上海市松江区社区居民高尿酸血症与慢性肾病的相关性研究

周晓燕; 赵琦; 王娜; 王瑞平; 张越; 郁雨婷; 姜永根; 赵根明

doi:10.16462/j.cnki.zhjbkz.2019.03.007

上海市松江区社区居民高尿酸血症与慢性肾病的相关性研究

doi: 10.16462/j.cnki.zhjbkz.2019.03.007

周晓燕^{1, 2},
赵琦^{1, 2},
王娜^{1, 2},
王瑞平³,
张越^{1, 2},
郁雨婷^{1, 2},
姜永根³,
赵根明^{1, 2, ,}

1.
200032 上海, 复旦大学公共卫生学院流行病学教研室
2.
200032 上海, 公共卫生安全教育部重点实验室
3.
201600 上海, 上海市松江区疾病预防控制中心

基金项目:

上海市高峰计划公共卫生与预防医学重点学科建设项目 2016

国家重点研发计划精准医学重点专项 2017YFC0907001

详细信息

通讯作者:
赵根明, E-mail: gmzhao@shmu.edu.cn

中图分类号: R181
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- 被引次数: 0
出版历程
- 收稿日期: 2018-09-13
- 修回日期: 2018-11-23
- 刊出日期: 2019-03-10

Relationship between hyperuricemia and chronic kidney disease in adult residents of communities in the Songjiang district, Shanghai

ZHOU Xiao-yan^{1, 2},
ZHAO Qi^{1, 2},
WANG Na^{1, 2},
WANG Rui-ping³,
ZHANG Yue^{1, 2},
YU Yu-ting^{1, 2},
JIANG Yong-gen³,
ZHAO Gen-ming^{1, 2
, ,}

1.
Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China
2.
Key Laboratory of Public Health Safety, Ministry of Education, Shanghai 200032, China
3.
Songjiang District Center for Disease Control and Prevention, Shanghai 201600, China

摘要

摘要: 目的分析社区居民高尿酸血症（hyperuricemia，HUA）及血清尿酸（serum uric acid，SUA）水平与慢性肾病（chronic kidney disease，CKD）的相关性。方法随机整群抽取上海市松江区新桥镇20~75岁的常住居民9 257名进行横断面调查，采用Logistic回归模型分析不同性别血清尿酸与慢性肾病的关系。结果不同性别分别依SUA水平将调查对象按五分位分为5组，男性CKD患病率依次为4.9%、5.7%、6.0%、8.0%和13.8%，女性CKD患病率依次为12.8%、12.7%、11.9%、13.3%和18.2%，且无论男女CKD患病率随着SUA水平升高均有增加趋势（均有P<0.05）。以SUA第一分位水平组为参照进行Logistic回归分析，男性第四、五分位水平组的调整OR值分别为2.12（95%CI：1.32~3.39）和3.84（95%CI：2.45~6.02），女性第五分位水平组的调整OR值为1.38（95%CI：1.05~1.80）。按SUA>420 μmol/L（男性）或>360 μmol/L（女性）标准定义HUA，在全体调查对象中，HUA与CKD明显相关（OR=2.03，95%CI：1.69~2.44，P<0.001），校正潜在混杂因素等后，两者仍独立相关（OR=2.04，95%CI：1.68~2.49，P<0.001），其中男性HUA患者CKD的患病风险是尿酸正常者的2.89倍（95%CI：2.12~3.94），女性是1.98倍（95%CI：1.51~2.60）。结论上海市松江区社区居民中，HUA可能是CKD的独立相关因素。
- 尿酸 /
- 高尿酸血症 /
- 慢性肾病 /
- 横断面研究
Abstract: Objective To explore the relationships between hyperuricemia (HUA), serum uric acid (SUA) level and the chronic kidney disease (CKD) in adult residents of communities. Methods A cross-sectional study was conducted in Xinqiao town of Songjiang district, Shanghai and a total of 9 527 residents aged 20-75 years were selected by random cluster sampling. Logistic regression models were used to evaluate the association between SUA and CKD. Results Subjects were divided into five groups according to the gender-specific quintiles of SUA. The CKD prevalence in serum uric acid quintiles of male were 4.9%, 5.7%, 6.0%, 8.0% and 13.8% respectively, while of female were 12.8%, 12.7%, 11.9%, 13.3% and 18.2% respectively, increasing along with the increase of SUA among both sexes (all P<0.05). Compared to the serum uric acid first quintile, the multivariate-adjusted odds for CKD in male of the fourth and fifth quintiles were 2.12 (95% CI: 1.32-3.39) and 3.84 (95% CI: 2.45-6.02), and the multivariate-adjusted odds for CKD in female of the fifth quintile was 1.38 (95% CI: 1.05-1.80). Hyperuricemia was defined by SUA>420 μmol/L(male) or >360 μmol/L(female). In the unadjusted model, HUA was significantly associated with CKD of all subjects (OR=2.03, 95% CI: 1.69-2.44, P<0.001), and the association was still significant (OR=2.04, 95% CI: 1.68-2.49, P<0.001) after adjustment for the potential confounders. The multivariate-adjusted odds of CKD associated with HUA was 2.89 (95% CI: 2.12-3.94, ) and 1.98 (95% CI: 1.51-2.60) for male and female, respectively. Conclusion Hyperuricemia was independently associated with the increased prevalence of CKD among community-based population living in the Songjiang district, Shanghai.
- Uric acid /
- Hyperuricemia /
- Chronic kidney disease /
- Cross-sectional study

