炎症因子及脂肪因子与高尿酸血症的关系及民族异质性研究
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摘要
目的：
随着经济的发展、社会富裕程度的提高以及饮食结构的改变，高尿酸血症的患病率逐年上升，且发病出现年轻化趋势。临床诸多研究结果发现，高尿酸血症不仅诱发尿酸性肾病、痛风性关节炎、尿石症、痛风，还常与肥胖、糖尿病、脂代谢紊乱及高血压等疾病并存。研究表明，在不同地区不同民族人群中发病仍存在一定差异。在高尿酸血症发病机制中的相关研究表明，炎症因子和脂肪因子也可能与高尿酸血症关联。本课题利用新疆丰富的民族疾病资源，分析新疆维、哈、汉三个民族尿酸水平及高尿酸血症的发病特征，分析炎症因子和脂肪因子在高尿酸血症疾病中的变化规律以及民族异质性，探讨炎症因子和脂肪因子在高尿酸血症发病机制中的作用及其关联性，从免疫角度探讨高尿酸血症发病机制，为今后采取有效的措施防止高尿酸血症、痛风的发生和提高生活质量提供理论依据，同时也为高尿酸血症相关代谢性疾病的预防及治疗提供新思路。
方法：
（1）采用随机抽样的方法在新疆少数民族聚居地阿勒泰市，布尔津县、哈巴河县、福海县，伊犁地区尼勒克县、新源县等医院及我校各附属医院体检者及门诊、住院者中选择维吾尔族、哈萨克族、汉族人群作为研究对象，进行流行病学调查；
（2）对研究对象一般健康指标及生化指标进行检测；
（3）采用ELASA方法检测炎症因子TNF-α、IL-6、CRP以及脂肪因子FFA、Visfatin、APN、Leptin、Resistin；
（4）通过现代统计分析方法分析炎症因子及脂肪因子与高尿酸血症的民族异质性。
结果：
（1）维、哈、汉三民族高尿酸血症发病特征：1）不同民族尿酸水平表现出民族异质性：汉族高于维吾尔族，维吾尔族又高于哈萨克族，差异有统计学意义（F＝17.823，P＝0.000）；2）不同民族尿酸水平及高尿酸血症表现出性别差异：三个民族男性均高于女性（t_汉＝11.104，P＝0.000；t维＝8.607，P＝0.000；t哈＝6.484，P＝0.000）；3）不同民族尿酸水平表现出年龄变化趋势：维吾尔族、哈萨克族及汉族男性的尿酸水平随年龄变化不大，尤其维吾尔族随年龄增长，尿酸值反而下降；但相反，女性的尿酸水平均是从30岁以后随年龄增长而增长的，汉族女性的尿酸增长幅度最大，均在40岁左右开始出现明显的增幅；维吾尔族分性别后男女的尿酸水平均随年龄变化而变化（P＜0.05）；哈萨克族无论群体还是分性别，尿酸与年龄间均没有发现变化的趋势；汉族群体中尿酸随年龄变化，而分性别后仅女性有明显的变化趋势；4）高尿酸血症与高血压、高血糖、高血脂及肥胖等密切相关（P＜0.01），有高尿酸血症者罹患以上疾病的危险系数分别为正常对照组的1.378倍、1.886倍、2.456倍、1.717倍；但不同民族之间仍存在一定差异，维吾尔族与高血脂、高血糖以及肥胖密切相关，与高血压相关性不大；哈萨克族与高血压、高血脂以及肥胖密切相关，但与高血糖相关性不大；而汉族与高血压、高血脂、高血糖及肥胖的相关性均有统计学意义（P＜0.05）。
（2）炎症因子TNF-α、IL-6、CRP与高尿酸血症的关系及民族异质性：1）炎症因子TNF-α、IL-6、CRP在维、哈、汉三民族间总体差异有统计学意义（P＜0.01），再进一步作多重比较又得出，各炎症因子除了CRP在维汉民族间差异没有统计学意义外（P＝0.094），其他各因子各民族两两间比较差异均有统计学意义（P＜0.05）。分别分析高尿酸血症组以及对照组中三个民族炎症因子的差异时发现，在高尿酸血症组中，TNF-α除了维哈间、CRP除了维汉间及哈汉间外，其余变量在民族间两两比较差异均有统计学意义（P＜0.05）；在对照组中，除了TNF-α在维汉间、IL-6在维汉间、CRP在维汉间及在哈汉间外，其余变量在民族间两两比较差异均有统计学意义（P＜0.01）；2）TNF-α在维吾尔族及汉族的高尿酸血症组与对照组间差异有统计学意义（P＜0.05），而在哈萨克族两组间的比较差异没有统计学意义（P＞0.05），从相关性分析发现，仅维吾尔族的TNF-α与SUA呈现正相关（P＜0.05），而汉族仅是女性的TNF-α与SUA呈现正相关（P＜0.05）；IL-6在维吾尔族、哈萨克族及汉族的高尿酸血症组与对照组的比较中，差异均有统计学意义（P＜0.05），从相关性分析也发现，IL-6在三个民族中与SUA均呈现相关（P＜0.05），按性别分组后，女性的IL-6也与SUA呈现密切相关（P＜0.05）；CRP与三个民族高尿酸血症没有直接相关性（P＞0.05）；3）维吾尔族TNF-α和IL-6均与CREA相关，按性别分组比较后，男性CRP与TG呈正相关，维吾尔族女性TNF-α与BUN及CREA均呈正相关；汉族TNF-α与血压关系密切，即使在调整了年龄和性别后，仍然与血压呈现正相关；汉族IL-6与体质指数BMI呈现正相关；当按性别分组后，女性TNF-α与腰高比WHTR呈正相关，而IL-6与BMI、WHTR、以及血糖FPG均呈现正相关，与HDL-C呈现负相关；汉族的女性中IL-6与HDL-C呈现负相关（P＜0.05）；4）维、哈、汉三民族按不同尿酸水平进行分级后比较各炎症因子的变化趋势分析时发现：维吾尔族TNF-α与IL-6均是以SUA-2与SUA-3为界线，且随SUA水平升高炎症水平升高；哈萨克族仅IL-6以SUA-2与SUA-3为界线，不同的是，其随SUA水平的升高而降低，汉族趋势分析结果发现也仅是IL-6在不同尿酸分级水平间差异有统计学意义，且随着SUA水平的升高而升高（P＜0.01）；5）维、哈、汉三民族合并代谢性疾病的组SUA水平均高于单纯HUA组，但仍表现出民族差异：维吾尔族当合并（HUA+DM）时SUA水平最高，哈萨克族当合并（HUA+DM+HL）时SUA水平最高，而汉族为当合并肥胖时SUA水平最高；6）维、哈、汉三民族合并代谢性疾病时炎症因子的差异：维吾尔族TNF-α及IL-6均为在单纯HUA组时水平最低，TNF-α当HUA合并肥胖时水平最高，IL-6当（HUA+DM）时水平最高；汉族的IL-6和CRP水平均为单纯HUA时水平最低，TNF-α和CRP当（HUA+DM+HL）时水平最高，IL-6当HUA合并肥胖时水平最高；
（3）高尿酸血症与脂肪因子FFA、Visfatin、APN、Leptin、Resistin关系及民族异质性研究：1）各脂肪因子在三民族间的差异均有统计学意义（P＜0.01），多重比较分析发现，各脂肪因子除了APN在维汉间差异无统计学意义外，其余各因子在民族的两两比较中差异均有统计学意义；2）维、哈及汉民族高尿酸血症组与对照组比较：FFA在哈萨克族中高尿酸血症组高于对照组，在汉族中高尿酸血症组低于对照组，差异均有统计学意义（P＜0.05），在维吾尔族两组间差异没有统计学意义；Visfatin分别在三个民族的两组间比较差异均有统计学意义（P＜0.05），均是高尿酸血症组高于对照组；APN在维吾尔族中为高尿酸血症组低于对照组，在哈萨克族中为高尿酸血症组高于对照组，差异均有统计学意义（P＜0.05），在汉族两组间比较差异没有统计学意义；Leptin在维吾尔族中为高尿酸血症组高于对照组，在哈萨克族中为高尿酸血症组低于对照组，在汉族两组间比较差异没有统计学意义；而Resistin在维吾尔族两组间比较，高尿酸血症组高于对照组，在哈萨克族两组间比较高尿酸血症组低于对照组，在汉族两组间比较差异没有统计学意义；3）性别差异比较发现，在整个人群中，仅Visfatin、APN及Leptin存在性别差异，其中Visfatin水平为男性显著高于女性，而APN和Leptin水平均为女性显著高于男性（P＜0.01）；按民族分，仅哈萨克族在以上指标中不存在性别差异（P＞0.05）；4）维吾尔族除了FFA外，Visfatin、APN、Leptin、Resistin与血清尿酸均呈现相关性（P＜0.05），其中APN与SUA呈现负相关（P＜0.05）；哈萨克族仅Visfatin、APN、Leptin与SUA有直接相关，其中Leptin与SUA呈负相关，FFA和Resistin与SUA无直接相关性（P＞0.05）；汉族仅FFA和Visfatin与SUA呈现正相关，其中FFA与SUA呈负相关；5）维吾尔族按性别分组后发现男性除了以上的相关外APN与TG呈现负相关；Leptin与TG呈正相关；Resistin与TG呈正相关，而与SBP呈负相关。女性除了以上的相关外，FFA与SUA呈正相关，与TC呈正相关；Visfatin与TC呈正相关，与WHR呈正相关；APN与BMI呈负相关；Resistin与TC呈负相关；哈萨克族相关性分析发现，FFA与HbAlc呈现负相关；Visfatin与HbAlc呈现负相关，与FINS呈负相关；APN与FINS呈现正相关，与HOMA-IR呈正相关；Leptin与收缩压SBP呈现负相关，与WHR呈现负相关；Resistin与HbAlc呈现正相关。按性别分组后，除以上相关外，男女性Visfatin均与TC呈正相关；男性APN与WHTR呈负相关。汉族相关性分析可见，FFA与TC呈正相关；Visfatin与BMI、WHTR、TG、均呈正相关，而与HDL-C呈负相关；APN与WHR呈负相关；Leptin与SBP、DBP、BMI、WHTR、TC、LDL-C及CREA均呈现正相关。按性别分组后，除以上相关外，男性FFA与LDL-C呈正相关，男性Leptin与TG呈正相关；而女性Leptin与SUA呈正相关，与TG呈正相关，与HDL-C呈负相关，与FPG呈正相关（P＜0.05）；6）多元逐步回归分析发现，在高尿酸血症的发生中，维吾尔族和汉族中CRP均从不同程度影响Resistin水平，相关性分析也发现，维吾尔族Resistin与TNF-α、IL-6、CRP均呈现正相关，汉族Resistin与TNF-α、CRP均呈现正相关。
