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Article(id=1211268930979631967, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1211268928383348982, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2021.02.08, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1595174400000, receivedDateStr=2020-07-20, revisedDate=1603123200000, revisedDateStr=2020-10-20, acceptedDate=null, acceptedDateStr=null, onlineDate=1766718617433, onlineDateStr=2025-12-26, pubDate=1614441600000, pubDateStr=2021-02-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1766718617433, onlineIssueDateStr=2025-12-26, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1766718617433, creator=13701087609, updateTime=1766718617433, updator=13701087609, issue=Issue{id=1211268928383348982, tenantId=1146029695717560320, journalId=1189873630562394117, year='2021', volume='46', issue='2', pageStart='107', pageEnd='211', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1766718616815, creator=13701087609, updateTime=1766718805938, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1211269721685627740, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1211268928383348982, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1211269721685627741, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1211268928383348982, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=156, endPage=162, ext={EN=ArticleExt(id=1211268931357119340, articleId=1211268930979631967, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Risk factors and intervention strategies of hyperuricemia in helicopter pilots, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To analyze the risk factors inducing hyperuricemia (HUA) in helicopter pilots and put forward the corresponding intervention measures. Methods A total of 190 male helicopter pilots, aged 20-50 years and with more than 100 hours of flight time, were recruited from April to October 2020 in a flight brigade. A self-designed questionnaire was used, by which the basic information of subjects were collected including eating habits, physical exercise, smoking and drinking, exposure to noise and vibration at work, mood, disease, work performance, sleep status, genetic factors, and so on. At the same time, 28 SPF grade 6-week-old male C57BL/6J mice were randomly divided into 7 groups (4 each): control group, noise group, noise + vitamin C (Vit C)group, noise + multivitamin (Multi Vit) group, noise + hyperbaric oxygen (HBO) group, noise + HBO + Vit C group, and noise +HBO + Multi Vit group. After continuous intervention for 7 days, Multiskan Ascent was used to detect the uric acid (UA) level in mice sera. Results Finally, 186 subjects, aged 22-50 years and with (1378±569) hours of flight time, were included in present study. Of whom 17 (9.14%) were self-reported with HUA (HUA group) and 169 (9.14%) were with normal uric acid (NUA group).No significant difference existed between the two groups in age, height, body mass index and the proportion of hyperglycemia. The proportions of hyperlipidemia and fatty liver were significantly higher in HUA group (17.6% and 29.4%, respectively) than those in NUA group (4.7% and 10.1%, respectively) with statistically significant difference (P<0.05). The scores of noise exposure and vibration exposure were significantly higher in HUA group [(22.942±3.960) and (16.351±3.552), respectively] than those in NUA group [(19.413±4.086) and (13.323±3.476), respectively] with statistically significant difference (P<0.05); there was no significant difference between the two groups (P>0.05) in the other 8 dimensions. Noise and vibration exposure were closely related to the occurrence of HUA. Among them, strong noise and long daily exposure, great influence on emotion, the poor effect and low use frequency of protective measures would significantly increase the risk of HUA; Long daily exposure and great influence on emotion of vibration would also increase the risk of HUA. Compared with the control group, the serum UA level in noise group increased significantly [(38.710±10.201) μmol/L vs. (191.935±9.542) μmol/L] with significant difference (P<0.05); The serum UA levels in noise + Vit C group [(127.419±5.349) μmol/L], noise + Multi Vit group [(111.290±7.030) μmol/L], noise + HBO group [(53.226±11.518) μmol/L], noise + HBO + Vit C group [(61.290±7.213) μmol/L] and noise + HBO + Multi Vit group[(69.355±13.968) μmol/L] were all lower significantly than that in noise group (P<0.05). The UA levels in noise + Vit C group, noise + Multi Vit group, noise + HBO + Vit C group and noise + HBO + Multi Vit group were still higher than that in control group(P<0.05), while there was no significant difference between noise + HBO group and control group (P>0.05). Conclusions HUA in helicopter pilots is related to noise and vibration exposure in working environment. Hyperbaric oxygen and dietary vitamin supplementation can effectively reduce the increase of serum uric acid level caused by noise exposure.

