老年2型糖尿病患者高尿酸血症患病率及其影响因素

目的 调查老年2型糖尿病（T2DM）患者高尿酸血症（HUA）的患病率,分析其影响因素。方法 选择2019年1月—2021年4月于四川大学华西广安医院诊治的老年T2DM患者。收集患者的人口学信息,检测空腹血糖（FBG）、餐后2h血糖（2hPG）、糖化血红蛋白（HbAlc）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、三酰甘油（TG）、血尿素氮（BUN）、血肌酐（Scr）、预估肾小球滤过率（eGFR）、尿微量白蛋白（UMalb）和血尿酸水平。统计患者的HUA患病率并分析其影响因素。结果 共纳入216例老年T2DM患者,年龄60～87岁,平均（74.3±5.2）岁,HUA患病率为35.65%。不同年龄、居住地区老年T2DM患者HUA患病率及血尿酸水平差异有统计学意义（P<0.05）,而不同性别的患者HUA患病率及血尿酸水平差异无统计学意义（P> 0.05）。HUA组的体质量指数（BMI）、TG、BUN、Scr和UMalb水平高于非HUA组,HDL-C和eGFR水平低于非HUA组,2组其余生化指标差异无统计学意义（P> 0.05）。L...     

Serum uric acid level and all-cause and cardiovascular mortality in Chinese elderly: A community-based cohort study in Shanghai

Background and aimsThe association between serum uric acid (SUA) and the all-cause and cardiovascular diseases (CVD) mortality remains controversial, but few studies based on the community population in Shanghai have been reported. We aimed to evaluate the association of SUA level with all-cause and CVD mortality in Chinese elderly based on a community-based cohort study in Shanghai of China.Methods and resultsA total of 12,071 eligible participants were included, with a cumulative follow-up period of 46,063.65 person-years and a median of 4.67 years. The time-dependent Cox regression model indicated that when SUA level was classified into quartile groups, no significant association was observed between SUA level and all-cause death in both men and women and between SUA level and CVD mortality in men. However, the HR (95%CI) between SUA groups and CVD death in women was 3.75 (1.49–9.43) for quartile 1, 3.66 (1.53–8.76) for quartile 2, and 2.98 (1.33–6.69) for quartile 4, respectively, when compared with the quartile 3 SUA level. A significant non-linear association was observed between SUA level and CVD death in elderly women. An increased risk of CVD death was observed among women with SUA level less than 4.30 mg/dL at the baseline, and a lower risk, among women with SUA level of 4.30–4.72 mg/dL at the baseline.ConclusionThe non-linear association between SUA level and CVD mortality in elderly women suggests a potential benefit of controlling SUA level at4.30–4.72 mg/dL in elderly Chinese women.     

Higher consumption of sugar-sweetened soft drinks increases the risk of hyperuricemia in Korean population: The Korean Multi-Rural Communities Cohort Study

Objective

The clinical implication of sugar-sweetened soft drinks on the risk of hyperuricemia has increased, especially in Western population studies. The aim of this study is to clarify the association between sugar-sweetened soft drinks and fruit drinks made from oranges and apples and the risk of hyperuricemia in the Korean Multi-Rural Communities Cohort.

Methods

A total of 9400 subjects were enrolled in the Korean Multi-Rural Communities Cohort Study, and a cross-sectional analysis was performed. Five quintiles (Q1–Q5) according to consumption of soft drinks and other fruit/fruit juices were classified and then categorized into three groups (Q1–Q3, Q4, and Q5) to assess the risk of hyperuricemia. Information on dietary intake was collected by well-trained interviewers using validated food frequency questionnaires.

