血清尿酸水平与代谢综合征的相关性研究

目的 探讨血清尿酸水平与代谢综合征(MS)及组成MS的因素肥胖、血脂异常、血糖异常、高血压之间的相关性.方法 选择病历资料完整的住院病例654例,年龄30～90岁,中位年龄65岁.代谢综合征的诊断采纳国内标准.检测血清尿酸(SUA)水平及其他相关生化指标.采用Excel软件建立数据库,运用SPSS11.0版软件进行单因素分析、逐步回归分析.结果 超重、空腹血糖(FBG)过高、高TG、高HDL-C增高及高血压(EH)患者的SUA水平均高于非超重、FBG正常、TG正常、HDL-C低及非EH患者[(270.52±81.63)μmol/L比(226.61±67.42)μmol/L,t=-7.387,P=0.000;(265.71±73.50)μmol/L比(235.03±75.00)μmol/L,t=-4.459,P=0.000;(262.80±74.44)μmol/L比(235.82±75.04)μmol/L,t=-3.927,P=0.000;(243.97±76.33)μmol/L比(212.78±57.60)μmol/L,t=-2.412,P=0.016;(282.87±64.79)μmol/L比(180.22±41.60)μmol/L,t=22.586,P=0.000].在654例患者中,MS患者107例、非MS患者547例,MS患者的SUA水平高于非MS患者[(301.22±68.55)μmol/L比(230.72±71.63)μmol/L,t=9.376,P=0.000].经逐步回归分析提示:收缩压(SBP)、舒张压(DBP)、体重指数(BMI)、TG、HDL-C、FBG均与SUA水平呈正相关(t值分别为3.409、13.401、6.979、2.943、3.514、4.706;P值分别为0.000、0.001、0.000、0.003、0.000、0.000).结论 MS患者的SUA水平高于非MS患者.SUA 水平与组成MS的因素之间呈正相关.     

Microalbuminuria and the metabolic syndrome and its components in the Chinese population

BACKGROUND: Microalbuminuria and the metabolic syndrome (MetS) have both been linked to chronic kidney disease and cardiovascular disease. This study investigated the association between urinary albumin-to-creatinine ratio (ACR) and MetS and its components. MATERIALS AND METHODS: A total of 2311 subjects aged 40 years and over were recruited in 2004 in a metropolitan city in Taiwan. The biochemical indices, such as fasting glucose levels, urinary albumin, urinary creatinine and anthropometric indices, were measured. We defined microalbuminuria as a urinary ACR ranging from 30 to 300 mg g(-1) creatinine. MetS was defined using the American Heart Association and the National Heart, Lung and Blood Institute (AHA/NHLBI) and the International Diabetes Federation (IDF) definitions. The relationship between MetS and microalbuminuria was examined using multiple logistical regression analysis. RESULTS: Subjects with microalbuminuria had higher age, body mass index (BMI), waist circumference, blood pressure, fasting plasma glucose, triglycerides, total cholesterol (TCHOL)/high-density lipoprotein cholesterol (HDL-C) ratio, prevalence of diabetes mellitus and hypertension and lower HDL-C than subjects with normoalbuminuria. After adjusting for age and BMI, microalbuminuria was associated with the individual components of MetS, except in central obesity in women and elevated fasting glucose in men. After adjusting for age, BMI, smoking and alcohol consumption status, multiple logistical regressions revealed that microalbuminuria is strongly associated with MetS in both genders and according to both definitions. The odds ratio of having MetS using the AHA/NHLBI and IDF definition was 1.76 (1.16-2.67) and 1.73 (1.06-2.83) in men and 2.19 (1.38-3.50) and 2.09 (1.24-3.51) in women, respectively. CONCLUSIONS: Microalbuminuria was strongly associated with MetS and its components. There is an increased likelihood of having MetS if subjects have microalbuminuria.     