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图 1 不同SUA水平组的CKD患病率

Figure 1. Prevalence of CKD in different SUA level groups

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表 1 不同SUA水平组的人口学及部分测量指标特征[M(P₂₅, P₇₅)]

Table 1. Demographics and partial measurement indicators of different SUA level groups[M(P₂₅, P₇₅)]

变量	第一分位水平组	第二分位水平组	第三分位水平组	第四分位水平组	第五分位水平组	F/H/χ²值	P值
男性
人数	676	683	678	665	668
年龄(岁)	59(52, 69)	56(48, 68)	54(45, 67)	54(41, 66)	53(41, 66)	101.82	<0.001
高血压史[n(%)]	226(33.4)	227(33.2)	229(33.8)	241(36.2)	298(44.6)	27.02	<0.001
糖尿病史[n(%)]	99(14.6)	65(9.5)	42(6.2)	44(6.6)	34(5.1)	51.76	<0.001
BMI(kg/m²)	23.87±3.13	24.09±3.09	24.61±3.19	25.06±3.29	25.97±3.33	46.06	<0.001
SBP(mmHg)	130.00(120.00, 146.00)	130.00(118.00, 144.50)	131.00(120.00, 146.00)	132.00(120.00, 144.00)	135.50(122.50, 148.00)	20.39	<0.001
DBP(mmHg)	78.00(71.50, 86.00)	78.00(71.50, 86.00)	80.00(72.00, 88.00)	82.00(74.00, 88.00)	82.00(75.50, 90.00)	69.85	<0.001
FPG(mmol/L)	4.58(4.21, 5.21)	4.51(4.21, 4.85)	4.50(4.19, 4.84)	4.49(4.18, 4.84)	4.48(4.21, 4.82)	15.67	0.003
HbA1c(%)	5.70(5.40, 6.20)	5.60(5.30, 5.90)	5.60(5.30, 5.90)	5.60(5.30, 6.00)	5.60(5.30, 5.90)	34.45	<0.001
TC(mmol/L)	4.63(4.09, 5.14)	4.64(4.06, 5.20)	4.61(4.09, 5.20)	4.66(4.11, 5.25)	4.77(4.27, 5.41)	21.06	<0.001
TG(mmol/L)	1.13(0.86, 1.62)	1.23(0.91, 1.71)	1.35(0.98, 1.95)	1.47(1.07, 2.19)	1.79(1.30, 2.74)	299.39	<0.001
LDL-C(mmol/L)	2.66(2.16, 3.12)	2.64(2.15, 3.12)	2.66(2.06, 3.10)	2.62(2.09, 3.11)	2.59(2.11, 3.14)	2.07	0.723
HDL-C(mmol/L)	1.38(1.16, 1.44)	1.35(1.13, 1.43)	1.27(1.08, 1.41)	1.26(1.05, 1.41)	1.20(0.99, 1.40)	123.07	<0.001
eGFR[mL·min^-1· (1.73 m²)^-1]	101.35±18.87	99.71±19.37	95.44±19.19	94.81±19.78	87.12±22.13	51.97	<0.001
女性
人数	970	989	946	975	957
年龄(岁)	52(43, 60)	52(42, 60)	53(45, 65)	54(45, 66)	56(49, 68)	69.00	<0.001
高血压史[n(%)]	173(17.8)	211(21.3)	228(24.1)	295(30.3)	402(42.0)	175.79	<0.001
糖尿病史[n(%)]	55(5.7)	66(6.7)	53(5.6)	59(6.1)	80(8.4)	8.20	0.085
BMI(kg/m²)	22.21(20.40, 24.26)	22.86(20.81, 24.96)	23.34(21.36, 25.78)	24.20(21.81, 26.52)	25.54(23.11, 28.08)	445.23	<0.001
SBP(mmHg)	126.00(112.00，143.00)	128.00(114.00, 144.00)	128.00(114.00, 144.00)	132.00(116.00, 148.00)	138.00(122.00, 153.00)	135.57	<0.001
DBP(mmHg)	74.00(68.00, 82.00)	74.00(68.00, 82.00)	74.00(68.00, 82.00)	76.00(70.00, 84.00)	78.00(72.00, 86.00)	102.05	<0.001
FPG(mmol/L)	4.50(4.19, 4.78)	4.45(4.17, 4.76)	4.48(4.19, 4.82)	4.51(4.21, 4.82)	4.56(4.21, 4.95)	25.42	<0.001
HbA1c(%)	5.60(5.30, 5.90)	5.60(5.30, 5.90)	5.60(5.40, 5.90)	5.70(5.40, 6.00)	5.70(5.40, 6.10)	86.72	<0.001
TC(mmol/L)	4.75(4.17, 5.40)	4.76(4.16, 5.41)	4.91(4.34, 5.47)	4.94(4.37, 5.63)	5.07(4.46, 5.77)	80.78	<0.001
TG(mmol/L)	1.03(0.78, 1.37)	1.13(0.85, 1.55)	1.23(0.90, 1.60)	1.34(0.98, 1.83)	1.57(1.14, 2.23)	432.21	<0.001
LDL-C(mmol/L)	2.63(2.10, 3.16)	2.60(2.12, 3.11)	2.78(2.27, 3.30)	2.78(2.27, 3.31)	2.84(2.29, 3.45)	51.94	<0.001
HDL-C(mmol/L)	1.62(1.42, 1.66)	1.58(1.36, 1.64)	1.56(1.31, 1.64)	1.48(1.26, 1.63)	1.40(1.19, 1.60)	271.60	<0.001
eGFR[mL·min^-1· (1.73 m²)^-1]	117.05±23.82	112.75±24.81	108.64±23.93	104.72±25.03	97.25±26.64	90.25	<0.001