Results

Higher consumption of sugar-sweetened soft drinks (Q5) increased the risk of hyperuricemia in males (adjusted OR = 1.35, 95% CI: 1.07–1.71) with a linear trend (p for trend = 0.01) and in females (adjusted OR = 1.40, 95% CI: 1.03–1.90) with no linear trend (p for trend = 0.09), compared to lower consumption (Q1–Q3). However, there were no significant differences of serum uric acid level according to the three categories of soft drink consumption, Q1–Q3, Q3, and Q5, in males (p = 0.21) or in females (p = 0.16), whereas all subjects showed statistical significance of serum uric acid level within the categories (p < 0.001). Estimated amount of soft drink intake was associated with serum uric acid level in males (β = 0.001; p = 0.01) but not in females (β = 0.0005; p = 0.10).

Conclusion

Higher consumption of sugar-sweetened soft drinks increased the risk of hyperuricemia in the Korean population, showing a differential linear trend for hyperuricemia according to gender.     

特殊人群血清尿酸分布特点及与其他心血管危险因素关系

目的调查城乡结合部中老年居民血清尿酸的分布特点,高尿酸血症患病情况及与其它心血管危险因素的关系。方法对广州城乡结合部石牌村现居住村民进行调查, 以该人群中55岁以上男女性642人为研究对象,对血清尿酸及其它多项心血管危险因素进行统计分析。结果①血清尿酸水平男性(357.30±66.77)μmol/L,女性(299.80±59.64)μmol/L,高尿酸血症患病率男性30.26%,女性30.82%;②男性尿酸水平高于女性(P<0.001);③血清尿酸与总胆固醇、甘油三酯、血压及体重指数正相关,与高密度脂蛋白负相关;④各种心血管危险因素在该人群中有聚集现象。结论血清尿酸升高可能是心血管及代谢性疾病的重要标志。该人群高尿酸血症及其它心血管危险因素的检出率高于一般人群,检出高危人群并进行相应干预治疗有重要价值。     

心脏代谢指数与高尿酸血症发病风险的关联性研究

[目的]探索中国健康与养老追踪调查项目中45岁以上人群心脏代谢指数与高尿酸血症发病风险的关联性。[方法]纳入2011年—2015年中国健康与养老追踪调查数据,采用前瞻性队列研究设计,以2011年数据为基线,于2015年随访高尿酸血症结局。采用Cox比例风险回归模型分析45岁以上人群心脏代谢指数与高尿酸血症发病风险的关联性,采用ROC曲线分析心脏代谢指数对高尿酸血症发病风险的预测价值。[结果] 3 002名研究对象中,调整相关混杂因素后,男性中最高心脏代谢指数组高尿酸血症发病风险是最低心脏代谢指数组的3.12倍(P<0.001),HR值为3.120,95%CI为1.606～6.062;女性中最高心脏代谢指数组高尿酸血症发病风险是最低心脏代谢指数组的为2.128倍(P<0.05),HR值为2.128,95%CI为1.060～4.272;且高尿酸血症发病风险随心脏代谢指数的增加而增加。ROC曲线分析显示,心脏代谢指数预测高尿酸血症发病风险的曲线下面积为0.618(95%CI:0.580～0.656),最佳截断值为0.433,灵敏度为46.97%,特异度为72.94%。[结论]心脏...     

Serum uric acid and its change with the risk of type 2 diabetes: A prospective study in China

ObjectiveTo assess the association of baseline uric acid levels and their changes from baseline to Year 1 with the risk of type 2 diabetes.Research design and methodsThis study cohort included 9471 subjects without a history of diabetes at baseline. The incident diabetes was diagnosed according to the American Diabetes Association standard.ResultsDuring a mean follow-up of 2.9 years, we identified 762 type 2 diabetes cases. Multivariate-adjusted hazard ratios (HRs) of diabetes across baseline tertiles of serum uric acid were 1.00, 1.15, and 1.32 (P for trend = 0.018), respectively. Participants with hyperuricemia compared with those without had a 1.20-fold (95% confidence interval [CI] 1.01−1.44) risk of diabetes. When uric acid was examined as a continuous variable, multivariable-adjusted HR of diabetes for each 1 mg/dL (60 μmol/L) increase in serum uric acid was 1.09 (95% CI 1.03−1.15). Compared with subjects with stable serum uric acid from baseline to Year 1 (±10%), those with uric acid gain ≥30% had a 30% (95% CI 1.01–1.79) increased risk of diabetes and those with uric acid loss ≥10% had a 21% (95% 0.62−0.99) decreased risk of diabetes. This positive association between baseline serum uric acid and diabetes risk was consistent among subjects younger and older than 45 years, non-obese and obese participants, and men.ConclusionsHigh level of baseline serum uric acid and serum uric acid gain from baseline to Year 1 are associated with an increased risk of type 2 diabetes among Chinese adults.     

