中国人群中血脂成分与血尿酸间的剂量-反应关系

高倩; 李婷; 彭刘庆; 王彤

doi:10.16462/j.cnki.zhjbkz.2023.10.005

中国人群中血脂成分与血尿酸间的剂量-反应关系

doi: 10.16462/j.cnki.zhjbkz.2023.10.005

山西医科大学公共卫生学院卫生统计学教研室，太原 030001；煤炭环境致病与防治教育部重点实验室，太原 030001

基金项目:

国家自然科学基金 82204163

国家自然科学基金 82073674

山西省基础研究计划资助项目 202203021212382

详细信息

通讯作者:
王彤，E-mail: tongwang@sxmu.edu.cn

中图分类号: R181.3;R589
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出版历程
- 收稿日期: 2023-03-08
- 修回日期: 2023-08-26
- 网络出版日期: 2023-10-23
- 刊出日期: 2023-10-10

Dose-response association between lipid profiles and serum urate acid in Chinese adults

Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan 030001, China; Key Laboratory of Coal Environmental Pathogenicity and Prevention, Ministry of Education, Taiyuan 030001, China

Funds:

National Natural Science Foundation of China 82204163

National Natural Science Foundation of China 82073674

Fundamental Research Program of Shanxi Province 202203021212382

More Information

Corresponding author: WANG Tong, E-mail: tongwang@sxmu.edu.cn

摘要

摘要: 目的探讨中国成人血脂成分与血尿酸(serum uric acid, SUA)间的剂量-反应关系，为高尿酸血症(hyperuricemia, HUA)的防治提供理论依据。方法基于中国健康与营养调查(China Health and Nutrition Survey, CHNS) 2009年和中国健康与养老追踪调查(China Health and Retirement Longitudinal Study, CHARLS) 2011-2012年的调查数据，分别纳入符合研究纳入排除标准的研究对象8 509名和6 749名。采用广义倾向性评分逆概率加权方法，均衡年龄、性别等潜在混杂因素后，估计血脂成分总胆固醇(cholesterol, TC)、低密度脂蛋白(low-density lipoprotein, LDL)、高密度脂蛋白(high-density lipoprotein, HDL)和三酰甘油(triglycerides, TG)与SUA间的剂量-反应关系。结果 CHNS和CHARLS研究对象的平均年龄分别为(50.32±15.08)岁和(58.52±9.17)岁，SUA升高者分别占15.30%和5.34%。在均衡可能的混杂因素后，逆概率加权法分析结果显示，TG和HDL与SUA间存在统计学剂量-反应关系，SUA水平随TG水平的升高和HDL水平的降低而升高。结论血脂异常可能导致SUA升高，及时调节血脂水平可能有助于HUA的防治。
- 血脂成分 /
- 血尿酸 /
- 高尿酸血症 /
- 剂量-反应关系 /
- 广义倾向性评分逆概率加权法
Abstract: Objective This study aims to estimate dose-response relationship of lipid profiles on serum urate acid (SUA), and to provide evidence for prevention and therapy of Hyperuricemia (HUA). Methods Based on China Health and Nutrition Survey (CHNS) in 2009 and China Health and Retirement Longitudinal Study (CHARLS) in 2011-2012, 8 509 and 6 749 participants with no missing key variables were included in this study, respectively. Generalized propensity score based inverse probability weighting (IPW) method was used to adjust for potential confounders, and to estimate dose-response curves of total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides (TG) on SUA. Results In CHNS, the mean age was (50.32±15.08) years old with 15.3% of individuals having high levels of SUA. In CHARLS, the mean age was (58.52±9.17) years old and, 5.34% of individuals had high levels of SUA. Results of IPW analysis showed that there were statistically significant dose-response relationship between TG, HDL and SUA in both CHNS and CHARLS. The SUA increased as TG increased and HDL decreased. Conclusions The abnormality of lipid profiles may lead to an increase in SUA, and the timely lipid-modifying may help to prevent and treat HUA.
- Lipid profiles /
- Serum urate acid /
- Hyperuricemia /
- Dose-response relationship /
- Generalized propensity score based inverse probability weighting (IPW) method

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图 1 CHNS和CHARLS数据集研究对象筛选流程图

CHNS, 中国健康与营养调查; CHARLS, 中国健康与养老追踪调查。

Figure 1. Flow chart of subject screening for CHNS and CHARLS datasets

CHNS, China Health and Nutrition Survey; CHARLS, China Health and Retirement Longitudinal Study.

下载: 全尺寸图片幻灯片

图 2 加权前后样本中协变量均衡性表现

CHNS, 中国健康与营养调查; CHARLS, 中国健康与养老追踪调查; SUA, 血尿酸; TC, 总胆固醇; TG, 三酰甘油; LDL, 低密度脂蛋白; HDL, 高密度脂蛋白。
图中星号表示离群点。

Figure 2. Performance of covariate balance in a sample before and after weighting

CHNS, China Health and Nutrition Survey; CHARLS, China Health and Retirement Longitudinal Study; TC, cholesterol; TG, triglycerides; LDL, low-density lipoprotein; HDL, high-density lipoprotein.
The asterisks in the figure indicate outliers.

