绝经前后血尿酸水平变化的队列研究

代巧云; 吴寿岭; 杨雪莹; 陈朔华; 曹宗富; 张亚亚; 马旭

doi:10.16462/j.cnki.zhjbkz.2024.01.002

绝经前后血尿酸水平变化的队列研究

doi: 10.16462/j.cnki.zhjbkz.2024.01.002

1.
国家卫生健康委科学技术研究所人类遗传资源中心，北京 100081
2.
华北理工大学附属开滦总医院心血管内科，唐山 063011
3.
华北理工大学研究生院，唐山 063210

基金项目:

国家科技资源共享服务平台项目 2005DKA21300

详细信息

通讯作者:
马旭，E-mail：maxubioinfo@163.com

中图分类号: R173
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出版历程
- 收稿日期: 2023-05-17
- 修回日期: 2023-08-29
- 网络出版日期: 2024-02-05
- 刊出日期: 2024-01-10

A cohort study on the changes of serum uric acid in the pre- and post-menopause

1.
Human Genetic Resources Center, National Research Institute for Family Planning, Beijing 100081, China
2.
Department of Cardiovascular, Kailuan General Hospital, North China University of Science and Technology, Tangshan 063011, China
3.
Graduate School of North China University of Science and Technology, Tangshan 063210, China

Funds:

National Science and Technology Resources Sharing Service Platform Project 2005DKA21300

More Information

Corresponding author: MA Xu, E-mail: maxubioinfo@163.com

摘要

摘要: 目的探讨绝经前后血尿酸(serum uric acid, SUA)水平变化。方法基于开滦体检队列，用线性和分段线性混合效应模型分析绝经前后SUA变化，并分析基线年龄和基线BMI分别与绝经前后时间分段的相乘交互作用。结果 2006—2020年的7次体检共3 747例女性，共21 223人次体检记录被纳入分析。首次体检平均年龄为(46.19±4.11)岁，中位绝经年龄为51.00(50.00, 53.00)岁。与绝经前相比，绝经后SUA水平升高10.15 μmol/L。SUA从绝经前11年开始缓慢增加，平均年增长量为1.99 μmol/L；绝经前5~前2年每年平均增加3.30 μmol/L；SUA在绝经前后2年的平均年增长量为4.60 μmol/L；随后平均年增长量下降，在绝经5年后，平均年增长量降至1.77 μmol/L。基线年龄 < 40岁与绝经后2~ < 5年(P_interaction=0.009)和绝经≥5年(P_interaction < 0.001)的时间分段存在交互作用，基线年龄40~ < 45岁与绝经前后2年时间有交互作用(P_interaction=0.033)；除基线年龄 < 40岁对绝经2年后SUA变化有影响，其他基线年龄组SUA在绝经前后的变化一致。基线BMI与绝经前后各时间分段均无交互作用(均P_interaction>0.05)。结论绝经对SUA有不良影响，中年女性在绝经前后应关注SUA水平，采取积极防控策略。
- 绝经 /
- 血尿酸 /
- 队列研究 /
- 体质指数
Abstract: Objective To investigate the changes of serum uric acid (SUA) around menopause. Methods The linear and piecewise linear mixed effect models were used to analyze SUA changes in the pre-and post-menopause on the Kailuan Health Examination cohort. Multiplicative interaction effects between baseline age as well as baseline BMI and segmented time periods pre- and post-menopause were also analyzed. Results A total of 3 747 female with 21 223 health examination records from 2006 to 2020 (7 health examinations) were included in the analysis. The average age at the first health examination was (46.19 ± 4.11) years, and the median age at menopause was 51(50, 53) years. Compared to pre-menopause, SUA increased by 10.15 μmol/L in post-menopause. SUA started to increase gradually from 11 years before menopause, with an average annual increase of 1.99 μmol/L; From 5 to 2 years before menopause, SUA increased by an average of 3.30 μmol/L per year; During the 2 years before and after menopause period, SUA increased by an average of 4.60 μmol/L per year. After that, the average annual increase slowed, and after 5 years of menopause, the average annual increase in SUA dropped to 1.77 μmol/L. There was an interaction between baseline age < 40 years and the time segments of postmenopausal 2- < 5 years after menopause (P_interaction=0.009) and 5 years or more after menopause (P_interaction < 0.001), as well as between baseline age 40- < 45 years and the 2 years before and after menopause (P_interaction=0.033). Except for age under 40 years, which had an impact on SUA changes during 2 years after menopause, the SUA changes around menopause in other baseline age groups were consistent. There was no multiplication interaction effect between baseline BMI and various time segments around menopause (all P_interaction>0.05). Conclusions Menopause has an adverse effect on SUA. Middle-aged women should pay attention to their SUA levels around menopause and adopt proactive prevention and control strategies.
- Menopause /
- Serum uric acid /
- Cohort study /
- Body mass index

