健康体检人群血尿酸与气流阻塞的相关性

doi:10.19723/j.issn.1671-167X.2024.04.024

摘要/Abstract

摘要：

目的: 探讨中国台湾健康体检人群中血尿酸水平与肺功能指标和气流阻塞之间的相关性。方法: 利用中国台湾美兆健康资源中心的体检资料，选取于1996—2016年间进行体检的40岁以上人群进行横断面分析，按照性别分别进行血尿酸水平与肺功能指标的相关性分析，以及血尿酸水平对气流阻塞影响的Logistic回归分析。结果: 共纳入35 465人，平均年龄(45.70±7.30)岁，男性16 411人，女性19 054人，其中，男性的血尿酸水平高于女性，存在气流阻塞的人群血尿酸水平高于无气流阻塞的人群。女性血尿酸水平与肺功能指标[第一秒用力呼气容积(forced expiratory volume in one second, FEV1)、用力肺活量(force vital capacity, FVC)]之间呈负相关(P＜0.05)，男性血尿酸水平与肺功能指标FEV1、FVC之间则无显著相关性(P>0.05)。在调整年龄、教育程度、吸烟、饮酒、工作强度、体重指数、是否咳嗽、高血压病史、糖尿病病史等指标，以及白细胞、白蛋白等生化指标后，随着血尿酸浓度的升高，女性更易存在气流阻塞(OR=1.12，95%CI: 1.02~1.22，P＜0.05)。按照是否患高尿酸血症进行分组，结果显示与血尿酸正常组相比，女性中高尿酸血症组更易存在气流阻塞(OR=1.36，95%CI: 1.06~1.75，P＜0.05)，而男性中血尿酸浓度与气流阻塞患病之间无显著相关性(OR=1.04，95%CI: 0.96~1.13，P>0.05)，是否患高尿酸血症与气流阻塞的存在无显著相关性(OR=1.12，95%CI: 0.89~1.39，P>0.05)。结论: 女性健康体检人群中，血尿酸水平与肺功能指标FEV1、FVC之间存在负相关，高尿酸血症与气流阻塞的存在有相关性，在男性中则不明显。未来仍需要前瞻性研究来进一步验证高血尿酸水平是否与气流阻塞的发生相关联。

关键词: 尿酸, 呼吸功能试验, 慢性阻塞性肺疾病, 横断面研究

Abstract:

Objective: To investigate the association between serum uric acid, pulmonary function and airflow obstruction in Chinese Taiwan healthy subjects. Methods: All the cross-sectional analysis was performed in the population over 40 years old using the physical examination data of Chinese Taiwan MJ Health Resource Center between 1996 and 2016 stratification by gender. The correlation analyses between serum uric acid were done and multivariate Logistic regression analysis was used to explore the effect of serum uric acid on airflow obstruction. Results: A total of 35 465 people were included in the study, including 16 411 men and 19 054 women. Among them, the serum uric acid concentration of men was higher than that of women, and the serum uric acid concentration of the people with airflow obstruction was higher than that of the people without airflow obstruction. There was a negative correlation between serum uric acid level and the forced expiratory volume in one second (FEV1) and the force vital capacity (FVC) in women (P < 0.05), but in men the correlation didn' t exist (P>0.05). After adjusting for age, education, smoking status, drinking status, work strength, body mass index, history of cough, history of hypertension, history of diabetes, history of dyslipidemia, white blood cells and blood albumin, the airflow obstruction in women was more likely to exist with the serum uric acid elevated (OR=1. 12, 95%CI: 1.02-1.22, P < 0.05). The results showed that women with hyperuricemia were more likely to have airflow obstruction than those without hyperuricemia (OR=1.36, 95%CI: 1.06-1.75, P < 0.05). There was no correlation between serum uric acid concentration and airflow obstruction in men (OR=1.04, 95%CI: 0.96-1.13, P>0.05), also the hyperuricemia and airflow obstruction (OR=1.12, 95%CI: 0.89-1.39, P>0.05). Conclusion: There is a negative correlation between serum uric acid and FEV1 and FVC in relatively healthy women, and there is an association between elevated serum uric acid and airflow obstruction in women, but not in men. Further prospective studies are needed to explore whether high serum uric acid level can increase the risk of airflow obstruction.

Key words: Uric acid, Respiratory function tests, Chronic obstructive pulmonary disease, Cross-sectional study

中图分类号:

R181.3

周庆欣,杨晴晴,石舒原,李沛,孙凤. 健康体检人群血尿酸与气流阻塞的相关性[J]. 北京大学学报（医学版）, 2024, 56(4): 693-699.