High-level uric acid in asymptomatic hyperuricemia could be an isolated risk factor of cardio-cerebrovascular diseases: A prospective cohort study

Background and aimsWhether the asymptomatic hyperuricemia (AH) raise the cardiovascular disease risk with or without hyperuricemia-related comorbidities still remains contentious. Our study was aimed to quantitatively access the incidence risk of coronary heart disease (CHD) and stroke associated with AH.Methods and resultsIn this prospective cohort study, multivariate-adjusted Cox regression models were applied to evaluate the risk of cardiovascular disease (CVD). Baseline serum uric acid beyond normouricemia (357 mmol/L) was quarterly stratified based on the distribution of healthy populations without CVD onset. 1062 CVD first-attack cases were collected among the 29,974 study population (age range: 18–91, mean age: 47.2 ± 13.9 years-old) with a mean follow-up duration of 5.78 ± 0.83 years. The AH showed overall non-association with the CVD incident. However, significantly increased adjusted hazard ratio (HR) of CVD with 95% confidence interval (CI) were observed when the fourth quartile compared with normouricemia stratum in the total cohort population (CHD: 1.42, 1.21–1.68; stroke: 1.27, 1.06–1.41), male (CHD: 1.26, 1.12–1.55), female (CHD: 1.34, 1.04–2.02; stroke: 2.06, 1.13–3.77) and aged over 50 years-old population. Meanwhile, the age-standardized incidence rate of CVD in the fourth quartile was 2–3 times higher than the normouricemia population. After excluded 14,464 baseline population with diabetes, dyslipidemia, and hypertension, consistent results were also observed in the AH population in absence of comorbidities (CHD: 1.51, 1.22–2.25; stroke: 1.68, 1.13–2.39).ConclusionAsymptomatic hyperuricemia patients exposed to a higher level of uric acid (>=428 mmol/L) could significantly increase the incidence risk of CHD and stroke, with or without hyperuricemia-related comorbidities.     

Association between serum uric acid levels and the prevalence of heart failure due to acute coronary syndrome in Chinese hospitalized patients: A cross-sectional study

Background and aimsSerum uric acid (SUA) may play a role in heart failure (HF). Our study was to find relationships between SUA and the prevalence of HF due to acute coronary syndrome (ACS), and the ethnic-specific relationship between them in an inpatient population.Methods and resultsWe analyzed 1075 Chinese ACS patients. SUA levels were cut to four groups as Q1 to Q4, according to quartiles. Binary logistic regression models were used to assess associations of SUA with HF due to ACS. Subgroup analysis was performed to find ethnic-specific association between SUA and HF due to ACS. We also performed univariate and multivariate logistic regression analyses taking into account an Italian's cut-off for SUA for HF prognosis stratification. After adjustment for all potential confounders, compared to the lowest quartile, quartiles 2, 3 and 4 had a prevalence OR of 0.69 (0.44–1.08), 1.06 (0.67–1.67) and 2.19 (1.35–3.56), respectively, for the HF due to ACS (p for trend <0.001). Subgroup analyses didn't reveal an ethnic-specific differences between SUA and HF due to ACS. In Han, the highest SUA level was significantly associated with the risk of HF due to ACS. OR with 95%CI for Q4 was 1.85 (1.02–3.37), Q1 as a reference. For Mongolians, the OR with 95%CI for Q4 was 6.82 (1.90–24.50), Q1 as a reference.ConclusionWe found positive associations between SUA and the prevalence of HF due to ACS among Chinese patients. No differences exist regarding ethnicity.     