云南大理白族血清尿酸与代谢综合征及危险因素相关性研究

目的探讨云南大理白族血尿酸的分布特点与代谢综合征（MS）及其危险因素的相关性。方法对5 444例包括城市、农村、城乡结合部居住5年以上的大理白族人群进行问卷调查、体格检查和生化指标进行分析。结果①随着血尿酸水平升高,研究对象收缩压、舒张压、甘油三酯、低密度脂蛋白胆固醇、体质量指数、腰臀比逐渐上升,高密度脂蛋白胆固醇逐渐下降（P<0.01）;随着血尿酸的升高,空腹血糖、糖化血红蛋白男性差异无统计学意义（P>0.05）,女性呈逐渐升高趋势（P<0.01）;②高尿酸血症（HUA）及MS患病率男性高于女性;随着年龄增加,患病率逐渐升高（P<0.01）;农民、城镇居民、城乡结合部居民患病率逐渐升高（P<0.01）。吸烟史、饮酒史、代谢病家族史男性高于女性（P<0.01）;农民、城镇居民、城乡结合部居民所占比例逐渐升高（P<0.01）;随着年龄的增加,吸烟史所占比例逐渐下降,饮酒史呈中年增高趋势而代谢疾病家族史呈中年下降趋势（P<0.01）。③随着血尿酸升高,男女性MS患病率逐渐升高（P<0.01）。④MS患病与UA水平有关。在同一年龄组,随着UA水平的增加,MS患病风险呈增加趋势,特别是中、老年女性。结论云南大理白族HUA患病率高,血尿酸水平与MS有关,血尿酸升高是MS的独立危险因素。     

Serum uric acid and appropriate cutoff value for prediction of metabolic syndrome among Chinese adults

The relation between serum uric acid and metabolic syndrome is observed not only with frank hyperuricemia but also with serum uric acid levels within the normal range. The current “normal” range set for hyperuricemia often fails to identify patients with potential metabolic disorders. We investigate the association between serum uric acid within the normal range and incident metabolic syndrome risk, and further to determine the optimal cut-off value of serum uric acid for the diagnosis or prediction of metabolic syndrome. A total of 7399 Chinese adults (2957 men and 4442 women; ≥20 years) free of metabolic syndrome were followed for 3 years. During the 3-year follow-up, 1190 normouricemic individuals developed metabolic syndrome (16.1%). After adjusting the associated variables, the top quartile of serum uric acid levels was associated with higher metabolic syndrome development compared with the bottom quartile in men (hazard ratio (HR), 1.29; p<0.05) and women (HR, 1.62; p<0.05). ROC curve analysis indicated that the optimal cut-off values for serum uric acid to identify metabolic syndrome were 6.3 mg/dl in men and 4.9 mg/dl in women. Our results suggested that high baseline serum uric acid levels within the normal range predict future development of metabolic syndrome after 3 y of follow-up.     

Sex disparities and the risk of urolithiasis: a large cross-sectional study

BackgroundUrolithiasis is one of the most common diseases in urology, with a lifetime prevalence of 14% and is more prevalent in males compared to females. We designed to explore sex disparities in the Chinese population to provide evidence for prevention measures and mechanisms of stone formation.Materials and methodsA total of 98232 Chinese individuals who had undergone a comprehensive examination in 2017 were included. Fully adjusted odds ratios for kidney stones were measured using restricted cubic splines. Multiple imputations was applied for missing values. Propensity score matching was utilised for sensitivity analysis.ResultsAmong the 98232 included participants, 42762 participants (43.53%) were females and 55470 participants (56.47%) were males. Patients’ factors might cast an influence on the development of kidney stone disease distinctly between the two genders. A risk factor for one gender might have no effect on the other gender. The risk for urolithiasis in females continuously rises as ageing, while for males the risk presents a trend to ascend until the age of around 53 and then descend.ConclusionsPatients’ factors might influence the development of kidney stones distinctly between the two genders. As age grew, the risk to develop kidney stones in females continuously ascended, while the risk in males presented a trend to ascend and then descend, which was presumably related to the weakening of the androgen signals.