, correspAuthors=Jun-Xiang Bao, authorNote=null, correspAuthorsNote=
*E-mail:
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目的 分析陆航直升机飞行员发生高尿酸血症(HUA)的危险因素，并探讨相应的干预对策。方法 2020年4—10月，在某飞行大队中选取年龄20~50岁、飞行时间>100 h的190名男性陆航直升机飞行员，采用自行设计的《飞行员HUA危险因素调查问卷》调查受试者的基本信息、饮食习惯、体育锻炼、吸烟饮酒、工作中的噪声与振动暴露、心情状态、疾病情况、工作绩效、睡眠情况、遗传因素等。同时选取SPF级6周龄雄性C57BL/6J小鼠28只，随机均分成7组：对照组、噪声组、噪声+维生素C(Vit C)组、噪声+多种维生素(Multi Vit)组、噪声+高压氧(HBO)组、噪声+HBO+Vit C组、噪声+HBO+Multi Vit组，持续干预7 d后用Multiskan Ascent酶标仪检测小鼠血清尿酸水平。结果 最终186名飞行员纳入本研究，年龄22~50岁，飞行时长(1378±569) h；自述有HUA者17例(HUA组)，占9.14%；自述正常尿酸(NUA)者169名(NUA组)。两组的年龄、身高、体重指数及高血糖比例差异无统计学意义。HUA组的高血脂及脂肪肝比例(分别为17.6%、29.4%)明显高于NUA组(分别为4.7%、10.1%)，差异有统计学意义(P<0.05)。HUA组的噪声暴露及振动暴露得分[分别为(22.942±3.960)分、(16.351±3.552)分]明显高于NUA组[(19.413±4.086)分、(13.323±3.476)分]，差异有统计学意义(P<0.05)；两组其余8个维度得分差异均无统计学意义(P>0.05)。噪声及振动暴露与HUA的发生密切相关，其中，噪声的暴露程度强、每日暴露时间长、对情绪影响大、防护措施效果差、防护措施使用频率低均会明显增加HUA的发生风险；振动的每日暴露时间长、对情绪影响大亦会增加患HUA的可能。与对照组小鼠的血清尿酸水平[(38.710±10.201) μmol/L]相比，噪声组的血清尿酸水平[(191.935±9.542) μmol/L]明显增加，差异有统计学意义(P<0.05)；噪声+Vit C组[(127.419±5.349) μmol/L]、噪声+Multi Vit组[(111.290±7.030) μmol/L]、噪声+HBO组[(53.226±11.518) μmol/L]、噪声+HBO+Vit C组[(61.290±7.213) μmol/L]及噪声+HBO+Multi Vit组[(69.355±13.968) μmol/L]的小鼠血清尿酸水平均低于噪声组，差异有统计学意义(P<0.05)；噪声+Vit C组、噪声+Multi Vit组、噪声+HBO+Vit C组及噪声+HBO+Multi Vit组的尿酸水平仍高于对照组，差异有统计学意义(P<0.05)，而噪声+HBO组的尿酸水平与对照组比较差异无统计学意义(P>0.05)。结论 陆航直升机飞行员发生HUA与工作环境中的噪声及振动暴露有关。高压氧和膳食维生素补充可有效降低噪声暴露所致血尿酸水平增高。

, correspAuthors=暴军香, authorNote=null, correspAuthorsNote=
暴军香，E-mail：
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弓大元，住院医师，主要从事流行病学和医疗大数据挖掘方面的研究。E-mail：

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弓大元，住院医师，主要从事流行病学和医疗大数据挖掘方面的研究。E-mail：