Qingxin ZHOU,Qingqing YANG,Shuyuan SHI,Pei LI,Feng SUN. Association between serum uric acid and airflow obstruction based on the health-checkup population[J]. Journal of Peking University (Health Sciences), 2024, 56(4): 693-699.

图/表 4

表1

研究人群基线特征"

Items	Men			Women
Items	Normal group (n=15 905)	Airflow obstruction group(n=506)	P value	Normal group(n=18 536)	Airflow obstruction group(n=518)	P value
Age/years	45.40±7.37	51.50±9.56	＜0.001	45.60±7.02	50.90±8.52	＜0.001
Marriage status			0.002			＜0.001
Unmarried	626 (4.14)	11 (2.26)		1 124 (6.41)	15 (3.02)
Married	14 035 (92.70)	448 (92.20)		14 657 (83.60)	403 (81.20)
Divorce/widowed	478 (3.16)	27 (5.56)		1 744 (9.95)	78 (15.70)
Education			＜0.001			＜0.001
High school and below	5 743 (37.20)	305 (61.90)		9 786 (54.40)	390 (77.20)
High school and above	9 700 (62.80)	188 (38.10)		8 217 (45.60)	115 (22.80)
Smoking status			0.001			0.203
Never	8 099 (52.80)	205 (44.00)		16 558 (95.10)	431 (96.60)
Passive smoking	1 853 (12.10)	69 (14.80)		167 (0.96)	1 (0.22)
Current smoking	5 380 (35.10)	192 (41.20)		690 (3.96)	14 (3.14)
Working strength			＜0.001			0.007
Mild	9 128 (59.80)	233 (50.70)		11 598 (65.60)	277 (58.30)
Moderate	3 783 (24.80)	120 (26.10)		4 790 (27.10)	159 (33.50)
Severe	1 847 (12.10)	82 (17.80)		1 169 (6.61)	34 (7.16)
Extremely severe	494 (3.24)	25 (5.43)		127 (0.72)	5 (1.05)
Hypertension	3 137 (19.70)	142 (28.10)	＜0.001	2 528 (13.60)	118 (22.80)	＜0.001
Diabetes	771 (4.85)	37 (7.31)	0.016	530 (2.86)	26 (5.02)	0.006
Hyperlipidemia	11 733 (73.80)	384 (75.90)	0.309	9 547 (51.50)	341 (65.80)	＜0.001
Obesity	5 992 (37.70)	175 (34.60)	0.172	3 800 (20.50)	151 (29.20)	＜0.001
Frequent cough	1 669 (11.40)	85 (19.30)	＜0.001	1 528 (8.91)	75 (16.40)	＜0.001
FEV1/L	3.54±0.40	3.29±0.44	＜0.001	2.58±0.28	2.39±0.29	＜0.001
FVC/L	4.32±0.48	4.05±0.50	＜0.001	3.15±0.32	2.95±0.32	0.123
WBC/(×10³/μL)	6.38±1.63	6.73±1.65	＜0.001	5.85±1.51	6.17±1.46	＜0.001
FBG/(mg/dL)	102±19.40	103±25.90	0.527	97.00±16.90	98.70±23.50	0.098
HDLC/(mg/dL)	47.9±12.50	46.30±13.40	0.009	59.40±15.40	55.20±15.40	＜0.001
LDLC/(mg/dL)	127±32.00	130±34.60	0.133	117±32.00	127±32.90	＜0.001
GFR/[mL/(min·1.73 m²)]	82.40±12.90	78.30±13.10	＜0.001	87.70±14.60	83.90±14.80	＜0.001
Triglycerides/(mg/dL)	145.00±99.60	136.00±87.00	0.025	98.70±66.00	113.00±78.90	＜0.001
Albumin/(g/dL)	4.54±0.24	4.59±0.28	＜0.001	4.42±0.24	4.50±0.26	＜0.001
ALT/(IU/L)	24.80±12.70	24.60±9.94	0.704	21.00±16.90	23.10±25.40	0.070
AST/(IU/L)	32.40±26.00	29.10±17.80	＜0.001	20.60±26.20	22.90±30.60	0.087
Creatinine/(mg/dL)	1.08±0.15	1.10±0.16	0.009	0.81±0.12	0.83±0.13	0.001
Serum uric acid/(mg/dL)	6.65±1.30	6.76±1.43	0.065	4.93±1.20	5.35±1.40	＜0.001
Hyperuricemia	5 660 (35.60)	207 (40.90)	0.016	2 954 (15.90)	147 (28.40)	＜0.001
Kidney injury	1 267 (7.97)	62 (12.30)	0.001	999 (5.39)	44 (8.49)	0.003

