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Article(id=1203036774781116662, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1203036770628755576, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2023.04.0445, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1645027200000, receivedDateStr=2022-02-17, revisedDate=null, revisedDateStr=null, acceptedDate=1657209600000, acceptedDateStr=2022-07-08, onlineDate=1764755918449, onlineDateStr=2025-12-03, pubDate=1682611200000, pubDateStr=2023-04-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1764755918449, onlineIssueDateStr=2025-12-03, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1764755918449, creator=13701087609, updateTime=1764755918449, updator=13701087609, issue=Issue{id=1203036770628755576, tenantId=1146029695717560320, journalId=1189873630562394117, year='2023', volume='48', issue='4', pageStart='367', pageEnd='488', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1764755917460, creator=13701087609, updateTime=1764756108290, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1203037571086508742, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1203036770628755576, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1203037571086508743, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1203036770628755576, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=445, endPage=450, ext={EN=ArticleExt(id=1203036775083106569, articleId=1203036774781116662, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Study on the relationship between plasma lipoprotein-associated phospholipase A2 and asymptomatic hyperuricemia in the middle-aged and elderly, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To explore the relativity of asymptomatic hyperuricemia(HUA) to lipoprotein associated phospholipase A2 (Lp-PLA2) in the middle-aged and elderly people. Methods From June 2019 to June 2020, 174 cases of epiphysically healthy middle-aged and elderly people were randomly screened from the Fuwai Hospital of the Chinese Academy of Medical Sciences for physical examination, and were divided into asymptomatic HUA group (n=58) and control group (n=116)according to the diagnostic criteria of HUA.The baseline clinical data of age, sex, body mass index (BMI) and laboratory data of blood routine, uric acid, creatinine, blood urea nitrogen, blood lipid, and Lp-PLA2 were retrospectively analyzed. Regression analysis was used to explore the risk factors of asymptomatic hyperuricemia. Results Among all the subjects, the incidence of HUA was significantly higher in women than in men (41.4% vs. 25.3%, P<0.05). The level of BMI, TG, LDL-C, Lp-PLA2 and the proportion of hypertension in asymptomatic HUA group was significantly higher than that in control group (P<0.05). Compared with the control group by sex, the incidence of HUA is higher in asymptomatic HUA group (P<0.05). The results of multivariate logistic regression analysis indicated that high level of Lp-PLA2 could be independent risk factors of high uric acid level. After divided into three quantile by the concentration of Lp-PLA2, compared with the lowest concentration, the OR value of the highest group increasing the risk of asymptomatic hyperuricemia was 4.61(95%CI 1.807-11.76, P<0.05). Conclusion Lipoprotein associated phospholipase A2 could be an independent risk factor of asymptomatic HUA in middle-aged and elderly adults.

, correspAuthors=Ya-Hui Lin, Yu-Long Cong, authorNote=null, correspAuthorsNote=
* Cong Yu-Long, E-mail:
Lin Ya-Hui, E-mail:
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目的 探讨人血浆脂蛋白相关磷脂酶A2（Lp-PLA2）与中老年无症状高尿酸血症（HUA）的相关性。方法 随机选取2019年6月-2020年6月在中国医学科学院阜外医院体检的表观健康中老年人174例，依据HUA诊断标准分为无症状HUA组（n=58）和对照组（n=116）。采集年龄、性别、体重指数（BMI）等一般资料，以及血常规、尿酸、肌酐、尿素氮、血脂、Lp-PLA2等实验室检查资料。采用回归分析探究无症状HUA可能的危险因素。结果 研究对象中，女性HUA发病率明显高于男性（41.4% vs. 25.3%，P<0.05）；无症状HUA组BMI、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、Lp-PLA2水平及高血压病发病率均明显高于对照组（P<0.05）；与对照组不同性别分别比较，无症状HUA组男性和女性患者Lp-PLA2水平均明显增高（P<0.05）。多元logistic回归分析显示，Lp-PLA2水平升高是无症状HUA的独立危险因素；按照Lp-PLA2浓度进行三分位分组，与低浓度Lp-PLA2组比较，高浓度Lp-PLA2组增加无症状HUA风险的OR值为4.61（95%CI 1.807~11.76，P<0.05）。结论 血浆Lp-PLA2水平增高可能是中老年无症状HUA的独立危险因素。