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表 2 SUA五分位数组别与CKD患病的关系

Table 2. Relationship between quintiles of SUA and CKD

SUA水平组别	模型1		模型2		模型3
SUA水平组别	粗OR(95 % CI) 值	P值	粗OR(95 % CI) 值	P值	粗OR(95 % CI) 值	P值
男性
第一分位	1.00		1.00		1.00
第二分位	1.18(0.73~1.90)	0.496	1.31(0.81~2.13)	0.269	1.34(0.82~2.19)	0.240
第三分位	1.25(0.78~2.01)	0.346	1.56(0.96~2.52)	0.071	1.55(0.95~2.53)	0.080
第四分位	1.69(1.08~2.64)	0.022	2.13(1.35~3.38)	0.001	2.12(1.32~3.39)	0.002
第五分位	3.11(2.06~4.71)	<0.001	3.98(2.59~6.12)	<0.001	3.84(2.45~6.02)	<0.001
女性
第一分位	1.00		1.00		1.00
第二分位	1.00(0.76~1.30)	0.977	1.00(0.76~1.30)	0.978	1.01(0.77~1.32)	0.967
第三分位	0.93(0.71~1.22)	0.577	0.90(0.68~1.18)	0.452	0.91(0.69~1.20)	0.508
第四分位	1.05(0.81~1.37)	0.719	1.00(0.76~1.30)	0.984	1.01(0.77~1.32)	0.971
第五分位	1.52(1.18~1.95)	0.001	1.36(1.05~1.76)	0.018	1.38(1.05~1.80)	0.021
注：模型1未调整；模型2调整年龄、高血压史、糖尿病史；模型3调整年龄、高血压史、糖尿病史、BMI、SBP、DBP、FPG、HbA1c、TC、TG、LDL-C、HDL-C。

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表 3 HUA与CKD患病的关系

Table 3. Relationship between HUA and CKD

组别	检查人数	CKD[n(%)]	χ²值	P值	粗OR (95% CI) 值	调整OR(95% CI) 值
全组
尿酸正常	7 326	758(10.3)			1.00	1.00
HUA	881	167(19.0)	58.28	<0.001	2.03(1.69~2.44)	2.04(1.68~2.49)
男性
尿酸正常	2 853	179(6.3)			1.00	1.00
HUA	517	79(15.3)	48.95	<0.001	2.69(2.03~3.58)	2.89(2.12~3.94)
女性
尿酸正常	4 473	579(12.9)			1.00	1.00
HUA	364	88(24.2)	34.78	<0.001	2.14(1.66~2.77)	1.98(1.51~2.60)
注：调整OR值为调整年龄、高血压史、糖尿病史、BMI、SBP、DBP、FPG、HbA1c、TC、TG、LDL-C、HDL-C。

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