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Clin Exp Pharmacol Physiol, 2020, 47(9): 1564-1574., articleTitle=Hyperbaric oxygen treatment mitigates liver damage in mice with noise exposure, refAbstract=null)], funds=[Fund(id=1211268939628286224, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268930979631967, awardId=2019ZFC002, language=EN, fundingSource=Military Medical "Everest Project" Funded by Air Force Military Medical University(2019ZFC002), fundOrder=null, country=null), Fund(id=1211268939703783701, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268930979631967, awardId=2019ZFC002, language=CN, fundingSource=空军军医大学军事医学“珠峰工程”资助项目(2019ZFC002), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1211268933320053643, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268930979631967, xref=1, ext=[AuthorCompanyExt(id=1211268933328442253, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268930979631967, 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of mice in each group (n=4), figureFileSmall=/zyd04jrmIirUdLoaYZ6nw==, figureFileBig=l+Hakj2zPTZP6K3ePd13rQ==, tableContent=null), ArticleFig(id=1211268938273525928, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268930979631967, language=CN, label=图1, caption=各组小鼠血清尿酸水平(n=4)

HBO. 高压氧；Vit C. 维生素C；Multi Vit. 多种维生素；与对照组比较，(1)P<0.05；与噪声组比较，(2)P<0.05。

, figureFileSmall=/zyd04jrmIirUdLoaYZ6nw==, figureFileBig=l+Hakj2zPTZP6K3ePd13rQ==, tableContent=null), ArticleFig(id=1211268938487435448, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268930979631967, language=EN, label=Tab.1, caption=

Reliability coefficient of questionnaire on risk factor of hyperuricemia in helicopter pilots

, figureFileSmall=null, figureFileBig=null, tableContent=
指标饮食习惯体育锻炼吸烟饮酒噪声暴露振动暴露心情状态疾病情况工作绩效睡眠情况遗传因素总体
Cronbach's α系数0.700.710.790.640.790.910.870.950.650.770.88
分半信度系数0.510.520.480.450.580.780.820.910.570.740.79
), ArticleFig(id=1211268938600681665, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268930979631967, language=CN, label=表1, caption=

陆航飞行员HUA危险因素问卷总体及各维度信度系数

, figureFileSmall=null, figureFileBig=null, tableContent=
指标饮食习惯体育锻炼吸烟饮酒噪声暴露振动暴露心情状态疾病情况工作绩效睡眠情况遗传因素总体
Cronbach's α系数0.700.710.790.640.790.910.870.950.650.770.88
分半信度系数0.510.520.480.450.580.780.820.910.570.740.79
), ArticleFig(id=1211268938697150662, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268930979631967, language=EN, label=Tab.2, caption=

KMO and Bartlett spherical test of questionnaire on risk factor of hyperuricemia in helicopter pilots

, figureFileSmall=null, figureFileBig=null, tableContent=
指标饮食习惯体育锻炼吸烟饮酒噪声暴露振动暴露心情状态疾病情况工作绩效睡眠情况遗传因素
KMO0.7030.7100.7910.6420.7910.9110.8650.9540.6530.765
Bartlett
 χ2值451.290.31311.9286.6454.51691.41618.01681.1599.0209.2
 自由度781521212112045455536
 P<0.01<0.01<0.01<0.01<0.01<0.01<0.01<0.01<0.01<0.01
), ArticleFig(id=1211268938806202576, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268930979631967, language=CN, label=表2, caption=

陆航飞行员HUA危险因素问卷总体及各维度KMO和Bartlett球形检验结果

, figureFileSmall=null, figureFileBig=null, tableContent=
指标饮食习惯体育锻炼吸烟饮酒噪声暴露振动暴露心情状态疾病情况工作绩效睡眠情况遗传因素
KMO0.7030.7100.7910.6420.7910.9110.8650.9540.6530.765
Bartlett
 χ2值451.290.31311.9286.6454.51691.41618.01681.1599.0209.2
 自由度781521212112045455536
 P<0.01<0.01<0.01<0.01<0.01<0.01<0.01<0.01<0.01<0.01
), ArticleFig(id=1211268938953003226, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268930979631967, language=EN, label=Tab.3, caption=

Variance contribution rate of each dimension of questionnaire on risk factors of hyperuricemia in helicopter pilots