, correspAuthors=蔺亚晖, 丛玉隆, authorNote=null, correspAuthorsNote=
丛玉隆，E-mail：
蔺亚晖，E-mail：
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马琳琳，副主任技师，副教授，主要从事临床检验诊断学方面的研究

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马琳琳，副主任技师，副教授，主要从事临床检验诊断学方面的研究

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Med Res Rev, 2020, 40(1): 79-134., articleTitle=Lipoprotein-associated phospholipase A2: the story continues, refAbstract=null)], funds=[Fund(id=1203036780393095709, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, awardId=null, language=EN, fundingSource=National Health of Commission of the People's Republic of China, fundOrder=null, country=null), Fund(id=1203036780468593185, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, awardId=null, language=CN, fundingSource=国家卫生健康委2019年资助项目, fundOrder=null, country=null), Fund(id=1203036780531507748, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, awardId=2020J014, language=EN, fundingSource=Health Technology Innovation Project of Jilin Province(2020J014), fundOrder=null, country=null), Fund(id=1203036780619588135, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, awardId=2020J014, language=CN, fundingSource=吉林省卫生与健康技术创新项目(2020J014), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1203036776211374413, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, xref=1, ext=[AuthorCompanyExt(id=1203036776219763023, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, companyId=1203036776211374413, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Medical Laboratory, Associated Hospital of Beihua University, Jilin City, Jilin Province 132011, China), AuthorCompanyExt(id=1203036776228151632, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, companyId=1203036776211374413, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1北华大学附属医院检验科，吉林吉林 132011)]), AuthorCompany(id=1203036776320426327, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, xref=2, ext=[AuthorCompanyExt(id=1203036776345592155, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, companyId=1203036776320426327, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2National Center for Cardiovascular Diseases, Experimental Diagnosis Center, Fuwai Hospital, Chinese Academy of Medical Sciences,Beijing 100037, China), AuthorCompanyExt(id=1203036776353980764, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, companyId=1203036776320426327, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2国家心血管病中心/中国医学科学院阜外医院实验诊断中心，北京 100037)]), AuthorCompany(id=1203036776425283938, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, xref=3, ext=[AuthorCompanyExt(id=1203036776437866852, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, companyId=1203036776425283938, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3Medical Laboratory Center, Second Medical Center of Chinese PLA General Hospital, Beijing 100853, China), AuthorCompanyExt(id=1203036776450449765, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, companyId=1203036776425283938, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3解放军总医院第二医学中心医学检验中心，北京 100853)])], figs=[ArticleFig(id=1203036779327742451, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, language=EN, label=Fig. 1, caption=Comparison of the level of Lp-PLA2 in male and female between control group and asymptomatic HUA group, figureFileSmall=Qf+7Mc1Od3aX5eO+yvHgbw==, figureFileBig=FDkkAsKH/BEv27mZHMKN5w==, tableContent=null), ArticleFig(id=1203036779415822840, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, language=CN, label=图1, caption=不同性别中老年无症状HUA患者与对照组Lp-PLA2水平比较

HUA. 高尿酸血症；Lp-PLA2. 脂蛋白相关磷脂酶A2；*P<0.05

, figureFileSmall=Qf+7Mc1Od3aX5eO+yvHgbw==, figureFileBig=FDkkAsKH/BEv27mZHMKN5w==, tableContent=null), ArticleFig(id=1203036779638120963, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, language=EN, label=Fig. 2, caption=Correlation analysis between Lp-PLA2 and serum urea acid in asymptomatic HUA patients of middle-aged and elderly, figureFileSmall=KGIakH44NFSMAK/zMjd/pA==, figureFileBig=73rhcDTb7Q1Fr7wDT4as4Q==, tableContent=null), ArticleFig(id=1203036779742978569, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, language=CN, label=图2, caption=中老年无症状HUA患者Lp-PLA2水平与血尿酸浓度的相关性分析