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图 1 不同基线年龄组(A)和不同基线BMI组(B)女性绝经前后SUA的分段线性混合效应模型拟合图

SUA：血尿酸。

Figure 1. Fitting graph of piece-wise linear mixed effect model for SUA before and after menopause in women according to different baseline age groups (A) and baseline BMI groups (B)

SUA: serum uric acid.

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表 1 研究队列信息

Table 1. The information of study cohort

队列信息The information of cohort	第1次体检The first examination	第2次体检The second examination	第3次体检The third examination	第4次体检The fourth examination	第5次体检The fifth examination	第6次体检The sixth examination	第7次体检The seventh examination
参加当次体检人数Number of participants in the current examination	3 746	3 160	3 340	3 229	2 948	2 901	3 080
缺失当次体检人数Missing of participants in the current examination	0	586	406	517	798	845	666
因SUA缺失而剔除的记录数Number of records excluded due to missing SUA	304	77	60	82	87	156	415
纳入分析的记录数Number of records included in the analysis	3 442	3 083	3 280	3 147	2 861	2 745	2 665
注：SUA, 血尿酸。 Note: SUA, serum uric acid.

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表 2 研究对象各次体检特征

Table 2. Characteristics of participants at each examination

变量Variable	第1次体检The first examination	第2次体检The second examination	第3次体检The third examination	第4次体检The fourth examination	第5次体检The fifth examination	第6次体检The sixth examination	第7次体检The seventh examination
记录数Records	3 442	3 083	3 280	3 147	2 861	2 745	2 665
年龄/岁Age/years, x±s	46.19±4.11	47.73±4.59	49.45±4.68	51.71±4.68	53.82±4.76	56.42±4.56	57.89±4.49
教育程度Education level
高中以下^① Below senior high school ^①	2 392(69.53)	2 055(66.66)	2 202(67.13)	2 105(66.89)	1 926(67.58)	1 918(69.9)	1 769(66.43)
高中及以上^① Senior high school or above ^①	1 048(30.47)	1 028(33.34)	1 078(32.87)	1 042(33.11)	924(32.42)	826(30.10)	894(33.57)
缺失人数Missing	2	0	0	0	1	1	2
基线吸烟状态^① Baseline smoking status ^①
不吸烟No smoking	3 388(98.43)	3 033(98.38)	3 233(98.57)	3 099(98.47)	2 828(98.85)	2 707(98.62)	2 634(98.84)
既往吸烟Previous smoking	9(0.26)	9(0.29)	8(0.24)	8(0.25)	6(0.21)	6(0.22)	6(0.23)
当前吸烟Current smoking	45(1.31)	41(1.33)	39(1.19)	40(1.27)	27(0.94)	32(1.17)	25(0.94)
饮酒状态Drinking status
不饮酒^① No drinking ^①	3 203(93.06)	2 824(91.63)	3 100(94.51)	2 975(94.68)	2 700(94.41)	2 598(94.82)	2 511(94.47)
偶尔饮酒^① Occasional drinking ^①	227(6.60)	246(7.98)	172(5.24)	152(4.84)	148(5.17)	128(4.67)	138(5.19)
经常饮酒^① Often drinking ^①	12(0.35)	12(0.39)	8(0.24)	15(0.48)	12(0.42)	14(0.51)	9(0.34)
缺失人数Missing	0	1	0	5	1	5	7
体育锻炼Physical activity
无^① No ^①	194(5.65)	550(17.90)	1 014(30.98)	1 003(31.96)	909(31.82)	806(29.50)	855(32.22)