高尿酸血症与冠心病的关系

目的 探讨血清尿酸水平升高与冠心病发生、发展的关系.方法 选取疑诊冠心病患者455例,根据冠状动脉造影情况分为冠心病组268例（又分为单支病变组102例和多支病变组166例）和非冠心病组187例.在未行冠状动脉造影前,所有病例分别进行血清尿酸（UA）、血肌酐（Cr）、尿素氮（BUN）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）水平测定.结果 冠心病组与非冠心病组比较血清UA、Cr、BUN差异有统计学意义（P均＜0.05）,冠心病单支病变、多支病变血清UA、Cr、TG、LDL-C水平比较有统计学差异（P均＜0.05）.结论 高尿酸血症与冠心病的发生、发展有关,冠脉病变程度增加,血清尿酸水平增高.     

老年冠心病患者高尿酸血症与其他危险因素相关性分析

目的探讨老年冠心病高尿酸血症(HUA)与其他危险因素的相关性。方法收集2007—2009年在北京大学人民医院住院的300例老年冠心病患者,检测血尿酸(UA)、空腹血糖(FPG)、血压及血脂等指标,并记录年龄、性别、吸烟史、体重指数(BMI),分析HUA与冠心病其他危险因素的相关性。结果 300例冠心病患者中HUA的192例,尿酸正常的108例。Logistic多元回归结果表明,血尿酸与年龄、性别、血压及血脂水平、BMI均具有正相关性。HUA组冠心病患者的血压、血脂水平、BMI均明显高于尿酸正常组的冠心病患者。结论冠心病患者合并HUA的发病率高,后者常常与血压、血脂、血糖代谢异常并存,是冠心病的危险因素之一。     

急性冠状动脉综合征与血尿酸的相关性研究

目的探讨急性冠状动脉综合征(acute coronary syndrome,ACS)与血尿酸的关系及ACS患者血尿酸升高的相关危险因素。方法选择ACS患者306例,根据诊断分为急性心肌梗死(acute myocardial infarction,AMI)组150例,不稳定性心绞痛(unstable angina pectoris,UAP)组156例。又根据血尿酸水平分为:A组(血尿酸<260.0μmol/L)102例、B组(血尿酸260.0～356.9μmol/L)127例、C组(血尿酸>356.9μmol/L)77例,另选择健康体检者160例作为对照组。观察各组年龄、性别、吸烟史、饮酒史、高血压史、脂肪肝情况、LVEF、血肌酐、尿素、TG、TC、HDL-C、LDL-C、糖化血红蛋白,采用logistic回归分析血尿酸升高的主要因素。结果 AMI组和UAP组血尿酸水平明显高于对照组,差异有统计学意义(P<0.05)。A组、B组、C组在性别、脂肪肝、LVEF、血肌酐和TG等方面差异有统计学意义(P<0.05)。logistic回归分析显示,尿素、血肌酐、TG是ACS患者血尿酸升高的危险因素。结论 ACS患者具有较高的高尿酸发生率,且尿素、血尿酸、TG水平升高可能为ACS患者发生高尿酸血症的重要原因。     

血尿酸与代谢危险因素交互作用对高血压的影响

探讨血尿酸与高血压的关系,评估代谢危险因素与血尿酸交互作用对高血压风险的影响.检测8 415名健康体检人群的血压及其他相关指标,进行统计分析.高血压风险随血尿酸水平的升高而增加(P＜0.01).血尿酸与年龄、高密度脂蛋白胆固醇(HDL-C)交互作用对高血压风险的影响有统计学意义(交互作用P值分别为0.012,0.001).血尿酸水平与高血压风险有关,年龄和HDL-C水平可能影响这种联系.