HUA. 高尿酸血症；Lp-PLA2. 脂蛋白相关磷脂酶A2

, figureFileSmall=KGIakH44NFSMAK/zMjd/pA==, figureFileBig=73rhcDTb7Q1Fr7wDT4as4Q==, tableContent=null), ArticleFig(id=1203036779839447564, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, language=EN, label=Tab. 1, caption=

Comparison of demographic and clinical features between two groups

, figureFileSmall=null, figureFileBig=null, tableContent=
项目对照组(n=116)无症状HUA组(n=58)t/χ2P
年龄(岁)64.09±8.6763.12±8.100.7070.480
男性[例(%)]65(56.0)22(37.9)5.0690.024
BMI (kg/m2)24.17±4.2124.86±3.32-2.3080.026
高血压[例(%)]67(57.8)43(74.1)3.0210.082
WBC (×109/L)5.78±1.125.74±1.050.2400.791
TG (mmol/L)1.19±0.371.31±0.32-2.0790.039
TC (mmol/L)4.21±0.654.41±0.68-1.8800.062
HDL-C (mmol/L)1.43±0.351.35±0.291.5380.099
LDL-C (mmol/L)2.26±0.602.46±0.57-2.0170.045
ALT (U/L)20.10±8.5620.12±8.70-0.0120.990
CREA (μmol/L)79.29±14.6581.28±14.36-0.8520.396
Lp-PLA2 (ng/ml)100.92±41.65132.28±57.85-4.094<0.001
), ArticleFig(id=1203036779940110865, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, language=CN, label=表1, caption=

无症状HUA组与对照组的临床资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
项目对照组(n=116)无症状HUA组(n=58)t/χ2P
年龄(岁)64.09±8.6763.12±8.100.7070.480
男性[例(%)]65(56.0)22(37.9)5.0690.024
BMI (kg/m2)24.17±4.2124.86±3.32-2.3080.026
高血压[例(%)]67(57.8)43(74.1)3.0210.082
WBC (×109/L)5.78±1.125.74±1.050.2400.791
TG (mmol/L)1.19±0.371.31±0.32-2.0790.039
TC (mmol/L)4.21±0.654.41±0.68-1.8800.062
HDL-C (mmol/L)1.43±0.351.35±0.291.5380.099
LDL-C (mmol/L)2.26±0.602.46±0.57-2.0170.045
ALT (U/L)20.10±8.5620.12±8.70-0.0120.990
CREA (μmol/L)79.29±14.6581.28±14.36-0.8520.396
Lp-PLA2 (ng/ml)100.92±41.65132.28±57.85-4.094<0.001
), ArticleFig(id=1203036780044968466, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, language=EN, label=Tab. 2, caption=

Multiple linear regression analysis of correlation of Lp-PLA2 concentration and uric acid level in asymptomatic middle-aged and elderly (n=174)

, figureFileSmall=null, figureFileBig=null, tableContent=
类别非标准化系数β标准误差标准化系数βt95%CIP
模型一0.3890.1170.2433.3240.158~0.6200.001
模型二0.4180.1220.2603.4360.178~0.6580.001
模型三0.4090.1220.2553.3610.169~0.6500.001
), ArticleFig(id=1203036780133048851, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, language=CN, label=表2, caption=

中老年表观健康人群Lp-PLA2与血尿酸水平相关性的多元线性回归分析结果（n=174）

, figureFileSmall=null, figureFileBig=null, tableContent=
类别非标准化系数β标准误差标准化系数βt95%CIP
模型一0.3890.1170.2433.3240.158~0.6200.001
模型二0.4180.1220.2603.4360.178~0.6580.001
模型三0.4090.1220.2553.3610.169~0.6500.001
), ArticleFig(id=1203036780200157718, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, language=EN, label=Tab. 3, caption=

Multivariate logistic regression analysis of risk factors for asymptomatic hyperuricemia in middle-aged and elderly(n=174)