偶尔^① Occasional ^①	2 901(84.53)	1 941(63.18)	1 833(56.00)	1 786(56.92)	1 649(57.72)	1 619(59.26)	1 521(57.31)
经常^① Often ^①	337(9.82)	581(18.91)	426(13.02)	349(11.12)	299(10.47)	307(11.24)	278(10.47)
缺失人数Missing	10	11	7	9	4	13	11
高血压Hypertension
无^① No ^①	2 595(75.48)	2 281(74.03)	2 309(70.40)	2 099(66.72)	1 783(62.83)	1 635(59.67)	1 548(58.33)
有^① Yes ^①	843(24.52)	800(25.97)	971(29.60)	1 047(33.28)	1 055(37.17)	1 105(40.33)	1 106(41.67)
缺失人数Missing	4	2	0	1	23	5	11
糖尿病Diabetes
无^① No ^①	3 256(94.73)	2 854(92.66)	3 010(91.80)	2 801(89.20)	2 492(87.81)	2 347(85.84)	2 235(84.69)
有^① Yes ^①	181(5.27)	226(7.34)	269(8.20)	339(10.80)	346(12.19)	387(14.16)	404(15.31)
缺失人数Missing	5	3	1	7	23	11	26
血脂异常Dyslipidemia
无^① No ^①	2 554(74.20)	1 921(62.31)	1 985(60.54)	1 690(53.72)	1 446(50.65)	1 324(48.29)	1 144(42.93)
有^① Yes ^①	888(25.80)	1 162(37.69)	1 294(39.46)	1 456(46.28)	1 409(49.35)	1 418(51.71)	1 521(57.07)
缺失人数Missing	0	0	1	1	6	3	0
BMI/(kg·m^-2), x±s	24.61±3.39	24.51±3.32	24.78±3.34	24.82±3.29	24.81±3.21	24.86±3.35	24.84±3.37
肌酐/(μmol·L^-1) Creatinine /(μmol·L^-1), x±s	78.35±23.19	71.99±20.38	67.36±18.22	64.97±18.68	61.05±28.87	59.36±17.22	59.32±14.63
SUA/(μmol·L^-1), x±s	229.89±63.49	239.38±65.97	244.32±64.68	258.78±69.77	271.14±69.75	280.67±71.32	285.03±70.84
注：SUA, 血尿酸。 ①以人数(占比%)表示。 Note: SUA, serum uric acid. ① Number of people(proportion%).

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表 3 与绝经相关的各时间分段内SUA的估计年度变化：分段线性混合效应模型的结果

Table 3. Estimated annual changes in SUA within each time segment in relation to final menstrual period: results of piece-wise linear mixed effect models

变量Variable	粗模型Crude model		多变量调整模型^② Multivariable adjustment model ^②
变量Variable	β值value (s_x)	P值value	β值value (s_x)	P值value
绝经相关时间分段^①Menopausal related time segments ^①
A. < -5年years	3.146(0.427)	< 0.001	1.992(0.501)	< 0.001
B. -5~ < -2年years	4.362(0.554)	< 0.001	3.304(0.617)	< 0.001
C. -2~ < 2年years	5.541(0.406)	< 0.001	4.597(0.489)	< 0.001
D. 2~ < 5年years	4.408(0.523)	< 0.001	3.652(0.598)	< 0.001
E. ≥5年years	2.564(0.364)	< 0.001	1.771(0.448)	< 0.001
相邻时间分段比较Comparison of adjacent time segments
A与B (A∶B)		0.155		0.134
B与C (B∶C)		0.162		0.137
C与D (C∶D)		0.168		0.268
D与E (D∶E)		0.018		0.020
注：①绝经相关时间分段，负值表示绝经前时间，正值表示绝经后时间; ②调整的变量包括基线文化程度、吸烟状态、时变的年龄、BMI、饮酒状态、体育锻炼、肌酐、高血压、糖尿病、血脂异常。 Note: ① Menopausal related time segments, negative values represent premenopausal time, and positive values represent postmenopausal time; ②The adjusted variables included baseline of education level, smoking status, and time-varying age, BMI, drinking status, physical activity, creatinine, hypertension, diabetes, dyslipidemia.

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