表1

图1

表2

图2

参考文献 34

1	The Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2021 Report)[EB/OL]. (2020-11-07)[2021-02-13]. https://goldcopd.org/2021-gold-reports/.
2	Zhou MG , Wang HD , Zeng XY , et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2019, 394 (10204): 1145- 1158. doi: 10.1016/S0140-6736(19)30427-1
3	Wang C , Xu JY , Yang L , et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health[CPH] study): A national cross-sectional study[J]. Lancet, 2018, 391 (10131): 1706- 1717. doi: 10.1016/S0140-6736(18)30841-9
4	Bowler RP , Barnes PJ , Crapo JD . The role of oxidative stress in chronic obstructive pulmonary disease[J]. COPD, 2004, 1 (2): 255- 277. doi: 10.1081/COPD-200027031
5	Brajer B , Batura-Gabryel H , Nowicka A , et al. Concentration of matrix metalloproteinase-9 in serum of patients with chronic obstructive pulmonary disease and a degree of airway obstruction and disease progression[J]. J Physiol Pharmacol, 2008, 59 (Suppl 6): 145- 152.
6	Cosio MG , Saetta M , Agusti A . Immunologic aspects of chronic obstructive pulmonary disease[J]. N Engl J Med, 2009, 360 (23): 2445- 2454. doi: 10.1056/NEJMra0804752
7	Li X , Meng XR , Timofeeva M , et al. Serum uric acid levels and multiple health outcomes: Umbrella review of evidence from observational studies, randomised controlled trials, and Mendelian randomisation studies[J]. BMJ, 2017, 358, j3799.
8	Holme I , Aastveit AH , Hammar N , et al. Uric acid and risk of myocardial infarction, stroke and congestive heart failure in 417, 734 men and women in the Apolipoprotein MOrtality RISk study (AMORIS)[J]. J Intern Med, 2009, 266 (6): 558- 570. doi: 10.1111/j.1365-2796.2009.02133.x
9	Cao X , Wu LX , Chen ZH . The association between elevated serum uric acid level and an increased risk of renal function decline in a health checkup cohort in China[J]. Int Urol Nephrol, 2018, 50 (3): 517- 525. doi: 10.1007/s11255-017-1732-6
10	Wattanachayakul P , Rujirachun P , Charoenngam N , et al. Chro-nic obstructive pulmonary disease (COPD) is associated with a higher level of serum uric acid. A systematic review and meta-analysis[J]. Adv Respir Med, 2020, 88 (3): 215- 222. doi: 10.5603/ARM.2020.0119
11	Aida Y , Shibata Y , Osaka D , et al. The relationship between serum uric acid and spirometric values in participants in a health check: The Takahata study[J]. Int J Med Sci, 2011, 8 (6): 470- 478. doi: 10.7150/ijms.8.470
12	Fukuhara A , Saito J , Sato S , et al. The association between risk of airflow limitation and serum uric acid measured at medical health check-ups[J]. Int J Chron Obstruct Pulmon Dis, 2017, 12, 1213- 1219. doi: 10.2147/COPD.S126249
13	Hong JW , Noh JH , Kim DJ . Association between serum uric acid and spirometric pulmonary function in Korean adults: The 2016 Korea National Health and Nutrition Examination Survey[J]. PLoS One, 2020, 15 (10): e0240987. doi: 10.1371/journal.pone.0240987
14	杨兴华, 陶秋山, 孙凤, 等. 台湾地区35~74岁健康体检人群代谢综合征发病风险预测模型的建立[J]. 中华流行病学杂志, 2013, 34 (9): 874- 878. doi: 10.3760/cma.j.issn.0254-6450.2013.09.004
15	Lin WY , Yao CA , Wang HC , et al. Impaired lung function is associated with obesity and metabolic syndrome in adults[J]. Obesity (Silver Spring), 2006, 14 (9): 1654- 1661. doi: 10.1038/oby.2006.190
16	《中国高血压基层管理指南》修订委员会. 中国高血压基层管理指南(2014年修订版)[J]. 中国医学前沿杂志(电子版), 2015, 7 (7): 18- 40.
17	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版)[J]. 中国实用内科杂志, 2018, 38 (4): 292- 344.
18	中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 血脂异常基层诊疗指南(实践版2019)[J]. 中华全科医师杂志, 2019, 18 (5): 417- 421. doi: 10.3760/cma.j.issn.1671-7368.2019.05.004
19	Levey AS , Stevens LA , Schmid CH , et al. A new equation to estimate glomerular filtration rate[J]. Ann Intern Med, 2009, 150 (9): 604- 612. doi: 10.7326/0003-4819-150-9-200905050-00006