, figureFileSmall=null, figureFileBig=null, tableContent=
类别β标准误差Wals χ2OR(95%CI)P
模型一
 低浓度Lp-PLA2*   --
 中浓度Lp-PLA20.4370.4440.9711.549(0.649~3.695)0.324
 高浓度Lp-PLA21.4110.43910.3204.098(1.733~9.691)0.001
模型二
 低浓度Lp-PLA2*   --
 中浓度Lp-PLA20.5230.4541.3231.686(0.692~4.110)0.250
 高浓度Lp-PLA21.4400.4639.6554.220(1.702~10.467)0.002
模型三
 低浓度Lp-PLA2*   --
 中浓度Lp-PLA20.4150.4660.7901.514(0.607~3.776)0.374
 高浓度Lp-PLA21.5280.47810.2294.610(1.807~11.760)0.001
), ArticleFig(id=1203036780300821018, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203036774781116662, language=CN, label=表3, caption=

中老年表观健康人群无症状高尿酸血症危险因素的多因素logistic回归分析结果（n=174）

, figureFileSmall=null, figureFileBig=null, tableContent=
类别β标准误差Wals χ2OR(95%CI)P
模型一
 低浓度Lp-PLA2*   --
 中浓度Lp-PLA20.4370.4440.9711.549(0.649~3.695)0.324
 高浓度Lp-PLA21.4110.43910.3204.098(1.733~9.691)0.001
模型二
 低浓度Lp-PLA2*   --
 中浓度Lp-PLA20.5230.4541.3231.686(0.692~4.110)0.250
 高浓度Lp-PLA21.4400.4639.6554.220(1.702~10.467)0.002
模型三
 低浓度Lp-PLA2*   --
 中浓度Lp-PLA20.4150.4660.7901.514(0.607~3.776)0.374
 高浓度Lp-PLA21.5280.47810.2294.610(1.807~11.760)0.001
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血浆脂蛋白相关磷脂酶A2与中老年无症状高尿酸血症的相关性分析
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马琳琳 1 , 杨琼 2 , 龚美亮 3 , 于金星 2 , 周洲 2 , 蔺亚晖 2, * , 丛玉隆 3, *
解放军医学杂志 | 临床研究 2023,48(4): 445-450
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解放军医学杂志 | 临床研究 2023, 48(4): 445-450
血浆脂蛋白相关磷脂酶A2与中老年无症状高尿酸血症的相关性分析
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马琳琳1, 杨琼2, 龚美亮3, 于金星2, 周洲2, 蔺亚晖2, * , 丛玉隆3, *
作者信息
  • 1北华大学附属医院检验科，吉林吉林 132011
  • 2国家心血管病中心/中国医学科学院阜外医院实验诊断中心，北京 100037
  • 3解放军总医院第二医学中心医学检验中心，北京 100853

    • 马琳琳，副主任技师，副教授，主要从事临床检验诊断学方面的研究

通讯作者:

