Association between uric acid and brachial-ankle pulse wave velocity among hypertensive population in rural areas of Eastern China
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摘要:
目的 了解华东农村地区高血压人群中血尿酸水平与臂踝脉搏波传导速度(brachial-ankle pulse wave velocity，baPWV)的相关性，并进一步探索可能影响两者关系的危险因素。 方法 本研究是于2013年7~9月在连云港市赣榆县和东海县、安庆枞阳和望江县进行的一项横断面研究。检测研究人群的血尿酸水平，并进行baPWV测定，采用多元线性回归分析来评估两者间关系。 结果 4278名成年高血压患者最终纳入本研究，平均年龄为(65.2±7.4)岁，baPWV水平为(1 835.1±383.4) cm/s。多元线性回归分析结果显示，调整年龄、性别等危险因素后，血尿酸水平与baPWV呈现正相关关系(每标准差(standard deviation，SD)增加(β=20.5 cm/s，95% CI：8.5~32.5，P=0.001)。按照血尿酸水平进行三等分组时，相较于第一等分组患者(< 277 μmol/L)，第三等分组患者(≥ 349 μmol/L)的baPWV水平增加(β=51.2 cm/s，95% CI：23.8~78.6，P=0.001)。分层分析结果发现，在收缩压(systolic blood pressure，SBP) ≥ 140 mm Hg人群中，血尿酸水平与baPWV具有更强的关联(交互P值=0.001)。 结论 华东农村地区高血压人群的血尿酸水平与baPWV呈现正相关关系，血压控制不佳(SBP ≥ 140 mm Hg)人群具有更强的关联。 Abstract:Objective To investigate the association between serum uric acid and brachial-ankle pulse wave velocity (baPWV) levels and to examine any possible effect modifiers among hypertensive patients in rural areas of Eastern China. Methods This cross-sectional study was conducted in Lianyungang and Anqing Cities from July to September 2013. Hypertensive patients with serum uric acid and baPWV measurements were included in this study. Multivariate linear regression was used to assess the relationship between serum uric acid levels and baPWV. Results Finally, a total of 4 278 participants were included in this study. The mean age was 65.2 (standard deviation(SD): 7.4) years and the mean value of baPWV levels were 1835.1 (SD: 383.4) cm/s. Regression analysis showed that there is a positive correlation between serum uric acid and baPWV levels (per SD increment, β=20.5 cm/s, 95% CI: 8.5-32.5, P=0.001. When uric acid was categorized in tertiles, a significantly higher baPWV level was found in participants in tertile 3 (≥ 349μmol/L)(β=51.2 cm/s, 95% CI: 23.8-78.6, P=0.001), compared with those in tertile 1(< 277 μmol/L). Furthermore, the serum uric acid-baPWV association was significantly stronger in those systolic blood pressure (SBP) ≥ 140 mm Hg (vs. < 140 mm Hg; p-interaction=0.001). Conclusion There is a positive relationship between uric acid levels and baPWV among hypertensive patients, especially in those with higher SBP levels. -
Key words:
- Uric acid /
- Brachial-ankle pulse wave velocity /
- Arteriosclerosis /
- Hypertension
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图 1 血尿酸与BaPWV的相关性
注：调整变量：年龄、性别、体质指数、SBP、DBP、吸烟、饮酒情况、总胆固醇、甘油三酯、高密度脂蛋白、空腹血糖、同型半胱氨酸、肌酐、降压药。
Figure 1. The relationship between serum uric acid and baPWV levels
表 1 研究人群描述(x±s)
Table 1. Baseline characteristics of study participants(x±s)