, figureFileSmall=null, figureFileBig=null, tableContent=
维度提取平方和载入旋转平方和载入
方差贡献率累计方差贡献率方差贡献率累计方差贡献率
饮食情况14.32314.3238.8318.831
体育锻炼9.36223.6847.88816.719
吸烟饮酒5.48329.1676.99623.715
噪声暴露5.17934.3465.75829.472
振动暴露4.20338.5494.80534.277
心情状态3.26141.8104.24638.524
疾病状况3.02544.8354.24242.765
工作绩效2.90647.7413.69746.463
睡眠状态2.78550.5263.58650.049
遗传疾病2.58753.1123.06353.112
), ArticleFig(id=1211268939028500708, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268930979631967, language=CN, label=表3, caption=

陆航飞行员HUA危险因素问卷各维度方差贡献率

, figureFileSmall=null, figureFileBig=null, tableContent=
维度提取平方和载入旋转平方和载入
方差贡献率累计方差贡献率方差贡献率累计方差贡献率
饮食情况14.32314.3238.8318.831
体育锻炼9.36223.6847.88816.719
吸烟饮酒5.48329.1676.99623.715
噪声暴露5.17934.3465.75829.472
振动暴露4.20338.5494.80534.277
心情状态3.26141.8104.24638.524
疾病状况3.02544.8354.24242.765
工作绩效2.90647.7413.69746.463
睡眠状态2.78550.5263.58650.049
遗传疾病2.58753.1123.06353.112
), ArticleFig(id=1211268939162718445, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268930979631967, language=EN, label=Tab.4, caption=

Demographic and clinical information of helicopter pilots in two groups

, figureFileSmall=null, figureFileBig=null, tableContent=
指标HUA组(n=17)NUA组(n=169)t/χ2P
年龄(岁，$\bar{x}±s$)33.9±8.229.9±6.81.7100.103
身高(cm，$\bar{x}±s$)173.7±4.3173.2±11.70.1520.879
体重指数(kg/m2，$\bar{x}±s$)24.0±2.724.9±11.40.2840.862
高血脂[例(%)]3(17.6)8(4.7)4.6290.031
脂肪肝[例(%)]5(29.4)17(10.1)5.5470.019
高血糖[例(%)]0(0)3(1.8)–0.667△
), ArticleFig(id=1211268939275964662, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268930979631967, language=CN, label=表4, caption=

两组陆航飞行员一般资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
指标HUA组(n=17)NUA组(n=169)t/χ2P
年龄(岁，$\bar{x}±s$)33.9±8.229.9±6.81.7100.103
身高(cm，$\bar{x}±s$)173.7±4.3173.2±11.70.1520.879
体重指数(kg/m2，$\bar{x}±s$)24.0±2.724.9±11.40.2840.862
高血脂[例(%)]3(17.6)8(4.7)4.6290.031
脂肪肝[例(%)]5(29.4)17(10.1)5.5470.019
高血糖[例(%)]0(0)3(1.8)–0.667△
), ArticleFig(id=1211268939355656445, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268930979631967, language=EN, label=Tab.5, caption=

Scores of each dimension of questionnaire in helicopter pilots in two groups

, figureFileSmall=null, figureFileBig=null, tableContent=
问卷维度HUA组(n=17)NUA组(n=169)tP
饮食习惯34.529±4.17034.667±4.5020.1210.904
体育锻炼16.824±1.62916.181±2.4851.4650.156
吸烟饮酒16.177±7.15215.474±6.5040.4210.674
噪声暴露22.942±3.96019.413±4.0863.6550.001
振动暴露16.351±3.55213.323±3.4763.5650.001
心情状态31.353±11.37436.714±11.1171.8920.060
疾病情况15.824±4.94013.749±4.3411.8560.070
工作绩效18.059±5.33216.409±5.3061.2220.223
睡眠情况21.706±6.66920.105±5.0621.2060.229
遗传因素13.118±4.31411.983±4.1961.0610.290
), ArticleFig(id=1211268939494068490, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268930979631967, language=CN, label=表5, caption=