丛玉隆，E-mail：
蔺亚晖，E-mail：
Study on the relationship between plasma lipoprotein-associated phospholipase A2 and asymptomatic hyperuricemia in the middle-aged and elderly
Lin-Lin Ma1, Qiong Yang2, Mei-Liang Gong3, Jin-Xing Yu2, Zhou Zhou2, Ya-Hui Lin2, * , Yu-Long Cong3, *
Affiliations
  • 1Medical Laboratory, Associated Hospital of Beihua University, Jilin City, Jilin Province 132011, China
  • 2National Center for Cardiovascular Diseases, Experimental Diagnosis Center, Fuwai Hospital, Chinese Academy of Medical Sciences,Beijing 100037, China
  • 3Medical Laboratory Center, Second Medical Center of Chinese PLA General Hospital, Beijing 100853, China
出版时间: 2023-04-28 doi: 10.11855/j.issn.0577-7402.2023.04.0445
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摘要
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目的 探讨人血浆脂蛋白相关磷脂酶A2（Lp-PLA2）与中老年无症状高尿酸血症（HUA）的相关性。方法 随机选取2019年6月-2020年6月在中国医学科学院阜外医院体检的表观健康中老年人174例，依据HUA诊断标准分为无症状HUA组（n=58）和对照组（n=116）。采集年龄、性别、体重指数（BMI）等一般资料，以及血常规、尿酸、肌酐、尿素氮、血脂、Lp-PLA2等实验室检查资料。采用回归分析探究无症状HUA可能的危险因素。结果 研究对象中，女性HUA发病率明显高于男性（41.4% vs. 25.3%，P<0.05）；无症状HUA组BMI、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、Lp-PLA2水平及高血压病发病率均明显高于对照组（P<0.05）；与对照组不同性别分别比较，无症状HUA组男性和女性患者Lp-PLA2水平均明显增高（P<0.05）。多元logistic回归分析显示，Lp-PLA2水平升高是无症状HUA的独立危险因素；按照Lp-PLA2浓度进行三分位分组，与低浓度Lp-PLA2组比较，高浓度Lp-PLA2组增加无症状HUA风险的OR值为4.61（95%CI 1.807~11.76，P<0.05）。结论 血浆Lp-PLA2水平增高可能是中老年无症状HUA的独立危险因素。

尿酸  /  脂蛋白相关磷脂酶A2  /  无症状高尿酸血症  /  心血管疾病

Objective To explore the relativity of asymptomatic hyperuricemia(HUA) to lipoprotein associated phospholipase A2 (Lp-PLA2) in the middle-aged and elderly people. Methods From June 2019 to June 2020, 174 cases of epiphysically healthy middle-aged and elderly people were randomly screened from the Fuwai Hospital of the Chinese Academy of Medical Sciences for physical examination, and were divided into asymptomatic HUA group (n=58) and control group (n=116)according to the diagnostic criteria of HUA.The baseline clinical data of age, sex, body mass index (BMI) and laboratory data of blood routine, uric acid, creatinine, blood urea nitrogen, blood lipid, and Lp-PLA2 were retrospectively analyzed. Regression analysis was used to explore the risk factors of asymptomatic hyperuricemia. Results Among all the subjects, the incidence of HUA was significantly higher in women than in men (41.4% vs. 25.3%, P<0.05). The level of BMI, TG, LDL-C, Lp-PLA2 and the proportion of hypertension in asymptomatic HUA group was significantly higher than that in control group (P<0.05). Compared with the control group by sex, the incidence of HUA is higher in asymptomatic HUA group (P<0.05). The results of multivariate logistic regression analysis indicated that high level of Lp-PLA2 could be independent risk factors of high uric acid level. After divided into three quantile by the concentration of Lp-PLA2, compared with the lowest concentration, the OR value of the highest group increasing the risk of asymptomatic hyperuricemia was 4.61(95%CI 1.807-11.76, P<0.05). Conclusion Lipoprotein associated phospholipase A2 could be an independent risk factor of asymptomatic HUA in middle-aged and elderly adults.