变量 总人群 尿酸(μmol/L) F/χ2值 P值 第一等分组(< 277) 第二等分组(277~) 第三等分组(≥349) 例数 4 278 1 412 1 440 1 426 年龄(岁) 65.2±7.4 64.6±7.3 64.8±7.4 66.2±7.4 20.15 < 0.001 男性[n(%)] 1 268(29.6) 172(12.2) 369(25.6) 727(51.0) 528.95 < 0.001 体质指数(kg/m2) 24.8±3.9 24.1±3.6 25.1±3.9 25.3±4.1 38.31 < 0.001 收缩压(mm Hg) 142.1±18.4 142.4±18.2 142.1±17.9 141.9±19.2 0.23 0.792 舒张压(mm Hg) 83.3±11.1 82.6±10.5 83.8±11.1 83.5±11.6 4.24 0.015 目前吸烟[n(%)] 707(16.6) 123(8.7) 210(14.6) 374(26.3) 164.09 < 0.001 目前饮酒[n(%)] 717(17.2) 134(8.7) 198(14.1) 385(28.1) 180.12 < 0.001 自述糖尿病[n(%)] 129(3.0) 34(2.4) 51(3.5) 44(3.1) 3.17 0.205 自述高脂血症[n(%)] 96(2.2) 23(1.6) 33(2.3) 40(2.8) 4.53 0.104 总胆固醇(mmol/L) 5.3±1.1 5.2±1.1 5.3±1.1 5.3±1.1 3.72 0.024 甘油三酯(mmol/L) 1.8±1.3 1.6±1.1 1.8±1.2 2.0±1.6 42.13 < 0.001 空腹血糖(mmol/L) 6.2±1.9 6.3±2.2 6.2±1.8 6.3±1.7 1.50 0.224 肌酐(μmol/L) 66.7±23.3 57.4±12.4 64.0±13.5 78.5±32.5 352.43 < 0.001 同型半胱氨酸(μmol/L) 13.9±7.2 12.1±5.2 13.5±6.8 16.2±8.7 125.47 < 0.001 baPWV(cm/s) 1 835.1±383.4 1 812.7±361.6 1 822.2± 371.9 1 870.2±412.7 9.21 < 0.001 
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表 2 血尿酸水平与baPWV的回归分析(多元线性回归)
Table 2. Multiple linear regression analysis of serum uric acid and baPWV levels
尿酸(μmol/L) baPWV(cm/s) x±s 粗模型 调整模型a β(95% CI) P值 β (95% CI) P值 总人群 每SD增加 1 835.1±383.4 22.8(11.3~34.2) < 0.001 20.5(8.5~32.5) 0.001 三等分组 第一等分组(< 277) 1 812.7±361.6 ref ref 第二等分组(277~) 1 822.2±371.9 9.5(-18.6~37.6) 0.506 21.8(-2.2~45.8) 0.075 第三等分组(≥349) 1 870.2±412.7 57.4(29.3~85.6) < 0.001 51.2(23.8~78.6) < 0.001 趋势性检验 < 0.001 < 0.001 男性人群 每SD增加 1 838.0±395.6 24.5(3.5~45.4) 0.022 22.1(0.2~44.0) 0.048 三等分组 第一等分组(< 329) 1 825.3±352.9 ref ref 第二等分组(329~) 1 808.5±367.1 -16.8(-70.1~36.5) 0.537 -7.3(-56.8~42.2) 0.774 第三等分组(≥403) 1 880.0±455.8 54.7(1.5~107.8) 0.044 59.2 (6.2~112.3) 0.029 趋势性检验 0.044 0.034 女性人群 每SD增加 1 833.8±378.3 26.4(10.9~41.8) 0.001 21.1(6.5~35.7) 0.005 三等分组 第一等分组(< 262) 1 808.8±358.4 ref ref 第二等分组(262~) 1 829.2±379.9 20.4(-12.8~53.5) 0.228 19.6(-7.4~46.6) 0.155 第三等分组(≥322) 1 863.0±393.8 54.2 (21.2~87.3) 0.001 43.1(13.5~72.7) 0.004 趋势性检验 0.001 0.004 注：a调整变量：年龄、性别、体质指数、SBP、DBP、吸烟、饮酒情况、总胆固醇、甘油三酯、高密度脂蛋白、空腹血糖、同型半胱氨酸、肌酐、降压药。
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表 3 血尿酸水平与baPWV的分层回归分析(x±s)
Table 3. Stratified analyses by potential effect modifiers for serum uric acid and baPWV levels(x±s)
变量 总人数 baPWV(cm/s) β (95%CI)a 交互P值 性别[n(%)] 0.363 男性 1 268 1 838.0±395.6 22.1(0.2~44.0) 女性 3 010 1 833.8±378.3 21.1(6.5~35.7) 年龄(岁) 0.752 < 60 1 101 1 635.1±321.8 16.3(-8.2~40.8) ≥60 3 177 1 904.4±378.8 23.9 (9.1~38.6) 体质指数(kg/m2) 0.709 < 24 1 829 1 883.5±393.7 18.2(-0.8~37.1) 24~ 1 594 1 824.4 ± 388.9 27.4(6.6~48.2) ≥28 836 1 750.2 ± 331.7 12.6(-10.5~35.7) 收缩压(mm Hg) 0.001 < 140 1 951 1 705.1±331.6 0.5(-15.8~16.7) ≥140 2 285 1 946.3±389.6 35.8(17.8~53.8) 目前吸烟[n(%)] 0.314 否 3 558 1 838.7±377.2 16.7(3.9~29.5) 是 707 1 817.7±414.6 34.9(1.7~68.1) 目前饮酒[n(%)] 0.381 否 3 451 1 838.9±375.9 20.4 (7.5~33.3) 是 717 1 819.8±421.7 17.6 (-15.1~50.3) 总胆固醇(mmol/L) 0.092 < 5.2 2 107 1 811.4±374.4 13.8(-2.2~29.8) ≥5.2 2 107 1 859.1±390.4 27.0(9.1~44.8) 降压药[n(%)] 0.125 否 3 346 1 853.9±387.2 16.7(3.1~30.3) 是 878 1 767.5±361.6 38.8(13.4~64.2) 注：a调整变量：年龄、性别、体质指数、SBP、DBP、吸烟、饮酒情况、总胆固醇、甘油三酯、高密度脂蛋白、空腹血糖、同型半胱氨酸、肌酐、降压药。
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