结论：
（1）血尿酸水平表现出民族差异：汉族高于维吾尔族，维吾尔族又高于哈萨克族，汉族是相对最易高发高尿酸血症的民族，哈萨克族是相对低发的民族；由民族间的比较发现在高尿酸血症发生中合并的代谢异常指标越多，则血尿酸水平也越高，疾病的发生几率也越大；
（2）三个民族中男性血尿酸水平的发生均远高于女性；
（3）维吾尔族和哈萨克族尿酸水平均随年龄变化而变化，但哈萨克族高尿酸血症的发生与年龄无关；
（4）炎症因子TNF-α、IL-6、CRP在维、哈、汉三民族间差异有统计学意义，维吾尔族、汉族血尿酸水平对炎症因子有影响，哈萨克族中炎症因子未对血尿酸造成直接影响；
（5）在高尿酸血症组与对照组的比较中炎症因子呈现民族差异；且与代谢异常指标密切相关，当合并代谢异常指标时，炎症水平升高。维、哈、汉三民族合并代谢异常指标后SUA水平均高于单纯HUA组，不同民族存在差异，推测炎症因子参与了代谢性疾病的发生以及病理变化的过程；
（6）脂肪因子在不同民族中的表现存在差异，且与血尿酸水平相关；Visfatin与Leptin水平可能是联系肥胖与高尿酸血症的中间环节；维吾尔族中Resistin可能也是作为肥胖和高尿酸血症联系的纽带；APN在不同民族中表现不一，但仍然可以认为空腹血清APN降低可能是高尿酸血症的保护因子；
（7）在高尿酸血症的发生中，维吾尔族和汉族中CRP均从不同程度影响Resistin水平，相关性分析也发现，维吾尔族Resistin与TNF-α、IL-6、CRP均呈现正相关，汉族Resistin与TNF-α、CRP均呈现正相关，推测高尿酸血症是否也是倾向于一种亚临床炎症发病机制，从抵抗素表达与CRP等炎症因子的密切相关关系给我们提示，炎症反应很可能影响到血清Resistin水平，可能成为调节人类抵抗素表达的诱因之一；
（8）APN能间接影响高尿酸血症的发生发展；Leptin能负性调节FFA的水平；Resistin间接受炎症反应的影响而与高尿酸血症密切相关。
Objectives:
With the economic developed and the improvement in the level of social well-off aswell as diet changes, the prevalence of hyperuricemia increased year by year, and theincidence getting younger and younger. Many of the clinical findings found thathyperuricemia is not only induced uric acid nephropathy, gouty arthritis, urolithiasis, gout,and they often coexist with obesity, diabetes, lipid metabolism disorders and high bloodpressure. Many study have shown that there are still some differences in different parts ofthe population incidence. In the pathogenesis of hyperuricemia studies have shown thatinflammatory factors and adipokines may also be associated with hyperuricemia. Thissubject used the rich resources of the national disease in Xinjiang, to analysis uric acidlevels and clinical characteristics of hyperuricemia among Xinjiang Uygur, Kazakh, Hanethnic groups, to analysis variation and ethnic heterogeneity of cytokine and adipokine inthe hyperuricemia, Explore the role and relevance of inflammatory factors and adipokinesin the pathogenesis of hyperuricemia, and to explore the pathogenesis of hyperuricemiafrom the immunological point, to provide a theoretical basis for taking effective measuresto prevent hyperuricemia, gout incidence and improve the quality of life in future, toprovide new ideas for prevention and treatment of hyperuricemia related metabolicdisorders.
Methods:
(1) By random sampling method to collect samples of Uygur, Kazak, Han inXinjiang, where ethnic minorities live in compact communities: the city of Altay, BurqinCounty, Habahe County Fuhai County, Nileke County and Xinyuan County and theUniversity Affiliated Hospitals to conduct epidemiological investigations;
(2) To detecte general health indicators and biochemical parameters;
(3) Measured by ELISA of inflammatory cytokines: TNF-α, IL-6and CRP andadipocytokines: FFA, Visfatin, APN, Leptin and Resistin.
Results:
(1) Clinical characteristics of hyperuricemia in Uygur, Kazak, Han:1) Uric acidlevels of different ethnic groups showed ethnic heterogeneity: Han’s is higher than theUygur’s, The Uygur’s is higher than the Kazak’s (F＝17.823, P＝0.000);2) The levels ofuric acid and incidence of hyperuricemia showed gender differences on different nation:men’s is higher than women’s (t汉＝11.104, P＝0.000; t维＝8.607, P＝0.000; t哈＝6.484,P＝0.000);3) The uric acid levels showed age trends on d ifferent ethnic: Men's uric acidlevels changed little with age, especially Uygur age decreasing with uric acid levelsincreasing; but on the contrary, women's uric acid levels after the age of30increasedwith age growth. Han women's uric acid level has largest increase and marked increase inthe40-year-old; The uric acid levels of Uygur changed with age changed (P＜0.05); andfound no trends between uric acid and age in Kazak; uric acid level in the Han populationchanged with age, but after gendering was only women have a significant trend;4)Hyperuricemia was with closely related to hypertension, high blood sugar, highcholesterol and obesity (P＜0.01), the risk coefficient of hyperuricemia who suffer fromthose diseases is1.378,1.886,2.456and1.717times; There were still some differencesbetween the different ethnic groups: Hyperuricemia onUygur was closely related to highcholesterol, high blood sugar and obesity but hypertension (P＜0.01); Hyperuricemia onKazak was closely related to hypertension, high cholesterol and obesity but high bloodsugar (P＜0.01); The correlation between hyperuricemia on Han with high bloodpressure, high cholesterol, high blood sugar and obesity was statistically significant (P＜0.05);