20	中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 痛风及高尿酸血症基层诊疗指南(实践版2019)[J]. 中华全科医师杂志, 2020, 19 (6): 486- 494.
21	Chen CY , Lv JM , Yao QZ . Hyperuricemia-related diseases and xanthine oxidoreductase (XOR) inhibitors: An overview[J]. Med Sci Monit, 2016, 22, 2501- 2512. doi: 10.12659/MSM.899852
22	Ciencewicki J , Trivedi S , Kleeberger SR . Oxidants and the pathogenesis of lung diseases[J]. J Allergy Clin Immunol, 2008, 122 (3): 456- 468. doi: 10.1016/j.jaci.2008.08.004
23	Tuder RM , Zhen LJ , Cho CY , et al. Oxidative stress and apoptosis interact and cause emphysema due to vascular endothelial growth factor receptor blockade[J]. Am J Respir Cell Mol Biol, 2003, 29 (1): 88- 97. doi: 10.1165/rcmb.2002-0228OC
24	Ruggiero C , Cherubini A , Miller E , et al. Usefulness of uric acid to predict changes in C-reactive protein and interleukin-6 in 3-year period in Italians aged 21 to 98 years[J]. Am J Cardiol, 2007, 100 (1): 115- 121. doi: 10.1016/j.amjcard.2007.02.065
25	冯思玮, 马万里, 熊亮. 血尿酸在慢性阻塞性肺疾病患者中临床意义的Meta分析[J]. 中国临床研究, 2020, 33 (1): 35- 44.
26	Horsfall LJ , Nazareth I , Petersen I . Serum uric acid and the risk of respiratory disease: A population-based cohort study[J]. Thorax, 2014, 69 (11): 1021- 1026. doi: 10.1136/thoraxjnl-2014-205271
27	Palmer TM , Nordestgaard BG , Benn M , et al. Association of plasma uric acid with ischaemic heart disease and blood pressure: Mendelian randomisation analysis of two large cohorts[J]. BMJ, 2013, 347, f4262. doi: 10.1136/bmj.f4262
28	Song JU , Hwang J , Ahn JK . Serum uric acid is positively associated with pulmonary function in Korean health screening examinees[J]. Mod Rheumatol, 2017, 27 (6): 1057- 1065. doi: 10.1080/14397595.2017.1285981
29	Waring WS , Convery A , Mishra V , et al. Uric acid reduces exercise-induced oxidative stress in healthy adults[J]. Clin Sci (Lond), 2003, 105 (4): 425- 430.
30	Lu N , Dubreuil M , Zhang YQ , et al. Gout and the risk of Alzheimer' s disease: A population-based, BMI-matched cohort study[J]. Ann Rheum Dis, 2016, 75 (3): 547- 551.
31	Wang YF , Li JX , Sun XS , et al. High serum uric acid levels are a protective factor against unfavourable neurological functional outcome in patients with ischaemic stroke[J]. J Int Med Res, 2018, 46 (5): 1826- 1838.
32	Hu LH , Hu GP , Xu BP , et al. U-shaped association of serum uric acid with all-cause and cause-specific mortality in US adults: A cohort study[J]. J Clin Endocrinol Metab, 2020, 105 (1): e597- e609.
33	Lipovec NA , Beijers RJ , Borst B , et al. The prevalence of metabolic syndrome in chronic obstructive pulmonary disease: A systematic review[J]. COPD, 2016, 13 (3): 399- 406.
34	Adnan E , Rahman IA , Faridin HP . Relationship between insulin resistance, metabolic syndrome components and serum uric acid[J]. Diabetes Metab Syndr, 2019, 13 (3): 2158- 2162.

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Items	Model 1		Model 2		Model 3		Model 4		Model 5
Items	OR (95%CI)	P value	OR (95%CI)	P value	OR (95%CI)	P value	OR (95%CI)	P value	OR (95%CI)	P value
Men
Serum uric acid	1.07 (1.00-1.15)	0.040	1.05 (0.98-1.13)	0.158	1.06 (0.98-1.15)	0.160	1.07 (0.98-1.16)	0.120	1.04 (0.96-1.13)	0.305
Hyperuricemia	1.23 (1.03-1.48)	0.025	1.16 (0.95-1.42)	0.158	1.15 (0.92-1.43)	0.216	1.16 (0.93-1.45)	0.184	1.12 (0.89-1.39)	0.342
Women
Serum uric acid	1.07 (1.00-1.15)	0.040	1.09 (1.00-1.19)	0.044	1.14 (1.04-1.24)	0.003	1.14 (1.05-1.25)	0.002	1.12 (1.02-1.22)	0.016
Hyperuricemia	1.41 (1.15-1.73)	0.001	1.43 (1.13-1.79)	0.003	1.43 (1.12-1.83)	0.004	1.45 (1.13-1.86)	0.003	1.36 (1.06-1.75)	0.016

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