Key messages

• We found that patients’ factors might cast an influence on the development of kidney stone disease distinctly between the two sexes.
• The association between age and urolithiasis presents distinct trends in the two sexes
• The results will provide evidence to explore the mechanisms underlying such differences can cast light on potential therapeutic targets and promote the development of tailored therapy strategies in prospect.

     

初诊2型糖尿病合并代谢综合征患者血清尿酸水平与血液流变学相关性分析

目的探讨初诊2型糖尿病(T2DM)合并代谢综合征(MetS)患者血清尿酸(UA)水平和血液流变学指标的关系。方法检测并比较91例单纯T2DM患者、122例T2DM合并MetS患者及256例健康者(对照组)体质量指数、血压、血糖、血脂、UA及血液流变学等指标检测结果。结果单纯T2DM患者和T2DM合并MetS患者体质量指数、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、UA、糖化清蛋白水平均高于健康者(P<0.05),患者组间总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、UA、糖化清蛋白比较差异亦有统计学意义(P<0.05)。患者组间红细胞刚性指数、红细胞变形指数、血液黏度、血液还原黏度、微循环滞留时间、血栓形成系数等血液流变学指标比较差异有统计学意义(P<0.05)。各研究组间高尿酸血症患病率比较差异有统计学意义(P<0.01)。控制了年龄、性别、体质量指数、总胆固醇、三酰甘油等水平后,UA水平与血细胞比容、红细胞聚集指数、红细胞刚性指数、血液黏度、血液还原黏度、微循环滞留时间、血栓形成系数等血液流变学指标存在正相关。结论合并MetS的T2DM患者较单纯T2DM患者存在更明显的血液流变学改变和更高的UA水平,且UA水平与血液流变学指标关系密切。初诊T2DM患者除应控制血糖、血压、血脂及体质量外,更应控制UA水平及改善血液流变性,从而阻止或延缓病情的发生与发展。     

慢性肾脏病不同分期血尿酸的变化及其影响因素分析

目的 单中心横断面调查慢性肾脏病(CKD)患者血尿酸(UA)水平的基础状况.方法 对我院肾内科门诊就诊的CKD患者进行为期9个月的前瞻性横断面调查.结果 共有713例CKD患者入选.前3位CKD的病因分别为原发性肾小球疾病(61.2%,436/713)、高血压肾病(7.2%,51/713)和糖尿病肾病(5.8%,41/713).随着CKD分期的进展,UA水平(F=73.569,P=0.000)和高尿酸血症的发生率(χ2=138.156,P=0.000)显著上升.多元回归分析结果显示,UA水平和GFR呈显著负相关(RR=-1.045,P=0.000),UA水平和DBP、尿蛋白、吸烟、BMI呈显著正相关(RR分别为1.400、15.149、37.696和3.421,P均<0.05).结论 针对CKD患者UA水平进行单中心横断面调查,有助于确定CKD患者UA水平的变化规律,为进一步综合防治CKD及其心血管并发症奠定基础.     

2型糖尿病患者血尿酸水平及相关危险因素分析

目的探讨2型糖尿病患者血尿酸代谢与代谢综合征（MS）及其组分的关系。方法272例2型糖尿病患者,按性别和女性绝经与否分组,组内分为MS亚组和非MS亚组,对血尿酸进行相关分析和回归分析。结果①MS组血尿酸高于非MS组;②血尿酸与腰围、甘油三酯（TG）、收缩压、舒张压正相关,与血糖、高密度脂蛋白负相关;③腰围和TG是血尿酸独立相关因素。结论2型糖尿病患者血尿酸升高与MS有关,腰围和TG是血尿酸升高的危险因素。     

Association between metabolic syndrome and calcium oxalate stone risk in Chinese individuals: a nomogram prediction model