(2) Relationship and ethnic heterogeneity between inflammatory cytokines andhyperuricemia:1) The difference of nflammatory cytokines was statistically significantamong three ethnics (P＜0.01), in addition to CRP which was no significant differencebetween Uygur and Han (P＝0.094) that there were significant differences between anytwo ethnics on other cytokines (P＜0.05). In the hyperuricemia group, in addition to theUygur and Kazak compare on TNF-α (P＝0.281), Uygur and Han compare on CRP (P＝0.223), Kazak and Han compare on CRP (P＝0.264), there were significant differencesbetween the two ethnic on the remaining variables (P＜0.05); In the control group, inaddition to the Uygur and Han compare on TNF-α (P＝0.486), the Uygur and Han compare on IL-6(P＝0.468), the Uygur and Han compare on CRP (P＝0.260), the Kazakand Han compare on CRP (P＝0.092), there were significant differences between the twoethnic on the remaining variables (P＜0.05);2) There was significant difference betweenhyperuricemia group and control group of Uygur and Han on TNF-α (P＜0.05), but thedifference in Kazakh between the two groups was not statistically significant (P＞0.05).TNF-α and SUA was positively correlated Only in Uygur (P＜0.05). There was onlywomen’s TNF-α was positively correlated with SUA in Han (P＜0.05). There wassignificant difference between hyperuricemia group and control group of Uygur and Hanon IL-6(P＜0.05).IL-6and SUA was positively correlated on three ethnic.There were nodirect correlation on CRP of three ethnic groups with hyperuricemia (P＞0.05);3) TheTNF-α and IL-6are associated with CREA on Uygur (r＝0.138, P＝0.005and r＝0.139,P＝0.011); There was a positive correlation between CRP and TG on men (r＝0.183, P＝0.011); There was a positive correlation between TNF-α and BUN, CREA on womenof Uygur (r＝0.142, P＝0.045and r＝0.180, P＝0.011); TNF-α and blood pressure isclosely related on Han (r＝0.146, P＝0.004and r＝0.116, P＝0.021); There was apositive correlation between IL-6and BMI on Han (r＝0.121, P＝0.016);4) Trendanalysis of various inflammatory factors in the classification of uric acid levels on thethree national found that with SUA levels increased the levels of TNF-α and IL-6wereincreased on Uygur;but only IL-6in Han and in the contrary of IL-6on Kazak (P＜0.01);5) The HUA group associated with metabolic diseases which level of SUA were higherthan those of Simple HUA group among three ethnic: the level of SUA was highest onUygur when combined (HUA+DM); when combined (HUA+DM+HL) on Kazak;whencombined obesity on Han;6) The differences of inflammatory factors among threeethnics when HUA combined with metabolic diseases: the levels of TNF-α and IL-6werelowest on simple HUA group on Uygur, there was highest level on TNF-α when HUAcombined with obesity and there was highest level on IL-6when HUA combined with(HUA+DM); the levels of CRP and IL-6were lowest on simple HUA group on Han,there was highest level on TNF-α and CRP when HUA combined with (HUA+DM+HL),and there was highest level on IL-6when HUA combined with obesity.
