作者：杨玉环，王军，缪瑾瑾，张明明，蒿花，苏石，马茂

单位：

710061陕西省西安市，西安交通大学第一附属医院健康医学科

单位（英文）：

Department of Health Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China

关键词：

斑块，动脉粥样硬化；尿酸；心血管疾病风险；随访研究

关键词（英文）：

Plaque, atherosclerotic; Uric acid; Cardiovascular disease risk; Follow-up studies

中图分类号：

R 543.5

DOI：

10.12114/j.issn.1008-5971.2023.00.322

基金项目：

陕西省自然科学基金青年项目（2019SF-026）

摘要：

　目的　分析健康体检人群血清尿酸（SUA）与颈动脉粥样硬化（CAP）、10年心血管疾病风险的关 系。方法　2013—2016年在西安交通大学第一附属医院健康医学科进行健康体检（包括SUA检查和颈动脉超声检查） 者共74 539例，选取其中符合纳入与排除标准者 34 473例。根据首次颈动脉超声检查结果将健康体检者分为CAP组 （n=15 818）和无CAP组（ n=18 655）。收集健康体检者的一般资料及实验室检查结果，以首次颈动脉超声检查为 随访起点，以后续体检时发现CAP为随访终点事件，随访截止时间为2023-01-31。最后1次随访时，采用国人缺血 性心血管病10年发病风险评估表对无CAP组中完成≥2次颈动脉超声检查、年龄＞35岁且有吸烟情况的2 352例健康 体检者的10年心血管疾病风险进行评估。健康体检者发生CAP的影响因素分析采用多因素Logistic回归分析，SUA与 健康体检者10年心血管疾病风险的相关性分析采用Spearman秩相关分析。结果　CAP组年龄大于无CAP组，男性占 比、BMI、收缩压（SBP）、舒张压（DBP）、SUA、TC、TG、LDL-C、AST、球蛋白、空腹血糖、尿素氮、肌酐高 于无CAP组，HDL-C、ALT、总蛋白、白蛋白低于无CAP组（P＜0.05）。多因素Logistic回归分析结果显示，年龄、 男性、BMI、SBP、SUA、TC、TG、HDL-C、白蛋白、空腹血糖、尿素氮、肌酐是健康体检者发生CAP的独立影响因 素（P＜0.05）。本研究对无CAP组中完成≥2次颈动脉超声检查的3 308例健康体检者共随访了7～9年，结果显示， 共1 530例健康体检者发生了 CAP ， CAP 发生率为 46.2% 。根据基线 SUA 的四分位数将 3 308 例健康体检者分为 Q1 组 （SUA≤259 μmol/L ， n=829）、 Q2 组（ 259 μmol/L ＜SUA ≤316 μ mol/L ，n=830）、Q3 组（ 316 μmol/L＜SUA≤ 379 μmol/L ， n=824 ）、 Q4组（SUA＞379 μmol/L， n =825 ）。随着 SUA 升高，健康体检者 CAP 发生率呈逐渐升高趋势 （χ 2 趋势=11.716 ，P=0.008）。Q2组、Q3组、Q4组10年心血管疾病风险高于Q1组，Q3组、Q4组10年心血管疾病风险高 于Q2组，Q4组10年心血管疾病风险高于Q3组（P＜0.05）。Spearman秩相关分析结果显示，SUA与健康体检者10年心 血管疾病风险呈正相关（r s=0.223，P＜0.001）。结论　SUA升高是健康体检人群发生CAP的危险因素，且SUA越高的 健康体检人群CAP发生风险、10年心血管疾病风险越高。

英文摘要：

Objective To analyze the association of serum uric acid (SUA) with carotid atherosclerotic plaque (CAP) and 10-year risk of cardiovascular disease in the people undergoing health examinations. Methods There were 74 539 people undergoing health examinations (including SUA examination and carotid ultrasonography) in the Department of Health Medicine of the First Affiliated Hospital of Xi'an Jiaotong University from 2013 to 2016, among which 34 473 people met the inclusion and exclusion criteria were selected. According to the first results of carotid ultrasonography, the people undergoing health examinations were divided into CAP group (n=15 818) and non-CAP group (n=18 655) . The general data and laboratory examination results of people undergoing health examinations were collected, the first carotid ultrasonography was used as the starting point of follow-up, and CAP was found during follow-up physical examination as the end point event of follow-up. The follow-up deadline was 2023-01-31. The 10-year risk of cardiovascular disease of 2 352 people undergoing health examinations who completed ≥ 2 carotid ultrasonography, aged > 35 years, and had smoking history in the non-CAP group was assessed using the 10-year risk assessment table for ischemic cardiovascular disease in Chinese. Multivariate Logistic regression analysis was used to analyze the influencing factors of CAP in people undergoing health examinations. Spearman rank correlation analysis was used to analyze the correlation between SUA and 10-year risk of cardiovascular disease in people undergoing health examinations. Results The age of CAP group was older than that of non-CAP group, the male proportion, BMI, systolic blood pressure (SBP) , diastolic blood pressure (DBP) , SUA, TC, TG, LDL-C, AST, globulin, fasting blood glucose, urea nitrogen and creatinine were higher than those of non-CAP group, and HDL-C, ALT, total protein and albumin were lower than those of non-CAP group (P < 0.05) . Multivariate Logistic regression analysis showed that age, male, BMI, SBP, SUA, TC, TG, HDL-C, albumin, fasting blood glucose, urea nitrogen and creatinine were independent influencing factors for CAP in people undergoing health examinations ( P < 0.05) . A total of 3 308 people undergoing health examinations in non-CAP group who completed ≥ 2 carotid ultrasonography were followed up for 7-9 years in the study, the results showed that 1 530 people undergoing health examinations occurred CAP, and the incidence of CAP was 46.2 %. According to the baseline SUA quartile, the 3 308 people undergoing health examinations were divided into Q1 group (SUA ≤ 259 μmol/L, n=829) , Q2 group (259 μmol/L < SUA ≤ 316 μ mol/L, n=830) , Q3 group (316 μmol/L < SUA ≤ 379 μmol/L, n=824) and Q4 group (SUA > 379 μmol/L, n=825) . With the increase of SUA, the incidence of CAP in people undergoing health examinations showed an increasing trend (χ 2 trend=11.716, P= 0.008) . The 10-year risk of cardiovascular disease in Q2 group, Q3 group and Q4 group was higher than that in Q1 group, the 10-year risk of cardiovascular disease in Q3 group and Q4 group was higher than that in Q2 group, and the 10-year risk of cardiovascular disease in Q4 group was higher than that in Q3 group (P < 0.05) . Spearman rank correlation analysis showed that SUA was positively correlated with 10-year risk of cardiovascular disease in people undergoing health examinations (r s=0.223, P < 0.001) . Conclusion Elevated SUA is a risk factor for CAP in people undergoing health examinations. The higher SUA, the higher risk of CAP and 10-year risk of cardiovascular disease.

参考文献：