uric acid  /  lipoprotein-associated phospholipase A2  /  asymptomatic hyperuricemia  /  cardiovascular disease
马琳琳, 杨琼, 龚美亮, 于金星, 周洲, 蔺亚晖, 丛玉隆. 血浆脂蛋白相关磷脂酶A2与中老年无症状高尿酸血症的相关性分析. 解放军医学杂志, 2023 , 48 (4) : 445 -450 . DOI: 10.11855/j.issn.0577-7402.2023.04.0445
Lin-Lin Ma, Qiong Yang, Mei-Liang Gong, Jin-Xing Yu, Zhou Zhou, Ya-Hui Lin, Yu-Long Cong. Study on the relationship between plasma lipoprotein-associated phospholipase A2 and asymptomatic hyperuricemia in the middle-aged and elderly[J]. Medical Journal of Chinese People’s Liberation Army, 2023 , 48 (4) : 445 -450 . DOI: 10.11855/j.issn.0577-7402.2023.04.0445
正文
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高尿酸血症（hyperuricemia，HUA）以血清中尿酸（urea acid，UA）盐水平异常增高为特征[1-2]。受饮食结构和生活方式等因素的影响，HUA发病率近年持续上升且呈区域高流行趋势。据报道HUA总患病率达17.4%[3]，老年人总患病率为9.5%~21.9%[4]。HUA与糖尿病、高血压病、脂肪肝、肾损伤和心血管疾病密切相关[5]。这些代谢综合征的发生发展均与微血管炎症的发生密切相关[6]。与血清炎症标志物UA的促炎作用相似，脂蛋白相关磷脂酶A2（lipoprotein associated phospholipase A2，Lp-PLA2）也是一种促炎酶，其水解氧化的低密度脂蛋白为促炎产物，与内皮功能障碍和斑块炎症有关[7-8]，在冠状动脉病变的炎症反应中起重要作用[9-10]，被认为是动脉粥样硬化的独立危险因素[11-12]。近年文献报道健康体检人群无症状HUA检出率随年龄增长呈升高趋势，检出率达18.71%~21.34%[13]，且与性别、高血压病、脂肪肝、肥胖相关。本研究收集北京地区174例表观健康人群的Lp-PLA2及UA水平等临床资料，分析相关危险因素，旨在为无症状HUA的管理提供依据。
1 资料与方法
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1.1 研究对象
随机选取2019年6月-2020年6月在中国医学科学院阜外医院体检的表观健康中老年人174例，其中男、女各87例，年龄50~95（63.8±7.9）岁。按照HUA诊断标准分为无症状HUA组（n=58）和对照组（n=116）。表观健康人群标准为超声、胸部X线等影像学检查表现正常，肝肾功能、血脂、血常规和尿便常规均正常。无症状HUA纳入标准：（1）正常饮食状态下，不同时间点2次空腹血尿酸水平男性>420 μmol/L（7 mg/dl），女性>360 μmol/L（6 mg/dl）[14]；（2）不伴有痛风、尿结石或肾病等症状；（3）收缩压≤140 mmHg且舒张压≤90 mmHg，肝功能项目[谷丙转氨酶（ALT）、谷草转氨酶（AST）、总蛋白（TP）、白蛋白（ALB）、总胆红素（TBil）、直接胆红素（DBil）]检查值小于或等于国家卫生行业标准（WS/T 404-2012）推荐的临床常用生化检验项目正常值参考区间上线，三酰甘油（TG）≤1.76 mmol/L、总胆固醇（TC）≤5.98 mmol/L、高密度脂蛋白胆固醇（HDL-C）≥0.7 mmol/L、低密度脂蛋白胆固醇（LDL-C）≤3.4 mmol/L[1,15]。排除标准：（1）急慢性感染者、尿毒症患者、心力衰竭患者及系统性红斑狼疮患者；（2）有关节炎临床症状者。本研究经解放军总医院医学伦理委员会批准（批准文号：2018-01-01），所有对象均签署知情同意书。
1.2 方法
1.2.1 临床资料收集
收集所有研究对象的年龄、性别、血压、体重指数（BMI）等一般资料，以及血常规、UA、肌酐、ALT、血脂、Lp-PLA2等实验室检测数据。