两组陆航飞行员问卷各维度得分比较

, figureFileSmall=null, figureFileBig=null, tableContent=
问卷维度HUA组(n=17)NUA组(n=169)tP
饮食习惯34.529±4.17034.667±4.5020.1210.904
体育锻炼16.824±1.62916.181±2.4851.4650.156
吸烟饮酒16.177±7.15215.474±6.5040.4210.674
噪声暴露22.942±3.96019.413±4.0863.6550.001
振动暴露16.351±3.55213.323±3.4763.5650.001
心情状态31.353±11.37436.714±11.1171.8920.060
疾病情况15.824±4.94013.749±4.3411.8560.070
工作绩效18.059±5.33216.409±5.3061.2220.223
睡眠情况21.706±6.66920.105±5.0621.2060.229
遗传因素13.118±4.31411.983±4.1961.0610.290
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陆航直升机飞行员发生高尿酸血症的危险因素及其干预措施
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弓大元 1, 2 , 亚仁杰 3 , 谢小萍 4 , 常耀明 4 , 刘胜权 5 , 暴军香 4, *
解放军医学杂志 | 临床研究 2021,46(2): 156-162
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解放军医学杂志 | 临床研究 2021, 46(2): 156-162
陆航直升机飞行员发生高尿酸血症的危险因素及其干预措施
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弓大元1, 2 , 亚仁杰3, 谢小萍4, 常耀明4, 刘胜权5, 暴军香4, *
作者信息
  • 1空军军医大学基础医学院，西安 710032
  • 2解放军95926部队卫生队，长春 130000
  • 3解放军32145部队卫生连，河南 新乡 453000
  • 4空军军医大学航空航天卫生学教研室，西安 710032
  • 5空军航空大学初级飞行训练基地门诊部，长春 130000

    • 弓大元，住院医师，主要从事流行病学和医疗大数据挖掘方面的研究。E-mail：

通讯作者:

暴军香，E-mail：
Risk factors and intervention strategies of hyperuricemia in helicopter pilots
Da-Yuan Gong1, 2 , Ren-Jie Ya3, Xiao-Ping Xie4, Yao-Ming Chang4, Sheng-Quan Liu5, Jun-Xiang Bao4, *
Affiliations
  • 1School of Basic Medicine, Air Force Military Medical University, Xi’an 710032, China
  • 295926 Army Health Team of PLA, Changchun 130000, China
  • 332145 Army Health Company of PLA, Xinxiang, Henan 453000, China
  • 4Department of Aerospace Hygiene, Air Force Military Medical University, Xi’an 710032, China
  • 5Outpatient Department of Primary Flight Training Base of Air Force Aviation University, Changchun 130000, China
出版时间: 2021-02-28 doi: 10.11855/j.issn.0577-7402.2021.02.08
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摘要
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目的 分析陆航直升机飞行员发生高尿酸血症(HUA)的危险因素，并探讨相应的干预对策。方法 2020年4—10月，在某飞行大队中选取年龄20~50岁、飞行时间>100 h的190名男性陆航直升机飞行员，采用自行设计的《飞行员HUA危险因素调查问卷》调查受试者的基本信息、饮食习惯、体育锻炼、吸烟饮酒、工作中的噪声与振动暴露、心情状态、疾病情况、工作绩效、睡眠情况、遗传因素等。同时选取SPF级6周龄雄性C57BL/6J小鼠28只，随机均分成7组：对照组、噪声组、噪声+维生素C(Vit C)组、噪声+多种维生素(Multi Vit)组、噪声+高压氧(HBO)组、噪声+HBO+Vit C组、噪声+HBO+Multi Vit组，持续干预7 d后用Multiskan Ascent酶标仪检测小鼠血清尿酸水平。结果 最终186名飞行员纳入本研究，年龄22~50岁，飞行时长(1378±569) h；自述有HUA者17例(HUA组)，占9.14%；自述正常尿酸(NUA)者169名(NUA组)。两组的年龄、身高、体重指数及高血糖比例差异无统计学意义。HUA组的高血脂及脂肪肝比例(分别为17.6%、29.4%)明显高于NUA组(分别为4.7%、10.1%)，差异有统计学意义(P<0.05)。HUA组的噪声暴露及振动暴露得分[分别为(22.942±3.960)分、(16.351±3.552)分]明显高于NUA组[(19.413±4.086)分、(13.323±3.476)分]，差异有统计学意义(P<0.05)；两组其余8个维度得分差异均无统计学意义(P>0.05)。噪声及振动暴露与HUA的发生密切相关，其中，噪声的暴露程度强、每日暴露时间长、对情绪影响大、防护措施效果差、防护措施使用频率低均会明显增加HUA的发生风险；振动的每日暴露时间长、对情绪影响大亦会增加患HUA的可能。与对照组小鼠的血清尿酸水平[(38.710±10.201) μmol/L]相比，噪声组的血清尿酸水平[(191.935±9.542) μmol/L]明显增加，差异有统计学意义(P<0.05)；噪声+Vit C组[(127.419±5.349) μmol/L]、噪声+Multi Vit组[(111.290±7.030) μmol/L]、噪声+HBO组[(53.226±11.518) μmol/L]、噪声+HBO+Vit C组[(61.290±7.213) μmol/L]及噪声+HBO+Multi Vit组[(69.355±13.968) μmol/L]的小鼠血清尿酸水平均低于噪声组，差异有统计学意义(P<0.05)；噪声+Vit C组、噪声+Multi Vit组、噪声+HBO+Vit C组及噪声+HBO+Multi Vit组的尿酸水平仍高于对照组，差异有统计学意义(P<0.05)，而噪声+HBO组的尿酸水平与对照组比较差异无统计学意义(P>0.05)。结论 陆航直升机飞行员发生HUA与工作环境中的噪声及振动暴露有关。高压氧和膳食维生素补充可有效降低噪声暴露所致血尿酸水平增高。