下载: 全尺寸图片幻灯片

表 1 研究对象基线特征

Table 1. Baseline characteristics of the study subjects

变量 Variables	变量赋值 Value assignment	CHNS			CHARLS
变量 Variables	变量赋值 Value assignment	SUA正常^① Normal SUA levels^① (n=7 209)	SUA升高^① High SUA levels^① (n=1 300)	P值 value	SUA正常^① Normal SUA levels^① (n=6 403)	SUA升高^① High SUA levels^① (n=346)	P值 value
年龄组/岁Age group/years		49.82±15.02	53.06±15.14	< 0.001	58.36±9.12	61.38±9.71	< 0.001
18~＜45		2 684(37.2)	384(29.5)	< 0.001	173(2.7)	7(2.0)	< 0.001
45~＜60		2 600(36.1)	471(36.2)		3 670(57.3)	155(44.8)
≥60		1 925(26.7)	445(34.3)		2 560(40.0)	184(53.2)
性别Gender				< 0.001			< 0.001
男Male	1	3 149(43.7)	797(61.3)		3 021(47.2)	208(60.1)
女Female	2	4 060(56.3)	503(38.7)		3 382(52.8)	138(39.9)
婚姻状况Marital status				0.321			0.157
离婚/丧偶/分居/未婚Divorced/Widowed/Separated/Never married	0	1 127(15.6)	218(16.8)		3 610(56.4)	209(60.4)
已婚/同居Married/Live with partners	1	6 082(84.4)	1 082(83.2)		2 793(43.6)	137(39.6)
受教育程度Education				0.141			0.609
小学及以下Primary school or lower	0	3 145(43.6)	538(41.4)		4 387(68.5)	232(67.1)
初中及以上Middle school or higher	1	4 064(56.4)	762(58.6)		2 016(31.5)	114(32.9)
吸烟Smoking				< 0.001			0.742
从不吸烟Never	0	5 101(70.8)	808(62.2)		4 596(71.8)	253(73.1)
已戒烟Quit	1	224(3.1)	55(4.2)		455(7.1)	21(6.1)
现在仍吸Currently	2	1 884(26.1)	437(33.6)		1 352(21.1)	72(20.8)
饮酒Drinking				< 0.001			0.013
从不饮酒Never	0	5 026(69.7)	742(57.1)		5 207(81.3)	273(78.9)
每月少于1次Less than once a month	1	312(4.3)	57(4.4)		650(10.2)	51(14.7)
每月多于1次More than once a month	2	1 871(26.0)	501(38.5)		546(8.5)	22(6.4)
TG/(mmol·L^-1)		1.43±1.00	3.01±2.55	< 0.001	1.43±1.03	2.12±1.71	< 0.001
HDL/(mmol·L^-1)		1.47±0.47	1.28±0.59	< 0.001	1.33±0.40	1.20±0.42	< 0.001
LDL/(mmol·L^-1)		2.98±0.94	2.99±1.21	0.659	3.01±0.89	3.03±1.10	0.661
TC/(mmol·L^-1)		4.79±0.97	5.27±1.11	< 0.001	5.00±0.98	5.30±1.17	< 0.001
BMI/(kg·m^-2)					23.67±4.01	23.74±3.62	0.751
< 18.5					448(7.0)	12(3.5)	0.065
18.5~ < 24.0					3 177(49.6)	186(53.8)
24.0~ < 28.0					1 959(30.6)	106(30.6)
≥28.0					819(12.8)	42(12.1)
注：CHNS, 中国健康与营养调查; CHARLS, 中国健康与养老追踪调查; SUA, 血尿酸; TC, 总胆固醇; LDL, 低密度脂蛋白; HDL, 高密度脂蛋白; TG, 三酰甘油。 ①以[人数(占比/%)]或(x±s)表示。 Notes: CHNS, China Health and Nutrition Survey; CHARLS, China Health and Retirement Longitudinal Study; SUA, serum urate acid; TC, cholesterol; LDL, low-density lipoprotein; HDL, high-density lipoprotein; TG, triglycerides. ① [Number of people (proportion/%)]or (x±s).

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表 2 SUA与血脂成分间剂量-反应关系分析结果

Table 2. Analysis results of dose-response relationship between SUA and blood lipid components

数据集Datasets	单变量模型Univariate models	β	s_x	t值value	P值value
CHNS	TC	35.84	18.57	1.93	0.054
	TG	33.67	5.49	6.13	< 0.001
	HDL	-30.58	7.10	-4.31	< 0.001
	LDL	-0.706	1.85	-0.38	0.702
CHARLS	TC	10.06	0.97	10.41	< 0.001
	TG	13.31	1.17	11.42	< 0.001
	HDL	-16.34	2.46	-6.65	< 0.001
	LDL	4.68	1.10	4.24	< 0.001
注：CHNS, 中国健康与营养调查; CHARLS, 中国健康与养老追踪调查; SUA, 血尿酸; TC, 总胆固醇; TG, 三酰甘油; LDL, 低密度脂蛋白; HDL, 高密度脂蛋白。上述单变量模型指各血脂成分与SUA间的加权单变量线性回归模型，权重由非参数的协变量均衡广义倾向性评分方法估计 Notes: CHNS, China Health and Nutrition Survey; CHARLS, China Health and Retirement Longitudinal Study; TC, cholesterol; TG, triglycerides; LDL, low-density lipoprotein; HDL, high-density lipoprotein. The above univariate model refers to the weighted univariate linear regression model between each lipid component and SUA, the weight of which is estimated by the non-parametric covariate balancing generalized propensity score method.

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