increased HUA.However,previous studies linking obesity to HUA have shown different results.Objective To assess the association between diverse measures of obesity[body mass index(BMI),waist circumference(WC) and neck circumference(NC)]and HUA in the elderly in Puxing Community.Methods Elderly(65-99 years old) people(n=4 364) were recruited from the Puxing Community,Pudong New District,Shanghai.All of them participated in the free physical examination delivered by the Puxing Community Health Center during April to June,2015.A cross-sectional survey was used to collected the data concerning BMI,WC and NC,and other factors associated with HUA[history of smoking and drinking,hypertension,diabetes,levels of uric acid(UA)fasting plasma glucose(FPG),total cholesterol(TC),triacylglycerol(TG),urea,creatinine(Cr),total bilirubin,ALT and estimated glomerular filtration rate(eGFR)].They were divided into high sUA group(n=610) and normal UA group(n=3 754) according to the level of UA(UA>420 μmol/L in men and postmenopausal women was defined as the diagnostic criterion for HUA).And personal characteristics of both groups were compared.By BMI,the participants were stratified into underweight,normal weight,overweight,and obesity.On the basis of the quartile of WC,they were assigned to A1(WC<82.2 cm for men,<78.0 cm for women),A2(82.2 cm ≤ WC<88.5 cm for men,78.0 cm ≤ WC<85.0 cm for women),A3(88.5 cm ≤ WC<94.0 cm for men,85.0 cm ≤ WC<92.0 cm for women),A4(WC ≥ 94.0 cm for men,≥ 92.0 cm for women).They were also divided into 4 groups according to the quartile of NC,B1(NC<35.0 cm for men,<31.0 cm for women),B2(35.0 cm ≤ NC<37.0 cm for men,31.0 cm ≤ NC<33.0 cm for women),B3(37.0 cm ≤ NC<38.0 cm for men,33.0 cm ≤ NC<35.0 cm for women),B4(NC ≥ 38.0 cm for men, ≥ 35.0 cm for women).The relationships of HUA prevalence with BMI,WC and NC were analyzed by sex.Multivariable Logistic regression analyses were also performed to investigate the relationships of HUA prevalence with BMI,WC and NC.Results The average age,history of hypertension,BMI,WC,NC,systolic and diastolic blood pressure,UA,TG,urea,SCr,total bilirubin,ALT and eGFR,prevalence of overweight and obesity,abdominal obesity,increased NC,hypertension,and decreased eGFR were significant different between high UA group and normal UA group(all P<0.05).The prevalence of HUA significantly increased with the growth of age,BMI,WC,and NC in both men and women(P<0.05).After adjusting for sex,age,smoking,drinking,TC,TG,total bilirubin,ALT,hypertension,and diabetes,multivariate Logistic regression analyses of the models established with the BMI,WC and NC data showed that BMI,WC and NC were all associated with HUA(P<0.001).The prevalence of HUA increased by 42%,38%,29%,respectively,with every 1-standard deviation(3.4 kg/m~2) increase in BMI,every 1-standard deviation(9.5 cm) increase in WC,and every 1-standard deviation(3.3 cm) increase in NC.After further adjusting for WC and NC,multivariable Logistic regression analyses found that BMI was associated with HUA(P<0.05).In addition,male,TG,decreased eGFR,hypertension and diabetes were associated with HUA(P<0.05).Conclusion BMI,WC and NC were all associated with HUA.But after adjusting for the latter two,BMI was found to be associated with HUA.Compared with WC and NC,BMI might have a stronger association with HUA.
引文
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[2]LIU R,HAN C,WU D,et al.Prevalence of hyperurieemia and gout in mainland China from 2000 to 2014:a systematic review and meta analysis[J].Biomed Res Int,2015,2015:762820.DOI:10.1155/2015/762820.
[3]中国医师协会心血管内科医师分会,中国医师协会循证医学专业委员会.无症状高尿酸血症合并心血管疾病诊治建议中国专家共识[J].中国全科医学,2010,13(11):1145-1149.
[4]邹贵勉,黄江燕,车文体,等.广西城市社区居民高尿酸血症流行病学调查及其与慢性肾脏病的关系[J].中国内分泌代谢杂志,2011,27(7):561-565.DOI:10.3760/cma.j.issn.1000-6699.2011.07.005.ZOU G M,HUANG J Y,CHE W T,et al.An epidemiological study on the prevalence of hyperuricemia and its relationship to chronic kidney disease in the urban community residents of Guangxi[J].Chinese Journal of Endocrinology and Metabolism,2011,27(7):561-565.DOI:10.3760/cma.j.issn.1000-6699.2011.07.005.
[5]李瑞,苗蕾,秦丽岩,等.新疆地区高尿酸血症患者影响因素分析[J].山东医药,2015,55(46):17-19.DOI:10.3969/j.issn.1002-266X.2015.46.006.LI R,MIAO L,QIN L Y,et al.Risk factors for patients with hyperuricemia in Xinjiang area[J].Shandong Medical Journal,2015,55(46):17-19.DOI:10.3969/j.issn.1002-266X.2015.46.006.
[6]王娟,顾红霞,陆帅,等.崇明地区高尿酸血症患病率及其危险因素的流行病学调查[J].中国医师杂志,2013,15(12):1616-1618.DOI:10.3760/cma.j.issn.1008-1372.2013.12.009.WANG J,GU H X,LU S,et al.Epidemiological survey of prevalence of hyperuricemia and its risk factors in adult population of Chongming District,Shanghai[J].Journal of Chinese Physician,2013,15(12):1616-1618.DOI:10.3760/cma.j.issn.1008-1372.2013.12.009.
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