1.2.2 实验室检测
血UA采用LABOSPECT 008 AS全自动生化分析仪（日本日立）及尿酸酶法试剂盒（中生北控生物科技股份有限公司）进行检测。Lp-PLA2及生化指标检测采用威高全自动生化发光分析仪Autolumis 3000及其配套的检测试剂盒（磁微粒化学发光法，上海涵飞）。TG、TC、HDL-C、LDL-C、ALT和血肌酐（CREA）均采用LABOSPECT 008 AS全自动生化分析仪进行检测。
1.2.3 无症状HUA可能危险因素的分析
统计并分析中老年无症状HUA人群的性别、年龄、BMI、TG、LDL-C、WBC、他汀类药物使用、高血压等指标与健康人群的差异；对比分析Lp-PLA2浓度变化与中老年无症状HUA的相关性。采用三分位分组，评估Lp-PLA2浓度变化与中老年无症状HUA的风险关系。
1.3 统计学处理
采用SPSS 21.0 和Medclac 19.0软件进行统计分析。计量资料经正态性检验基本符合正态分布以$\bar{x}±s$表示，组间比较采用t检验；计数资料以例（%）表示，采用Fisher检验。Lp-PLA2和血UA浓度的关系采用Pearson相关分析；Lp-PLA2浓度对血UA浓度的影响采用多元线性回归分析，无症状HUA的危险因素采用多因素Logistic回归分析，采用全部进入（Enter）筛选变量。P<0.05为差异有统计学意义。
2 结果
收起
2.1 无症状HUA组与对照组的临床资料比较
174例研究对象UA为（340.23±42.66）ng/ml，男性为（360.36±41.56）ng/ml，女性为（320.09±40.65）ng/ml；女性HUA发病率明显高于男性（41.4% vs. 25.3%，P<0.05）。与对照组比较，无症状HUA组患者年龄、血压、TC、HDL-C、CREA和ALT水平差异无统计学意义（P>0.05），而BMI、TG、LDL-C及Lp-PLA2水平明显增高（P<0.05，表1）。与对照组按不同性别分别比较，无症状HUA组男性和女性患者Lp-PLA2水平均明显增高（P<0.05，图1）。
2.2 Lp-PLA2与血UA浓度的相关性
Pearson相关分析结果显示，中老年无症状HUA患者的血UA浓度与Lp-PLA2浓度呈正相关关系（r=0.27，P<0.05，图2）。
2.3 中老年无症状HUA的危险因素分析
进一步校正其他因素后，多元线性回归分析结果显示，Lp-PLA2浓度不同于性别、年龄、BMI、TG、LDL-C、WBC及他汀类用药使用、高血压等因素，是中老年无症状HUA的独立危险因素（β=0.409，95%CI 0.169~0.650，P<0.05，表2）。以无症状HUA为因变量，并按照Lp-PLA2低浓度（28.03~85.20 ng/ml）、中浓度（8 5.5 0~1 2 3.1 6 n g/m l）和高浓度（123.69~271.07 ng/ml）分为3组（每组58例）进行多因素logistic回归分析，结果显示，在校正性别、年龄、BMI、TG、LDL-C、WBC与他汀类药物使用、高血压因素后，与低浓度组比较，高浓度Lp-PLA2组无症状HUA风险增加的OR值为4.61（95%CI 1.807~11.760，P<0.05，表3）。
3 讨论
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Lp-PLA2由单核细胞、巨噬细胞或T细胞分泌，是磷脂酶A2超家族成员，由441个氨基酸残基组成，相对分子质量为45.4 kD[16]。Lp-PLA2进入血液循环后主要与低密度脂蛋白结合，可产生促炎分子如溶藻磷脂酰胆碱和氧化游离脂肪酸[17]，进而通过多种途径促进动脉粥样硬化。多项研究显示，高水平的Lp-PLA2与动脉粥样硬化风险增加有关，与安慰剂治疗比较，Lp-PLA2抑制剂可显著减少心血管事件的发生[18-19]。在高脂血症和高血糖动物模型中，与安慰剂治疗比较，Lp-PLA2抑制剂可减少巨噬细胞积聚，降低坏死的脂质核心体积，并可增厚冠状动脉粥样硬化斑块的纤维帽[20]。Lp-PLA2的代谢活性产物Lyso-PC与内皮功能障碍和动脉粥样硬化形成有关，且存在于冠状动脉粥样硬化的早期病变之中。因此，Lp-PLA2水平越高，内皮功能障碍和动脉粥样硬化可能越严重。而HUA患者本身由于内皮功能障碍，氧化应激增加，导致一氧化氮生物利用度降低和血管平滑肌细胞增殖。大规模流行病学研究结果显示，HUA会增高心血管疾病的病死率[21]。
