摘要
目的 探讨血清尿酸与高密度脂蛋白胆固醇比值(UHR)与新发动脉粥样硬化性心血管疾病(ASCVD)的关系。方法 采用前瞻性研究方法,以参加2006—2007年标准化健康体检的95 418名开滦集团职工为研究对象。将研究人群按UHR四分位数分为四组:第1四分位组(UHR<142.17μmol/mmol,n=23 859)、第2四分位组(142.17~<184.69μmol/mmol,n=23 851)、第3四分位组(184.69~<240.46μmol/mmol,n=23 857)和第4四分位组(UHR≥240.46μmol/mmol,n=23 851),用Kaplan-Meier法计算各组新发ASCVD的累积发病率,并用Log-Rank检验各组累积发病率的差异。采用多因素Cox回归模型分析UHR对新发ASCVD的影响。结果 随访时间中位数(P_(25),P_(75))为14.94(14.49,15.16)年,随访期间新发ASCVD 11 517例(12.1%)。在校正潜在的混杂因素后,Cox比例风险模型显示,与UHR第1四分位组相比,第3、4四分位组发生ASCVD的风险分别增加6.9%(HR=1.069,95%CI 1.013~1.129)和18.3%(HR=1.183,95%CI 1.121~1.248),第4四分位组发生心力衰竭的风险增加30.0%(HR=1.300,95%CI 1.168~1.446),第3、4四分位组发生心肌梗死及冠状动脉血运重建的风险分别增加12.4%(HR=1.124,95%CI 1.022~1.236)和27.1%(HR=1.271,95%CI 1.157~1.396),第4四分位组发生缺血性脑卒中的风险只增加9.7%(HR=1.097,95%CI 1.020~1.179);UHR每增加一个标准差,ASCVD的发生风险增加5.0%(HR=1.050,95%CI 1.032~1.068)。UHR分组与性别、年龄和高敏C反应蛋白(hsCRP)之间存在交互作用(均P<0.05)。性别分层显示,在男性人群中第4四分位组发生ASCVD的HR(95%CI)为1.150(1.086~1.218),而在女性人群中为1.444(1.224~1.704)。年龄分层显示,年龄45~<60岁人群中第3、4四分位组发生ASCVD的HR(95%CI)分别为1.091(1.012~1.177)和1.228(1.138~1.325),年龄≥60岁人群中第4四分位组发生ASCVD的HR(95%CI)为1.181(1.083~1.287),而在年龄<45岁人群中未能达到统计学意义(P>0.05)。hsCRP分层显示:在hsCRP<3 mg/L人群中第4四分位组发生ASCVD的HR(95%CI)为1.112(1.041~1.187),而在hsCRP≥3 mg/L人群中为1.346(1.224~1.479)。结论 高UHR是ASCVD的危险因素且呈现出性别和年龄差异,应该重点关注女性和中老年(年龄≥45岁)群体;在炎症性疾病(hsCRP≥3 mg/L)人群中UHR对新发ASCVD风险的影响可能更显著。另外,高UHR所致的ASCVD风险可能存在器官特异性,对心血管的影响可能大于对脑血管的影响。
Objective To investigate the association between serum uric acid to high-density lipoprotein cholesterol ratio(UHR)and new-onset atherosclerotic cardiovascular disease(ASCVD).Methods A prospective study was conducted in 95418 employees of Kailuan Group who participated in standardized physical examination from 2006 to 2007.The study population was divided into four groups according to the UHR quartile:The first quartile(UHR<142.17μmol/mmol,n=23859),the second quartile(142.17-<184.69μmol/mmol,n=23851),the third quartile(184.69-<240.46μmol/mmol,n=23857)and the fourth quartile(UHR≥240.46μmol/mmol,n=23851).Kaplan-Meier method was used to calculate the cumulative incidence of new-onset ASCVD among each group,and Log-Rank was used to test the differences of cumulative incidence among the groups.Multivariate Cox regression model was used to analyze the effect of UHR on new-onset ASCVD.Results During a median follow-up of 14.94(P_(25),P_(75):14.49-15.16)years,11517(12.1%)new-onset ASCVD cases were diagnosed.After adjusting for potential confounders,Cox proportional hazard models showed that compared with the subjects in the first quartile of UHR,the subjects in the third and fourth quartile had a 6.9%(HR=1.069,95%CI 1.013-1.129)and 18.3%(HR=1.183,95%CI 1.121-1.248)increased risk of ASCVD,respectively,the subjects in the fourth quartile had a 30.0%(HR=1.300,95%CI 1.168-1.446)increased risk of heart failure,the subjects in the third and fourth quartile groups had a 12.4%(HR=1.124,95%CI 1.022-1.236)and 27.1%(HR=1.271,95%CI 1.157-1.396)increased risk of myocardial infarction and coronary revascularization,and the subjects in the fourth quartile had a 9.7%(HR=1.097,95%CI 1.020-1.179)increased risk of ischemic stroke.The risk of ASCVD increased by 5%(HR=1.050,95%CI 1.032-1.068)for every one standard deviation increase in UHR.There was interactions between UHR group and gender,age,hypersensitive C-reactive proteins(hsCRP)(all P<0.05).The results of stratification analysis by gender showed that compared with the first quartile,the HR(95%CI)value of ASCVD in the fourth quartile was 1.150(1.086-1.218)in the male population and 1.444(1.224-1.704)in the female population.The results of stratification analysis by age showed that compared with the first quartile,the HR(95%CI)values of ASCVD in the third and fourth quartile group were 1.091(1.012-1.177)and 1.228(1.138-1.325)respectively in the subjects aged 45-<60 years old,the HR(95%CI)value of ASCVD in the fourth quartile group was 1.181(1.083-1.287)in the subjects aged≥60 years old,but there was no significant difference in the subjects aged under 45 years old.The HR(95%CI)value was 1.112(1.041-1.187)in the population with hsCRP<3 mg/L,while it was 1.346(1.224-1.479)in the population with hsCRP≥3 mg/L.Conclusions High UHR is a risk factor of ASCVD,and this relationship shows gender and age differences.The focus should be on women and middle-aged and elderly people(≥45 years old).The effect of UHR on the risk of new-onset ASCVD may be more significant in the population with inflammatory disease(hsCRP≥3 mg/L).Moreover,The risk of ASCVD may be organ-specific,with cardiovascular effects greater than cerebrovascular effects.
作者
邱文辉
闫新华
柳培培
龚英峰
张力
张树全
吴寿岭
陈朔华
QIU Wenhui;YAN Xinhua;LIU Peipei;GONG Yingfeng;ZHANG Li;ZHANG Shuquan;WU Shouling;CHEN Shuohua(Department of Laboratory,Luanzhou People's Hospital,Tangshan,Hebei 063700,China;Department of Critical Care Medicine,Luanzhou People's Hospital;School of Public Health,North China University of Science and Technology;Department of Oncology,Luanzhou People's Hospital;Department of Neurosurgery,Luanzhou People's Hospital;Department of Cardiology,Kailuan General Hospital)
出处
《中华高血压杂志(中英文)》
北大核心
2025年第1期47-58,共12页
Chinese Journal of Hypertension