(3) Relationship and ethnic heterogeneity between adipokines and hyperuricemia:1)The difference of adipokines was statistically significant among three ethnics (P＜0.01),in addition to APN which was no significant difference between Uygur and Han thatthere were significant differences between any two ethnics on other cytokines (P＜0.05);2) The comparation between Hyperuricemia group and the control group on three ethnics: The level of FFA on HUA group was higher than it on the control group in the Kazakh,and in the contray on Han (P＜0.05), but no Statistically significant on Uygur; Therewere significant differences between HUA group and the control group with Visfatin onthree ethnics (P＜0.05), the former was higher than the latter; The level of APN on HUAgroup was lower than it on the control group on Uygur, and in the contray on Kazak (P＜0.05), there was no significant differences on Han. The level of Leptin on HUA groupwas higher than it on the control group on Uygur, and in the contray on Kazak (P＜0.05),there was no significant differences on Han; The level of Resistin on HUA group washigher than it on the control group on Uygur, and in the contray on Kazak (P＜0.05),there was no significant differences on Han;3) Gender differences found that OnlyVisfatin, APN and Leptin has differences: The level of Visfatin on men was higher thanwomen’s (t＝3.940, P＝0.000); The level of APN and Leptin on men was lowerr thanwomen’s (t＝-2.440, P＝0.015, t＝-9.454, P＝0.000); The were gender differences onUygur and Han but Kazak (P＞0.05);4) In addition to FFA, the level of Visfatin, APN,Leptin, Resistin were significantly correlated with SUA (P＜0.05)(there was negativecorrelation between APN and SUA); There were significantly correlation between SUAwith Visfatin, APN, Leptin on Kazak (r_(Visfatin)＝0.150, P＝0.010; rAPN＝0.219, P＝0.000;rLeptin＝-0.115, P＝0.048); There were significantly correlation between SUA with FFAand Visfatin on Han (r_(FFA)＝-0.184, P＝0.011; r_(Visfatin)＝0.310, P＝0.000).5) On theoccurrence of hyperuricemia, CRP influenced Resistin from varying degrees.
Conclusions:
(1) The Surem uric acid level of Han is higher than the Uygur, and Uygur’s is higherthan Kazakh, Han is relatively most vulnerable to happen hyperuricemia and Kazak iswith a low incidence; When the hyperuricemia occur with more metabolic abnormalitiesindicators, the serum uric acid level is higher than other group and the probability of theoccurrence of diseases is greater;
(2) Analysis of difference gender, incidence of disease on men is much higher thanwomen in the three ethnic groups;
(3) The serum uric acid changes with age in the Uygur and Kazak, There are norelationship between age and Kazakh hyperuricemia;
(4) We suggested that serum uric acid was as an antioxidant in the Kazakh bodywhich may be trying to increased endogenous antioxidants to protect the body from freeradicalstoxic effects; when Kazakh serum uric acid level is higher than a certain standard (SUA-4) that the trend in this study will be weakened;
(5) The differences were statistically significant by TNF-alpha, IL-6, CRP in threeinter-ethnic, To suggest that we should use different indicators in the prediction ofhyperuricemia in the different ethnic groups and clinics where necessary, and to select thecombined detection of a comprehensive judgment; inflammatory cytokines inhyperuricemia comparison with the control group showing ethnic differences; andmetabolic abnormalities indicators closely associated with metabolic abnormalitiesindicators, elevated levels of inflammation. When the the HUA with metabolicabnormalities indicators of the three national average higher than that HUA group, thereare differences among different ethnic groups, suggesting that inflammatory factorsinvolved in the occurrence of metabolic diseases and pathological changes in the process.We suggest to reduce the level of SUA, TNF-alpha, IL-6which can help prevent theoccurrence and development of metabolic diseases, but also to reduce the occurrence ofcardiovascular and cerebrovascular diseases;
(6) The inflammatory cytokines affect the serum uric acid level in Uygur and Hanbut Kazakh;
(7) Adipocytokines are different among different ethnic groups, different adipokinesthrough a variety of abnormal metabolic pathway related to serum uric acid level;Resistin may also be a tie link with obesity and hyperuricemia; the APN may be aprotective factor for hyperuricemia.