Abstract：

The relationship between serum uric acid(SUA) and hypertension was investigated and the interactions of SUA with metabolic risk factors was assessed. Blood pressure and biomarkers features were evaluated for all the8 415 individuals from a community-based health examination survey in Xuzhou, and the statistical analysis was made. Raised blood pressure was associated with increased SUA concentration(P＜0.01). Age and high density lipoprotein cholesterol(HDL-C) significantly interacted with SUA(P for interaction=0.012 and 0.001, respectively). There is significant association between SUA and hypertension, which may be affected by age and HDL-C levels.     

Gout as a risk factor for osteoporosis: A Korean population-based study

Uric acid acts as both an antioxidant and a pre-oxidant that induces oxidative stress; thus, it plays a paradoxical role in inflammation. However, the effect of gout, a hallmark of hyperuricemia, on osteoporosis remains unclear. Therefore, this study aimed to investigate the association between gout and osteoporosis. This retrospective cohort study used data from the Korean National Health Insurance Service Database. In total, 628,565 participants who were diagnosed with gout and prescribed medications for gout for at least 90 days were selected. The control cohort included patients with no history of gout or use of gout medication. Age and sex 1:1 propensity score matching and Cox proportional hazards models were used to investigate risk factors for osteoporosis. In total, 305,810 patients with gout met the inclusion criteria. Compared with the control group, both men and women with gout showed an increased incidence rate ratio of osteoporosis. In the stratified analysis by age, patients with gout showed an increased incidence rate ratio for osteoporosis in all age groups, except for those over 80 years of age (P < .001). Gout showed an increased hazard ratio of 1.48 (95% CI: 1.45–1.51, P < .001). The female sex has also been identified as a risk factor for osteoporosis. Patients in their 70s had the highest HR. Gout is significantly associated with the risk of osteoporosis. In particular, the results of this study showed that the incidence of osteoporosis increased up to four times in male patients in their 20s with gout compared to without gout.     

An epidemiologic study on pathogenesis of uric acid urolithiasis

Recently, the number of patients with gout and hyperuricemia has increased in Japan; therefore, we expected to find an increase in the number of uric acid stones in our study. We examined the frequency of uric acid stones and its relationship with the number of patients with gout and hyperuricemia or their nutritional state. We reviewed the records of 5477 patients with urolithiasis who visited our hospital between 1975 and 1993. During this period, the incidence of calcium-containing stones remained at 86%. The percentage incidence of uric acid and urate stones during the same period showed a steady increase to 7.2%. This increase was computed to be 3-fold that of 1975. The male gender dominates among the patients with uric acid and urate stones. We believe that the increases in the incidence of gout and hyperuricemia and alcohol consumption are responsible for this trend.     

Prospective study of serum uric acid levels and stroke in a Chinese hypertensive cohort

Our aim was to investigate the association between serum uric acid (SUA) levels and the risk of first stroke in a Chinese population of hypertensive patients. This prospective study enrolled 20,577 hypertensive participants who without a history of stroke, and was conducted from May 2008 to August 2013 in Anqing and Lianyungang (China). A total of 632 (3.1%) first stroke events (510 ischemic events, 120 hemorrhagic events and 2 unspecified stroke events) were identified during a mean 4.5-year follow-up period. The risk of first stroke was not significantly associated with the increased SUA levels; this conclusion was also found after adjustment for gender and age. However, a statistically significant decreased risk of hemorrhagic stroke for the second SUA quartile (Q2) compared to the first quartile (Q1) (HR 0.56, 95%CI: 0.32–0.97, P = 0.037) was found. In addition, when grouped by tertiles of diastolic blood pressure (DBP), the results showed that high SUA lowered the risk of total stroke in participants in the third SUA quartile (Q3) (HR 0.69, 95%CI: 0.49–0.96, P = 0.028) and fourth SUA quartile (Q4) (HR 0.70, 95%CI: 0.50–0.99, P = 0.043) as compared with that in the first quartile (Q1). To sum up, no significant evidence in present study indicates that increased SUA levels are predictive of first stroke in a Chinese population of hypertensive patients.     