ObjectiveThis retrospective study explored the association between calcium oxalate (CaOx) stones and metabolic syndrome. It also developed and validated a nomogram to aid in the prediction of CaOx stones.MethodsThis case-control study enrolled 150 patients with CaOx stones and 635 individuals without urolithiasis from October 2016 to October 2018. Student’s t-test, the chi-squared test, and logistic univariate and multivariate regression analyses were used. A nomogram for prediction of CaOx stones was established based on independent associated factors. The concordance index and calibration curves were plotted to determine nomogram accuracy.ResultsFemale sex, age ≥66 years, blood pressure (systolic pressure ≥130 mmHg and/or diastolic pressure ≥85 mmHg), and blood uric acid level independently influenced the risk of CaOx stones, according to multivariate logistic regression analysis; these factors were included in the nomogram. The concordance index was 0.701 (95% confidence interval: 0.658–0.737). The standard curve showed a robust fit with the calibrated predictive curve.ConclusionsFemale sex, age ≥66 years, elevated blood pressure, and blood uric acid level independently influenced the risk of CaOx stones. Our nomogram for the prediction of CaOx stones may provide a clinical basis for the assessment of CaOx stone and facilitate early prevention efforts.     

阳江市市区健康成人血清尿酸浓度调查分析

目的调查阳江市市区健康成人的血清尿酸浓度,以便开展多种疾病的预防工作。方法随机抽取1181名健康成人,做血清尿酸浓度测定。结果男性平均值为352.3±80·3μmol/L,女性平均值267·1±68·2μmol/L,男女相差明显(P<0·01),其差异有统计学意义。结论各实验室最好建立自己的血清尿酸参考范围。     

血尿酸与代谢综合征关系的横断面研究

目的分析血尿酸(UA)与代谢综合征(MS)之间的关系。方法 1 680例北京社区居民纳入了此次调查分析。MS发病危险比值比(OR)采用多因素logistic回归计算,UA与各指标间的相关关系采用多元线性回归分析。结果校正性别、年龄后MS组UA水平高于非MS组(299.23μmol/L与269.15μmol/L,P<0.001),随着MS成分由0个增加至4或5个,UA水平逐渐升高为257.04μmol/L,263.03μmol/L,281.19μmol/L,295.80μmol/L和303.39μmol/L(线性趋势P=0.002)。校正年龄、性别、肌酐、估计肾小球滤过率(e GFR)、低密度脂蛋白胆固醇(LDL-C)、超敏C反应蛋白(hs-CRP)、吸烟、饮酒、运动等因素后,多元logistic回归分析显示与UA最低四分位水平(UAⅠ)相比,UA二、三、四分位水平(UAⅡ,Ⅲ,Ⅳ) MS发生风险比值比(OR)分别为1.721(95%CI:1.208～2.451,P<0.05),2.237(95%CI:1.562～3.204,P<0.01),4.559(95%CI:3.090～6.727,P<0.01)。多元线性回归分析显示,UA与腰围、体质指数、三酰甘油、LDL-C水平呈独立正相关。应用受试者工作曲线(ROC)诊断MS的UA最佳截断点为276.35μmol/L,敏感性和特异性分别为64.6%和52.8%。结论高UA水平是MS发生的相关因素,UA升高对MS有一定的筛查诊断价值。     