随着经济的发展、社会富裕程度的提高以及饮食结构的改变，高尿酸血症的患病率逐年上升，且发病出现年轻化趋势。临床诸多研究结果发现，高尿酸血症不仅诱发尿酸性肾病、痛风性关节炎、尿石症、痛风，还常与肥胖、糖尿病、脂代谢紊乱及高血压等疾病并存。研究表明，在不同地区不同民族人群中发病仍存在一定差异。在高尿酸血症发病机制中的相关研究表明，炎症因子和脂肪因子也可能与高尿酸血症关联。本课题利用新疆丰富的民族疾病资源，分析新疆维、哈、汉三个民族尿酸水平及高尿酸血症的发病特征，分析炎症因子和脂肪因子在高尿酸血症疾病中的变化规律以及民族异质性，探讨炎症因子和脂肪因子在高尿酸血症发病机制中的作用及其关联性，从免疫角度探讨高尿酸血症发病机制，为今后采取有效的措施防止高尿酸血症、痛风的发生和提高生活质量提供理论依据，同时也为高尿酸血症相关代谢性疾病的预防及治疗提供新思路。
方法：
（1）采用随机抽样的方法在新疆少数民族聚居地阿勒泰市，布尔津县、哈巴河县、福海县，伊犁地区尼勒克县、新源县等医院及我校各附属医院体检者及门诊、住院者中选择维吾尔族、哈萨克族、汉族人群作为研究对象，进行流行病学调查；
（2）对研究对象一般健康指标及生化指标进行检测；
（3）采用ELASA方法检测炎症因子TNF-α、IL-6、CRP以及脂肪因子FFA、Visfatin、APN、Leptin、Resistin；
（4）通过现代统计分析方法分析炎症因子及脂肪因子与高尿酸血症的民族异质性。
结果：
（1）维、哈、汉三民族高尿酸血症发病特征：1）不同民族尿酸水平表现出民族异质性：汉族高于维吾尔族，维吾尔族又高于哈萨克族，差异有统计学意义（F＝17.823，P＝0.000）；2）不同民族尿酸水平及高尿酸血症表现出性别差异：三个民族男性均高于女性（t_汉＝11.104，P＝0.000；t维＝8.607，P＝0.000；t哈＝6.484，P＝0.000）；3）不同民族尿酸水平表现出年龄变化趋势：维吾尔族、哈萨克族及汉族男性的尿酸水平随年龄变化不大，尤其维吾尔族随年龄增长，尿酸值反而下降；但相反，女性的尿酸水平均是从30岁以后随年龄增长而增长的，汉族女性的尿酸增长幅度最大，均在40岁左右开始出现明显的增幅；维吾尔族分性别后男女的尿酸水平均随年龄变化而变化（P＜0.05）；哈萨克族无论群体还是分性别，尿酸与年龄间均没有发现变化的趋势；汉族群体中尿酸随年龄变化，而分性别后仅女性有明显的变化趋势；4）高尿酸血症与高血压、高血糖、高血脂及肥胖等密切相关（P＜0.01），有高尿酸血症者罹患以上疾病的危险系数分别为正常对照组的1.378倍、1.886倍、2.456倍、1.717倍；但不同民族之间仍存在一定差异，维吾尔族与高血脂、高血糖以及肥胖密切相关，与高血压相关性不大；哈萨克族与高血压、高血脂以及肥胖密切相关，但与高血糖相关性不大；而汉族与高血压、高血脂、高血糖及肥胖的相关性均有统计学意义（P＜0.05）。
（2）炎症因子TNF-α、IL-6、CRP与高尿酸血症的关系及民族异质性：1）炎症因子TNF-α、IL-6、CRP在维、哈、汉三民族间总体差异有统计学意义（P＜0.01），再进一步作多重比较又得出，各炎症因子除了CRP在维汉民族间差异没有统计学意义外（P＝0.094），其他各因子各民族两两间比较差异均有统计学意义（P＜0.05）。分别分析高尿酸血症组以及对照组中三个民族炎症因子的差异时发现，在高尿酸血症组中，TNF-α除了维哈间、CRP除了维汉间及哈汉间外，其余变量在民族间两两比较差异均有统计学意义（P＜0.05）；在对照组中，除了TNF-α在维汉间、IL-6在维汉间、CRP在维汉间及在哈汉间外，其余变量在民族间两两比较差异均有统计学意义（P＜0.01）；2）TNF-α在维吾尔族及汉族的高尿酸血症组与对照组间差异有统计学意义（P＜0.05），而在哈萨克族两组间的比较差异没有统计学意义（P＞0.05），从相关性分析发现，仅维吾尔族的TNF-α与SUA呈现正相关（P＜0.05），而汉族仅是女性的TNF-α与SUA呈现正相关（P＜0.05）；IL-6在维吾尔族、哈萨克族及汉族的高尿酸血症组与对照组的比较中，差异均有统计学意义（P＜0.05），从相关性分析也发现，IL-6在三个民族中与SUA均呈现相关（P＜0.05），按性别分组后，女性的IL-6也与SUA呈现密切相关（P＜0.05）；CRP与三个民族高尿酸血症没有直接相关性（P＞0.05）；3）维吾尔族TNF-α和IL-6均与CREA相关，按性别分组比较后，男性CRP与TG呈正相关，维吾尔族女性TNF-α与BUN及CREA均呈正相关；汉族TNF-α与血压关系密切，即使在调整了年龄和性别后，仍然与血压呈现正相关；汉族IL-6与体质指数BMI呈现正相关；当按性别分组后，女性TNF-α与腰高比WHTR呈正相关，而IL-6与BMI、WHTR、以及血糖FPG均呈现正相关，与HDL-C呈现负相关；汉族的女性中IL-6与HDL-C呈现负相关（P＜0.05）；4）维、哈、汉三民族按不同尿酸水平进行分级后比较各炎症因子的变化趋势分析时发现：维吾尔族TNF-α与IL-6均是以SUA-2与SUA-3为界线，且随SUA水平升高炎症水平升高；哈萨克族仅IL-6以SUA-2与SUA-3为界线，不同的是，其随SUA水平的升高而降低，汉族趋势分析结果发现也仅是IL-6在不同尿酸分级水平间差异有统计学意义，且随着SUA水平的升高而升高（P＜0.01）；5）维、哈、汉三民族合并代谢性疾病的组SUA水平均高于单纯HUA组，但仍表现出民族差异：维吾尔族当合并（HUA+DM）时SUA水平最高，哈萨克族当合并（HUA+DM+HL）时SUA水平最高，而汉族为当合并肥胖时SUA水平最高；6）维、哈、汉三民族合并代谢性疾病时炎症因子的差异：维吾尔族TNF-α及IL-6均为在单纯HUA组时水平最低，TNF-α当HUA合并肥胖时水平最高，IL-6当（HUA+DM）时水平最高；汉族的IL-6和CRP水平均为单纯HUA时水平最低，TNF-α和CRP当（HUA+DM+HL）时水平最高，IL-6当HUA合并肥胖时水平最高；
（3）高尿酸血症与脂肪因子FFA、Visfatin、APN、Leptin、Resistin关系及民族异质性研究：1）各脂肪因子在三民族间的差异均有统计学意义（P＜0.01），多重比较分析发现，各脂肪因子除了APN在维汉间差异无统计学意义外，其余各因子在民族的两两比较中差异均有统计学意义；2）维、哈及汉民族高尿酸血症组与对照组比较：FFA在哈萨克族中高尿酸血症组高于对照组，在汉族中高尿酸血症组低于对照组，差异均有统计学意义（P＜0.05），在维吾尔族两组间差异没有统计学意义；Visfatin分别在三个民族的两组间比较差异均有统计学意义（P＜0.05），均是高尿酸血症组高于对照组；APN在维吾尔族中为高尿酸血症组低于对照组，在哈萨克族中为高尿酸血症组高于对照组，差异均有统计学意义（P＜0.05），在汉族两组间比较差异没有统计学意义；Leptin在维吾尔族中为高尿酸血症组高于对照组，在哈萨克族中为高尿酸血症组低于对照组，在汉族两组间比较差异没有统计学意义；而Resistin在维吾尔族两组间比较，高尿酸血症组高于对照组，在哈萨克族两组间比较高尿酸血症组低于对照组，在汉族两组间比较差异没有统计学意义；3）性别差异比较发现，在整个人群中，仅Visfatin、APN及Leptin存在性别差异，其中Visfatin水平为男性显著高于女性，而APN和Leptin水平均为女性显著高于男性（P＜0.01）；按民族分，仅哈萨克族在以上指标中不存在性别差异（P＞0.05）；4）维吾尔族除了FFA外，Visfatin、APN、Leptin、Resistin与血清尿酸均呈现相关性（P＜0.05），其中APN与SUA呈现负相关（P＜0.05）；哈萨克族仅Visfatin、APN、Leptin与SUA有直接相关，其中Leptin与SUA呈负相关，FFA和Resistin与SUA无直接相关性（P＞0.05）；汉族仅FFA和Visfatin与SUA呈现正相关，其中FFA与SUA呈负相关；5）维吾尔族按性别分组后发现男性除了以上的相关外APN与TG呈现负相关；Leptin与TG呈正相关；Resistin与TG呈正相关，而与SBP呈负相关。女性除了以上的相关外，FFA与SUA呈正相关，与TC呈正相关；Visfatin与TC呈正相关，与WHR呈正相关；APN与BMI呈负相关；Resistin与TC呈负相关；哈萨克族相关性分析发现，FFA与HbAlc呈现负相关；Visfatin与HbAlc呈现负相关，与FINS呈负相关；APN与FINS呈现正相关，与HOMA-IR呈正相关；Leptin与收缩压SBP呈现负相关，与WHR呈现负相关；Resistin与HbAlc呈现正相关。按性别分组后，除以上相关外，男女性Visfatin均与TC呈正相关；男性APN与WHTR呈负相关。汉族相关性分析可见，FFA与TC呈正相关；Visfatin与BMI、WHTR、TG、均呈正相关，而与HDL-C呈负相关；APN与WHR呈负相关；Leptin与SBP、DBP、BMI、WHTR、TC、LDL-C及CREA均呈现正相关。按性别分组后，除以上相关外，男性FFA与LDL-C呈正相关，男性Leptin与TG呈正相关；而女性Leptin与SUA呈正相关，与TG呈正相关，与HDL-C呈负相关，与FPG呈正相关（P＜0.05）；6）多元逐步回归分析发现，在高尿酸血症的发生中，维吾尔族和汉族中CRP均从不同程度影响Resistin水平，相关性分析也发现，维吾尔族Resistin与TNF-α、IL-6、CRP均呈现正相关，汉族Resistin与TNF-α、CRP均呈现正相关。