陆航直升机  /  飞行员  /  高尿酸血症  /  高压氧  /  维生素

Objective To analyze the risk factors inducing hyperuricemia (HUA) in helicopter pilots and put forward the corresponding intervention measures. Methods A total of 190 male helicopter pilots, aged 20-50 years and with more than 100 hours of flight time, were recruited from April to October 2020 in a flight brigade. A self-designed questionnaire was used, by which the basic information of subjects were collected including eating habits, physical exercise, smoking and drinking, exposure to noise and vibration at work, mood, disease, work performance, sleep status, genetic factors, and so on. At the same time, 28 SPF grade 6-week-old male C57BL/6J mice were randomly divided into 7 groups (4 each): control group, noise group, noise + vitamin C (Vit C)group, noise + multivitamin (Multi Vit) group, noise + hyperbaric oxygen (HBO) group, noise + HBO + Vit C group, and noise +HBO + Multi Vit group. After continuous intervention for 7 days, Multiskan Ascent was used to detect the uric acid (UA) level in mice sera. Results Finally, 186 subjects, aged 22-50 years and with (1378±569) hours of flight time, were included in present study. Of whom 17 (9.14%) were self-reported with HUA (HUA group) and 169 (9.14%) were with normal uric acid (NUA group).No significant difference existed between the two groups in age, height, body mass index and the proportion of hyperglycemia. The proportions of hyperlipidemia and fatty liver were significantly higher in HUA group (17.6% and 29.4%, respectively) than those in NUA group (4.7% and 10.1%, respectively) with statistically significant difference (P<0.05). The scores of noise exposure and vibration exposure were significantly higher in HUA group [(22.942±3.960) and (16.351±3.552), respectively] than those in NUA group [(19.413±4.086) and (13.323±3.476), respectively] with statistically significant difference (P<0.05); there was no significant difference between the two groups (P>0.05) in the other 8 dimensions. Noise and vibration exposure were closely related to the occurrence of HUA. Among them, strong noise and long daily exposure, great influence on emotion, the poor effect and low use frequency of protective measures would significantly increase the risk of HUA; Long daily exposure and great influence on emotion of vibration would also increase the risk of HUA. Compared with the control group, the serum UA level in noise group increased significantly [(38.710±10.201) μmol/L vs. (191.935±9.542) μmol/L] with significant difference (P<0.05); The serum UA levels in noise + Vit C group [(127.419±5.349) μmol/L], noise + Multi Vit group [(111.290±7.030) μmol/L], noise + HBO group [(53.226±11.518) μmol/L], noise + HBO + Vit C group [(61.290±7.213) μmol/L] and noise + HBO + Multi Vit group[(69.355±13.968) μmol/L] were all lower significantly than that in noise group (P<0.05). The UA levels in noise + Vit C group, noise + Multi Vit group, noise + HBO + Vit C group and noise + HBO + Multi Vit group were still higher than that in control group(P<0.05), while there was no significant difference between noise + HBO group and control group (P>0.05). Conclusions HUA in helicopter pilots is related to noise and vibration exposure in working environment. Hyperbaric oxygen and dietary vitamin supplementation can effectively reduce the increase of serum uric acid level caused by noise exposure.