近年来，国内外报道了较多的糖尿病、高胆固醇血症等“富贵病”年轻患者；伴随着年龄增长，机体血糖、血脂等代谢指标易发生紊乱，UA升高增多，但可能无明显的临床症状；这类人群有近三分之一最终发展为严重的内分泌疾病，显著降低了其生活质量。在日常生活中需要警惕无症状HUA，因为容易被人们忽略[22]。本研究结果显示，女性无症状HUA患者明显多于男性。既往研究显示，我国男性HUA患病率为19.4%，女性为7.9%[23]；一项美国的报道显示男性HUA患病率为21.2%，女性为21.6%[24]。出现这种不一致，可能与本研究纳入样本数量较少或样本年龄较大有关；此外，女性在绝经后受雌激素水平下降的影响，血UA水平可增高，可能导致本研究中女性HUA患者比例增高。由于雌激素的作用，绝经前女性血清UA浓度较低，绝经后，血UA升高到与男性相近的水平。之所以血UA>7 mg/dl（420 μmol/L）即被认为异常，是因为这一浓度是尿酸盐在水中的最大溶解度；然而，尿酸盐在血浆中更容易溶解，其浓度可>10 mg/dl（600 μmol/L）。HUA的成因是饮食中嘌呤过量和肾脏尿酸排泄减少。在稳定状态下，尿中尿酸盐的排泄反映了其生产速率，尿酸盐的排泄速率会随着嘌呤的增加而迅速增高。
越来越多的证据显示，HUA与多种慢性疾病有关，如高血压病、慢性肾疾病、血管性痴呆、血脂异常和非酒精性脂肪肝等[24-25]。肝脏中三酰甘油生成增加也与嘌呤合成增加有关。嘌呤是UA代谢的上游成分，血脂异常与UA水平增高之间有很强的相关性。研究显示HUA患者的BMI、TG、LDL-C及高血压病发病率均高于UA正常人群，提示HUA患者发生代谢异常和心血管疾病的概率更高[26-27]。
本研究显示，Lp-PLA2可能是中老年人群UA水平升高和无症状HUA的独立危险因素，提示应警惕Lp-PLA2和无症状HUA协同产生的心血管疾病风险。2020年我国高尿酸血症与痛风患者实践指南建议，由于降尿酸药物存在安全性问题，无症状HUA患者首选非药物治疗，应加强饮食和生活方式指导，改变不良生活习惯，合理运动[27-29]。欧美的相关指南则推荐无症状HUA仅在合并慢性肾病（chronic kidney disease，CKD）和心血管危险因素时才需进行降尿酸药物治疗[30-31]。
总之，对Lp-PLA2升高患者应同时关注血UA水平，积极预防二者协同带来的心血管疾病风险。临床报告血UA及Lp-PLA2升高且存在其他心血管疾病高危因素的患者，应警惕其已经存在冠状动脉病变。
本研究为单中心横断面回顾性对照研究，样本数量有限，或者受用药影响等，可能存在数据、结果偏倚；此外，由于新冠肺炎疫情的原因，难以跟踪相关无症状HUA者后续的BMI变化及高血压病发病等情况；研究结论有待进一步结合临床进行多中心大样本分析验证。
基金
收起
  • 国家卫生健康委2019年资助项目
  • 吉林省卫生与健康技术创新项目(2020J014)
文献
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2023年第48卷第4期
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doi: 10.11855/j.issn.0577-7402.2023.04.0445
  • 接收时间：2022-02-17
  • 首发时间：2025-12-03
  • 出版时间：2023-04-28
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  • 收稿日期：2022-02-17
  • 录用日期：2022-07-08
基金
National Health of Commission of the People's Republic of China
国家卫生健康委2019年资助项目
Health Technology Innovation Project of Jilin Province(2020J014)
吉林省卫生与健康技术创新项目(2020J014)
作者信息
    1北华大学附属医院检验科，吉林吉林 132011
    2国家心血管病中心/中国医学科学院阜外医院实验诊断中心，北京 100037
    3解放军总医院第二医学中心医学检验中心，北京 100853

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
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