结论：
（1）血尿酸水平表现出民族差异：汉族高于维吾尔族，维吾尔族又高于哈萨克族，汉族是相对最易高发高尿酸血症的民族，哈萨克族是相对低发的民族；由民族间的比较发现在高尿酸血症发生中合并的代谢异常指标越多，则血尿酸水平也越高，疾病的发生几率也越大；
（2）三个民族中男性血尿酸水平的发生均远高于女性；
（3）维吾尔族和哈萨克族尿酸水平均随年龄变化而变化，但哈萨克族高尿酸血症的发生与年龄无关；
（4）炎症因子TNF-α、IL-6、CRP在维、哈、汉三民族间差异有统计学意义，维吾尔族、汉族血尿酸水平对炎症因子有影响，哈萨克族中炎症因子未对血尿酸造成直接影响；
（5）在高尿酸血症组与对照组的比较中炎症因子呈现民族差异；且与代谢异常指标密切相关，当合并代谢异常指标时，炎症水平升高。维、哈、汉三民族合并代谢异常指标后SUA水平均高于单纯HUA组，不同民族存在差异，推测炎症因子参与了代谢性疾病的发生以及病理变化的过程；
（6）脂肪因子在不同民族中的表现存在差异，且与血尿酸水平相关；Visfatin与Leptin水平可能是联系肥胖与高尿酸血症的中间环节；维吾尔族中Resistin可能也是作为肥胖和高尿酸血症联系的纽带；APN在不同民族中表现不一，但仍然可以认为空腹血清APN降低可能是高尿酸血症的保护因子；
（7）在高尿酸血症的发生中，维吾尔族和汉族中CRP均从不同程度影响Resistin水平，相关性分析也发现，维吾尔族Resistin与TNF-α、IL-6、CRP均呈现正相关，汉族Resistin与TNF-α、CRP均呈现正相关，推测高尿酸血症是否也是倾向于一种亚临床炎症发病机制，从抵抗素表达与CRP等炎症因子的密切相关关系给我们提示，炎症反应很可能影响到血清Resistin水平，可能成为调节人类抵抗素表达的诱因之一；
（8）APN能间接影响高尿酸血症的发生发展；Leptin能负性调节FFA的水平；Resistin间接受炎症反应的影响而与高尿酸血症密切相关。
Objectives:
With the economic developed and the improvement in the level of social well-off aswell as diet changes, the prevalence of hyperuricemia increased year by year, and theincidence getting younger and younger. Many of the clinical findings found thathyperuricemia is not only induced uric acid nephropathy, gouty arthritis, urolithiasis, gout,and they often coexist with obesity, diabetes, lipid metabolism disorders and high bloodpressure. Many study have shown that there are still some differences in different parts ofthe population incidence. In the pathogenesis of hyperuricemia studies have shown thatinflammatory factors and adipokines may also be associated with hyperuricemia. Thissubject used the rich resources of the national disease in Xinjiang, to analysis uric acidlevels and clinical characteristics of hyperuricemia among Xinjiang Uygur, Kazakh, Hanethnic groups, to analysis variation and ethnic heterogeneity of cytokine and adipokine inthe hyperuricemia, Explore the role and relevance of inflammatory factors and adipokinesin the pathogenesis of hyperuricemia, and to explore the pathogenesis of hyperuricemiafrom the immunological point, to provide a theoretical basis for taking effective measuresto prevent hyperuricemia, gout incidence and improve the quality of life in future, toprovide new ideas for prevention and treatment of hyperuricemia related metabolicdisorders.
Methods:
(1) By random sampling method to collect samples of Uygur, Kazak, Han inXinjiang, where ethnic minorities live in compact communities: the city of Altay, BurqinCounty, Habahe County Fuhai County, Nileke County and Xinyuan County and theUniversity Affiliated Hospitals to conduct epidemiological investigations;
(2) To detecte general health indicators and biochemical parameters;
(3) Measured by ELISA of inflammatory cytokines: TNF-α, IL-6and CRP andadipocytokines: FFA, Visfatin, APN, Leptin and Resistin.
Results:
(1) Clinical characteristics of hyperuricemia in Uygur, Kazak, Han:1) Uric acidlevels of different ethnic groups showed ethnic heterogeneity: Han’s is higher than theUygur’s, The Uygur’s is higher than the Kazak’s (F＝17.823, P＝0.000);2) The levels ofuric acid and incidence of hyperuricemia showed gender differences on different nation:men’s is higher than women’s (t汉＝11.104, P＝0.000; t维＝8.607, P＝0.000; t哈＝6.484,P＝0.000);3) The uric acid levels showed age trends on d ifferent ethnic: Men's uric acidlevels changed little with age, especially Uygur age decreasing with uric acid levelsincreasing; but on the contrary, women's uric acid levels after the age of30increasedwith age growth. Han women's uric acid level has largest increase and marked increase inthe40-year-old; The uric acid levels of Uygur changed with age changed (P＜0.05); andfound no trends between uric acid and age in Kazak; uric acid level in the Han populationchanged with age, but after gendering was only women have a significant trend;4)Hyperuricemia was with closely related to hypertension, high blood sugar, highcholesterol and obesity (P＜0.01), the risk coefficient of hyperuricemia who suffer fromthose diseases is1.378,1.886,2.456and1.717times; There were still some differencesbetween the different ethnic groups: Hyperuricemia onUygur was closely related to highcholesterol, high blood sugar and obesity but hypertension (P＜0.01); Hyperuricemia onKazak was closely related to hypertension, high cholesterol and obesity but high bloodsugar (P＜0.01); The correlation between hyperuricemia on Han with high bloodpressure, high cholesterol, high blood sugar and obesity was statistically significant (P＜0.05);