血尿酸水平与帕金森病病情分级的相关性研究

目的 探讨血尿酸水平与帕金森病临床分期、认知功能损害的关系.方法 对符合入选标准的帕金森病患者作为帕金森病组(60例),登记病史及进行详细查体,测定UPDRSⅢ量表,进行Hoehn-Yahr分期及简易智能状态评分(MMSE)量表测定;同时收集与帕金森病组年龄、性别、教育程度等相匹配的同期健康体检者作为对照组(52名).两组均测定空腹血尿酸,对结果进行相应的统计学分析.结果 帕金森病组血尿酸水平明显低于对照组[(262.4 ±85.2) μmol/L和(357.6 ±73.3) μmol/L](t=1.013,P=0.00S);帕金森病患者Hoehn-Yahr分期各期之间的血尿酸水平相比较分析无等级相关性(r=0.143,P＞0.05);各期帕金森病患者的血尿酸水平比较差异无统计学意义(F=1.014,P=0.064);帕金森病组与对照组MMSE分值比较差别无统计学意义(26.12±2.87及28.32±2.17)(t=1.970,P=0.073).结论 帕金森病患者血尿酸水平降低很可能为帕金森病的危险因素之一.但不可以用来评定疾病严重程度.MMSE对于判定帕金森病认知功能损害不够敏感.     

不同血尿酸水平对代谢综合征患者血管内皮功能的影响

目的 研究不同血尿酸水平对代谢综合征患者血管内皮功能的影响.方法 将90例代谢综合征患者分为低血尿酸水平组30例(A组)、正常血尿酸水平组30例(B组)和高血尿酸水平组30例(C组),分别测定血浆髓过氧化物酶(MPO)和内皮素(ET)水平.结果 ①自A组至C组,随血尿酸水平逐渐升高,MPO水平也逐渐升高,分别为(42.7±10.3)μg/L、(91.4±15.3)μg/L和(101.9±10.3)μg/L(P＜0.05).同时,ET水平也有逐渐升高趋势,分别为(80.3±29.6)ng/L、(84.9±16.9)ng/L和(144.0±57.9)ng/L,ET水平C组显著高于A组和B组(均P＜0.01),但A组与B组之间差异无统计学意义(P＞0.05),②血尿酸与MPO和ET水平均呈正相关(r=0.787,0.301,均P＜0.01).结论 在代谢综合征患者中,随血尿酸水平的增高,血MP0和ET水平均呈显著增高趋势,提示血尿酸水平是代谢综合征患者血管内皮功能的重要影响因素.     

轻中度高血压患者早期肾损害血清尿酸检测意义

目的　探讨轻中度高血压患者早期肾损害与血清尿酸浓度的关系。方法　100例轻中度高血压患者在检测血、尿β2 微球蛋白及尿白蛋白同时检测血清尿酸浓度,并分析血清尿酸与肾损害发生的关系。结果　血、尿β2 微球蛋白及尿白蛋白增高的患者血清尿酸分别为( 504. 8±28. 3 )mmol/L、(484. 6±75. 3)mmol/L、(492. 6±66. 3)mmol/L;血、尿β2 微球蛋白及尿白蛋白正常患者血清尿酸分别为(320. 9±102. 6)mmol/L、(380. 7±42. 6)mmol/L、(374. 9±43. 8)mmol/L。血清尿酸浓度≥420mmol/L患者血、尿β2 微球蛋白及尿白蛋白分别为(4. 28±1. 14)mg/L、(1. 2±0. 74)mg/L、(27. 9±9. 3)mg/L;血清尿酸浓度<420mmol/L患者血、尿β2 微球蛋白及尿白蛋白分别为( 2. 56±1. 44 )mg/L、( 0. 54±0. 11 )mg/L、(18. 4±6. 6)mg/L。结论　高血压患者合并血清尿酸增高,可加重肾损害;同时,高血压发生肾损害后可增加血尿酸浓度。     