Changes of plasma concentration of osteoprotegerin and its association with endothelial dysfunction before and after hypouricemic therapy in patients with hyperuricemia

Abstract

Objective. Osteoprotegerin (OPG) is a secreted glycoprotein in the regulation of bone turnover. Recently, many studies showed that OPG acts as an important regulatory molecule in the vascular systems. Our objective was to examine the plasma OPG levels alteration and its association with endothelial function before and after hypouricemic therapy in patients with hyperuricemia.

Methods. Thirty patients (28 males and 2 females, serum uric acid > 7.0 mg/dl) with hyperuricemia were selected. Thirty healthy individuals (28 males and 2 females) with normal serum uric acid were also selected as control. Patients were administered with hypouricemic therapy for 6 months. Plasma OPG concentration was measured in duplicate using a sandwich ELISA and high-resolution ultrasound was used to measure brachial artery diameter at rest, after reactive hyperemia and after sublingual glyceryltrinitrate.

Results. Plasma OPG levels in patients with hyperuricemia before hypouricemic therapy was significantly higher than those in controls (3.39 ± 0.25 vs. 2.05 ± 0.74 ng/L, p < 0.01). After hypouricemic therapy, OPG levels decreased markedly (2.54 ± 0.38 ng/L, p < 0.01). Flow-mediated dilation (FMD) in patients with hyperuricemia was 3.07 ± 1. 23%, which was significantly lower than that in control subjects (4.62 ± 0.69%, p < 0.01), and it improved significantly after hypouricemic therapy (3.91 ± 1.37%, p < 0.01). The absolute changes in OPG showed a significant positive correlation with the changes in serum uric acid (p < 0.05) and negative correlation with the changes in FMD (p < 0.01) in patients with hyperuricemia during the course of hypouricemic therapy.

Conclusion. The current study demonstrates that plasma OPG levels increased significantly in patients with hyperuricemia and decreased significantly after hypouricemic therapy, and are correlated with FMD. These findings support the growing concept that elevated plasma OPG levels may be involved with the development of endothelial dysfunction in patients with hyperuricemia.     

Alcohol consumption and other risk factors for self-reported diabetes among middle-aged Japanese: a population-based prospective study in the JPHC study cohort I.

AIMS: Few prospective studies have examined the relationship between lifestyle characteristics and the incidence of diabetes mellitus in an Asian general population. This study was undertaken to evaluate the risk factors for Type 2 diabetes in a population-based prospective study of middle-aged Japanese. METHODS: We investigated 12,913 men and 15,980 women, aged 40-59 years at baseline (year 0), who participated in the Japan Public Health Center-based prospective study on cancer and cardiovascular diseases (JPHC Study) Cohort I. The participants were followed for up to 10 years. Incident cases of diabetes were identified by self-reporting of a physician's diagnosis on two questionnaires sent to each participant, one at year 5 and the second at year 10. RESULTS: During the 10-year follow-up, 703 men and 482 women reported newly diagnosed diabetes. Age, body mass index (BMI), family history of diabetes and cigarette smoking were independent risk factors in both genders by multivariate analysis. Among men with a BMI < or = 22 kg/m2, a significant positive association was observed between the diabetes incidence and moderate (23.0 < 46.0 g/day) to high (> 46.0 g/day) alcohol consumption, odds ratio 1.91 (95% CI, 1.05-3.46) and 2.89 (1.63-5.11), respectively. Among men with a BMI > 22 kg/m2, a small non-significant increase in odds ratio was observed with alcohol consumption. CONCLUSIONS: Established risk factors for diabetes in western populations were also identified as predictors of the disease among Japanese. Moderate to high alcohol consumption was positively associated with the incidence of diabetes in Japanese lean (BMI < or = 22 kg/m2) men.