(2) Relationship and ethnic heterogeneity between inflammatory cytokines andhyperuricemia:1) The difference of nflammatory cytokines was statistically significantamong three ethnics (P＜0.01), in addition to CRP which was no significant differencebetween Uygur and Han (P＝0.094) that there were significant differences between anytwo ethnics on other cytokines (P＜0.05). In the hyperuricemia group, in addition to theUygur and Kazak compare on TNF-α (P＝0.281), Uygur and Han compare on CRP (P＝0.223), Kazak and Han compare on CRP (P＝0.264), there were significant differencesbetween the two ethnic on the remaining variables (P＜0.05); In the control group, inaddition to the Uygur and Han compare on TNF-α (P＝0.486), the Uygur and Han compare on IL-6(P＝0.468), the Uygur and Han compare on CRP (P＝0.260), the Kazakand Han compare on CRP (P＝0.092), there were significant differences between the twoethnic on the remaining variables (P＜0.05);2) There was significant difference betweenhyperuricemia group and control group of Uygur and Han on TNF-α (P＜0.05), but thedifference in Kazakh between the two groups was not statistically significant (P＞0.05).TNF-α and SUA was positively correlated Only in Uygur (P＜0.05). There was onlywomen’s TNF-α was positively correlated with SUA in Han (P＜0.05). There wassignificant difference between hyperuricemia group and control group of Uygur and Hanon IL-6(P＜0.05).IL-6and SUA was positively correlated on three ethnic.There were nodirect correlation on CRP of three ethnic groups with hyperuricemia (P＞0.05);3) TheTNF-α and IL-6are associated with CREA on Uygur (r＝0.138, P＝0.005and r＝0.139,P＝0.011); There was a positive correlation between CRP and TG on men (r＝0.183, P＝0.011); There was a positive correlation between TNF-α and BUN, CREA on womenof Uygur (r＝0.142, P＝0.045and r＝0.180, P＝0.011); TNF-α and blood pressure isclosely related on Han (r＝0.146, P＝0.004and r＝0.116, P＝0.021); There was apositive correlation between IL-6and BMI on Han (r＝0.121, P＝0.016);4) Trendanalysis of various inflammatory factors in the classification of uric acid levels on thethree national found that with SUA levels increased the levels of TNF-α and IL-6wereincreased on Uygur;but only IL-6in Han and in the contrary of IL-6on Kazak (P＜0.01);5) The HUA group associated with metabolic diseases which level of SUA were higherthan those of Simple HUA group among three ethnic: the level of SUA was highest onUygur when combined (HUA+DM); when combined (HUA+DM+HL) on Kazak;whencombined obesity on Han;6) The differences of inflammatory factors among threeethnics when HUA combined with metabolic diseases: the levels of TNF-α and IL-6werelowest on simple HUA group on Uygur, there was highest level on TNF-α when HUAcombined with obesity and there was highest level on IL-6when HUA combined with(HUA+DM); the levels of CRP and IL-6were lowest on simple HUA group on Han,there was highest level on TNF-α and CRP when HUA combined with (HUA+DM+HL),and there was highest level on IL-6when HUA combined with obesity.