血清尿酸水平与急性缺血性脑卒中患者不良预后的相关性

目的：探讨血清尿酸水平（ SUA）与急性缺血性脑卒中（ AIS）患者不良预后的相关性。方法连续收集2011年1月至2013年9月兴宁市人民医院住院诊断为AIS患者463例。测量其入院SUA水平,分析SUA与在随访期30 d,3、6、12个月时使用改良 Rankin量表（ mRS）所评价的预后功能之间的相关性。mRS 评分为0～1时视为预后良好。结果研究共纳入463例患者,52%为男性,平均年龄68岁。入院时SUA平均水平为（6.1±3.7）mg/dl。与高SUA水平患者相比,SUA≤4.5 mg/dl患者的30 d良好预后的比例更高（ P=0.004）。尚不能认为SUA与30 d病死率或功能不良相关。同时,尚不能认为与卒中后3、6、12个月不良预后相关。然而,在校正年龄、性别、卒中类型和严重程度（NIHSS <9）、卒中发作后时间、血清肌酐、高血压、糖尿病和吸烟后,SUA 水平≤4.5 mg/dl与短期良好预后呈正相关（比值比=1.76,95%可信区间为1.05～2.95,阴性预测值=81.1%）,而尚不能认为与随访3、6或12个月的预后相关。与高水平SUA患者相比,SUA≤4.5 mg/dl患者往往年龄<55岁、多为女性、轻度中风、血清肌酐水平正常、很少患高血压。尚不能认为从卒中发作到入院的时间与AIS 严重程度或SUA水平相关。结论低SUA水平与短期良好预后相关, SUA是脑梗死程度的指标,而不是卒中预后的独立危险因素。     

急性脑梗死与血清尿酸水平的病例对照研究

目的探讨血尿酸水平与急性脑梗死发病及预后的关系。方法选取住院急性脑梗死患者60例为观察组,检测入院24h内血尿酸水平及相关指标,并与正常对照组比较和分析两组间的相关性;并同时对观察组中血尿酸正常(非高尿酸组)和异常(高尿酸组)的病例间相关因素及预后的关系分析比较。结果急性脑梗死患者血尿酸水平及异常率明显增高,与对照组之间比较有差异有统计学意义(P<0·01);在急性脑梗死患者中,血尿酸异常组高血糖、高脂血症发生率、病死率较正常组明显增高(P<0·01)。结论血尿酸水平与急性脑梗死的发病密切相关,参与了其发病机制,是预后不良的预测因素。     

慢性肾脏病不同分期血尿酸的变化及其影响因素分析

Objective To present the baseline characteristics of serum uric acid level in patients with chro-nic kidney disease(CKD). Methods A cross-sectional study on CKD patients was carried out in our hospital for 9 months. Results 713 patients were enrolled. The top three causes of CKD in these patients were primary glomerular disease(61.2%, 436/713), essential hypertensive kidney disease (7. 2%, 51/713 ) and diabetic nephropathy (5.8% ,41/713). Serum uric acid level and the incidence of hyperuricemia were associated with the stage of CKD (F = 73. 569, P = 0. 000;χ2= 138. 156, P = 0.000). A significantly negative correlation was discovered between ser-um uric acid level and the level of glomerular filtration rate(RR = - 1. 045 ,P =0. 000). A significantly positive cor-relation of serum uric acid level was found with diastohc blood pressure, proteinuia level, smoking and BMI ( RR = 1.400,15. 149,37. 696,and 3.421 ,P <0.05 ,respectively). Conclusions The cross-sectional study of serum uric acid level in patients with CKD will help to determine the dynamic changes of serum uric acid level in Chinese CKD patients and lay a solid basis for the prevention and treatment of CKD and its complications.     

慢性心力衰竭患者血清尿酸水平变化及临床意义

目的探讨慢性心力衰竭患者血清尿酸的变化及临床意义。方法选择300例慢性心力衰竭患者为研究组及180例心功能正常者为对照组。测定血清尿酸及血脂等指标，同时应用超声心动图测定左心室射血分数、左心室收缩末期内径、左心室舒张末期内径、每搏输出量、心排血量。结果血清尿酸水平与．心功能分级相关，合并高尿酸血症的慢性心力衰竭患者室性心律失常的发生率增加。结论血清尿酸水平与慢性心力衰竭的心功能分级相关，可能是慢性心力衰竭判定预后的预测因子。