army aviation helicopter  /  pilot  /  hyperuricemia  /  hyperbaric oxygen  /  vitamin
弓大元, 亚仁杰, 谢小萍, 常耀明, 刘胜权, 暴军香. 陆航直升机飞行员发生高尿酸血症的危险因素及其干预措施. 解放军医学杂志, 2021 , 46 (2) : 156 -162 . DOI: 10.11855/j.issn.0577-7402.2021.02.08
Da-Yuan Gong, Ren-Jie Ya, Xiao-Ping Xie, Yao-Ming Chang, Sheng-Quan Liu, Jun-Xiang Bao. Risk factors and intervention strategies of hyperuricemia in helicopter pilots[J]. Medical Journal of Chinese People’s Liberation Army, 2021 , 46 (2) : 156 -162 . DOI: 10.11855/j.issn.0577-7402.2021.02.08
正文
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尿酸是嘌呤代谢的终产物，属于弱酸，当空腹血尿酸水平高于饱和尿酸水平(男>416 μmol/L，女>356 μmol/L)时，即为高尿酸血症(hyperuricemia，HUA)。随着生活环境和饮食结构的变化，我国HUA人群逐年增多[1]，至2016年，至少有1.8亿HUA患者，仅排在高血压和高血脂之后[2]。HUA不仅是痛风的病理基础，而且与高血压、肥胖、胰岛素抵抗及动脉粥样硬化密切相关。HUA分为原发性和继发性两类，大部分病例为原发性HUA，即发生原因不明，因此患者对于是否需要治疗及如何治疗往往难以抉择。
飞行员是经严格体检的健康人群，但近年来发现，HUA在飞行员中并非少见[3]。陆军航空兵是为适应一体化联合作战需要而建立的一支快速机动力量，但陆航直升机飞行员中HUA的发病率呈逐年增高及年轻化趋势，原因不明，因此须进行针对性研究，以指导部队卫生防护和营养保障工作。研究发现，HUA的影响因素包括肥胖、药物、饮食习惯、遗传、疾病及情绪应激等[4]，本课题组结合已有报道及直升机飞行员的工作特点，设计了调查问卷进行横断面研究，并在此研究结果的基础上，利用动物实验进行验证，以探讨陆航直升机飞行员发生HUA的危险因素及其干预措施。
1 资料与方法
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1.1 问卷调查
1.1.1 调查对象
2020年4—10月，在某飞行大队中选取年龄20~50岁、飞行时间>100 h的男性陆航直升机飞行员，排除继发性HUA、肾实质疾病及继发性高血压病患者。在只告知本调查为健康相关研究，未告知具体研究方向的情况下190名自愿报名参加，排除未填写相关问题及失访者，最终纳入186名参与本研究，年龄22~50岁，飞行时长(1378±569) h。本研究经空军军医大学伦理委员会批准(20160904)。
1.1.2 调查方法及内容
