不同肥胖指标在高尿酸血症风险预测中的应用价值比较研究

背景高尿酸血症（HUA）已经超过糖尿病成为我国第二大代谢性疾病，其患病率呈逐年攀升态势且常伴发多系统疾病，如何有效预防其发生并控制其流行已成为我国亟待解决的重要公共卫生问题。目的明确不同肥胖指标〔腰围（WC）、体质指数（BMI）、腰高比（WHtR）、身体形态指数（ABSI）、身体圆度指数（BRI）、内脏脂肪指数（VAI）和脂质聚集指数（LAP）〕对HUA发生的影响，分析并比较不同肥胖指标对HUA发生风险的预测价值，旨在为HUA的早期预防及筛查提供参考与依据。方法采用整群抽样方法，选取2020年1—12月在广东省某三级甲等医院健康管理中心接受健康体检的体检者为研究对象。通过查阅健康管理中心的电子病历收集体检者的一般人口学、既往史、体格检查和实验室检查指标等资料，并计算BMI、WHtR、ABSI、BRI、VAI和LAP。采用二元Logistic回归探讨不同肥胖指标对HUA发生的影响，采用受试者工作特征（ROC）曲线评价不同肥胖指标对HUA的预测价值并计算切点。结果共纳入32 374例健康体检者，检出HUA 13 546例，HUA检出率为41.84%，其中，男性和女性体检者HUA检出率分别为54.11%（10 026/18 530）和25.43%（3 520/13 844），男性HUA检出率高于女性（P<0.001）。男性HUA体检者WC、BMI、WHtR、ABSI、BRI、VAI和LAP均高于女性HUA体检者（P<0.001）。二元Logistic回归结果显示，在校正混杂变量后，WC、BMI、WHtR、ABSI、BRI、VAI和LAP均是男性和女性HUA发生的影响因素（P<0.001）。男性WC、BMI、WHtR、ABSI、BRI、VAI和LAP预测HUA发生风险的ROC曲线下面积（AUC）分别为0.612、0.626、0.602、0.512、0.602、0.617和0.642，切点分别为80.5 cm、24.3 kg/m2、0.48、0.072、3.8、1.4和26.7；女性WC、BMI、WHtR、ABSI、BRI、VAI和LAP预测HUA发生风险的AUC分别为0.637、0.636、0.637、0.555、0.638、0.583和0.660，切点分别为72.5cm、22.7 kg/m2、0.47、0.074、4.2、1.3和15.3。无论在男性体检人群还是女性体检人群中，LAP预测HUA的AUC高于其他6项肥胖指标（P均<0.05），ABSI预测HUA的AUC低于其他6项肥胖指标（P均<0.05）。结论WC、BMI、WHtR、ABSI、BRI、VAI和LAP均是影响男性和女性HUA发生的因素，但不同肥胖指标对HUA的预测能力存在差异。无论对于男性还是女性，LAP均是预测HUA发生风险的最佳肥胖指标。

Values of Different Obesity Indicators in Predicting the Risk of Hyperuricemia:a Comparative Study

Background In China,hyperuricemia(HUA)is increasingly prevalent,which is often accompanied by multi-system diseases,and has become the second leading metabolic disease after diabetes mellitus.How to effectively contain its prevalence has become an important public health issue that needs to be solved urgently.Objective To examine relationships of different obesity indices〔waist circumference(WC),body mass index(BMI),waist-to-height ratio(WHtR),body shape index(ABSI),body roundness index(BRI),visceral adiposity index(VAI)and lipid aggregation index(LAP)〕with HUA,and compare their predictive values for HUA,providing a reference basis for early HUA screening and prevention.Methods Cluster sampling was used to recruit physical examinees from the health management center of a grade A tertiary hospital from January to December 2020.Anthropometric indices included in the analysis included WC,BMI,WHtR,ABSI,BRI,VAI and LAP.Binary Logistic regression was used to assess the correlation of HUA with different obesity indices.Receiver operating characteristic(ROC)curve analysis was performed to estimate the predictive values of these indices for HUA with suggested optimal cut-off points presented.Results Of the 32344 physical examinees in total,13546(41.84%)were found with HUA.Men had higher detection rate of HUA than women〔54.11%(10026/18530)vs 25.43%(3520/13844)〕(P<0.001).The values of all these obesity indices were higher in male HUA patients than in female HUA patients,with statistically significant differences(P<0.001).Binary Logistic regression showed that after correcting for confounding variables,WC,BMI,WHtR,ABSI,BRI,VAI,and LAP were all statistically associated with HUA occurrence in both men and women(P<0.001).In men,the area under the ROC curve(AUC)of WC,BMI,WHtR,ABSI,BRI,VAI and LAP in predicting HUA was 0.612,0.626,0.602,0.512,0.602,0.617 and 0.642,respectively,with corresponding optimal cut-off points of 80.5 cm,24.3 kg/m²,0.48,0.072,3.8,1.4 and 26.7.In women,the AUC for WC,BMI,WHtR,ABSI,BRI,VAI and LAP in predicting HUA was 0.637,0.636,0.637,0.555,0.638,0.583,and 0.660,respectively,with corresponding optimal cut-off points of 72.5 cm,22.7 kg/m²,0.47,0.074,4.2,1.3 and 15.3.In both male and female physical examinees,the AUC of LAP predicting HUA was higher than the other six obesity indicators(P<0.05),and the AUC of ABSI predicting HUA was lower than the other six obesity indicators(P<0.05).Conclusion These seven obesity indices were all significantly associated with the occurrence of HUA in men and women.The predictive values of them for HUA were different,and LAP may be the best indicator for predicting the risk of HUA in either men or women.