(3) Relationship and ethnic heterogeneity between adipokines and hyperuricemia:1)The difference of adipokines was statistically significant among three ethnics (P＜0.01),in addition to APN which was no significant difference between Uygur and Han thatthere were significant differences between any two ethnics on other cytokines (P＜0.05);2) The comparation between Hyperuricemia group and the control group on three ethnics: The level of FFA on HUA group was higher than it on the control group in the Kazakh,and in the contray on Han (P＜0.05), but no Statistically significant on Uygur; Therewere significant differences between HUA group and the control group with Visfatin onthree ethnics (P＜0.05), the former was higher than the latter; The level of APN on HUAgroup was lower than it on the control group on Uygur, and in the contray on Kazak (P＜0.05), there was no significant differences on Han. The level of Leptin on HUA groupwas higher than it on the control group on Uygur, and in the contray on Kazak (P＜0.05),there was no significant differences on Han; The level of Resistin on HUA group washigher than it on the control group on Uygur, and in the contray on Kazak (P＜0.05),there was no significant differences on Han;3) Gender differences found that OnlyVisfatin, APN and Leptin has differences: The level of Visfatin on men was higher thanwomen’s (t＝3.940, P＝0.000); The level of APN and Leptin on men was lowerr thanwomen’s (t＝-2.440, P＝0.015, t＝-9.454, P＝0.000); The were gender differences onUygur and Han but Kazak (P＞0.05);4) In addition to FFA, the level of Visfatin, APN,Leptin, Resistin were significantly correlated with SUA (P＜0.05)(there was negativecorrelation between APN and SUA); There were significantly correlation between SUAwith Visfatin, APN, Leptin on Kazak (r_(Visfatin)＝0.150, P＝0.010; rAPN＝0.219, P＝0.000;rLeptin＝-0.115, P＝0.048); There were significantly correlation between SUA with FFAand Visfatin on Han (r_(FFA)＝-0.184, P＝0.011; r_(Visfatin)＝0.310, P＝0.000).5) On theoccurrence of hyperuricemia, CRP influenced Resistin from varying degrees.
Conclusions:
(1) The Surem uric acid level of Han is higher than the Uygur, and Uygur’s is higherthan Kazakh, Han is relatively most vulnerable to happen hyperuricemia and Kazak iswith a low incidence; When the hyperuricemia occur with more metabolic abnormalitiesindicators, the serum uric acid level is higher than other group and the probability of theoccurrence of diseases is greater;
(2) Analysis of difference gender, incidence of disease on men is much higher thanwomen in the three ethnic groups;
(3) The serum uric acid changes with age in the Uygur and Kazak, There are norelationship between age and Kazakh hyperuricemia;
(4) We suggested that serum uric acid was as an antioxidant in the Kazakh bodywhich may be trying to increased endogenous antioxidants to protect the body from freeradicalstoxic effects; when Kazakh serum uric acid level is higher than a certain standard (SUA-4) that the trend in this study will be weakened;
(5) The differences were statistically significant by TNF-alpha, IL-6, CRP in threeinter-ethnic, To suggest that we should use different indicators in the prediction ofhyperuricemia in the different ethnic groups and clinics where necessary, and to select thecombined detection of a comprehensive judgment; inflammatory cytokines inhyperuricemia comparison with the control group showing ethnic differences; andmetabolic abnormalities indicators closely associated with metabolic abnormalitiesindicators, elevated levels of inflammation. When the the HUA with metabolicabnormalities indicators of the three national average higher than that HUA group, thereare differences among different ethnic groups, suggesting that inflammatory factorsinvolved in the occurrence of metabolic diseases and pathological changes in the process.We suggest to reduce the level of SUA, TNF-alpha, IL-6which can help prevent theoccurrence and development of metabolic diseases, but also to reduce the occurrence ofcardiovascular and cerebrovascular diseases;
(6) The inflammatory cytokines affect the serum uric acid level in Uygur and Hanbut Kazakh;
(7) Adipocytokines are different among different ethnic groups, different adipokinesthrough a variety of abnormal metabolic pathway related to serum uric acid level;Resistin may also be a tie link with obesity and hyperuricemia; the APN may be aprotective factor for hyperuricemia.
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