参考相关研究并结合临床实际自行设计《飞行员HUA影响因素调查问卷》。不告知调查对象研究目的，先选择30人进行预调查和信效度分析，根据结果对部分条目进行修改。最终问卷内容包括：基本信息、饮食习惯、体育锻炼情况、吸烟饮酒情况、工作中的噪声暴露、振动暴露、心情状态、疾病情况、工作绩效、睡眠情况、遗传因素等10个维度，每个维度有6~16个问题，其中噪声暴露维度中设计了7个条目，包括噪声暴露程度、暴露年限、每日暴露时长、对情绪的影响、有无防护、防护频率(受试者根据自身情况按1~5分打分，1分为每次都使用防护，5分为从不使用防护，1~3分称为很少防护，4~5分称为经常防护)及防护措施效果(受试者根据自身主观感受按1~5分打分，1~3分称为防护效果差，4~5分称为防护效果良好)。振动暴露维度中设计了5个条目，包括暴露程度、每日暴露时长、暴露年限、情绪影响、有无防护，排除11名未填写振动暴露相关指标者，对其余179名进行分析。每个问题根据专家推荐和现有研究推测的HUA风险由低到高按照李克特5分法赋值，分数越高代表可能对HUA发生的贡献越大(如高嘌呤饮食摄入：几乎不吃计1分，几周吃一次计2分，每周1或2次计3分，每周3~5次计4分，几乎每天吃计5分)。各维度得分相加即为总分数。
1.1.3 质量控制
问卷题目和维度设置由HUA、心血管疾病及统计学领域相关专家提供设计支持，将3名陆航直升机飞行大队卫生军医作为访问员，采用电话培训方式先对访问员进行专项培训，保证其能有序组织本调查，能监督完成此调查所有题目，调查结束后对所有问卷进行统一编号整理，现场确认无误后经专用快递寄回。在填写调查问卷前，由访问人员对受访者进行现场培训辅导，包括填写方式、填写标准、填写顺序等，充分做好受访者思想工作，使其高度配合此次调查。研究组织者在卫生统计学专家的帮助下对4名数据录入分析人员进行培训，为保证数据真实公正，全部数据分3次录入SPSS软件，每次随机抽取2名分析人员进行工作，录入分析数据全过程在统计专家、调查组织者及剩余2名分析人员监督下完成，严格执行各项标准。
1.1.4 问卷信效度分析
采用Cronbach's α系数和半分信度系数衡量问卷总体及各维度信度，KMO(Kaiser-Meyer-Olkin)和Bartlett球形检验分析效度，问卷总体的Cronbach's α系数为0.88，各维度Cronbach's α系数0.64~0.95，分半信度系数0.45~0.91。各个维度的KMO值均高于0.6，Bartlett球形检验效度皆达到显著，适合进行因子分析，同时各变量的因素负荷和总体解释度均达到要求，问卷总体信度和效度良好(表1、表2)。问卷各维度相应条目因子载荷系数均>0.5，因子分析各维度方差贡献率如表3所示。
1.2 动物实验
1.2.1 实验动物
选取SPF级6周龄雄性C57BL/6J小鼠(购自空军军医大学动物中心)，于实验前筛选听性脑干反应(auditory brainstem responses，ABR)正常的28只小鼠入组。将小鼠随机分成7组：对照组、噪声组、噪声+维生素C(vitamin C，Vit C)组、噪声+多种维生素(multivitamin，Multi Vit)组、噪声+高压氧(hyperbaric oxygen，HBO)组、噪声+HBO+Vit C组、噪声+HBO+Multi Vit组，每组4只。均采用同鼠龄、同批次小鼠。所有实验操作均按动物实验伦理规定进行。
1.2.2 噪声暴露
使用标准声级计(AWA5636，北京宏昌信科技有限公司)对声音进行校准。噪声频率为20~20 000 Hz，声压级(SPL)强度为90~110 dB，经功率放大后送入两个扬声器。随后将小鼠置于鼠笼(尺寸为：318 mm×202 mm×135 mm)中，放置于距离扬声器30 cm的正前方，在隔声室中每天给予小鼠3 h的噪声刺激，连续7 d，期间小鼠不受约束。
1.2.3 灌胃给药
噪声暴露前7 d用灌胃针给予维生素C(商品名：维福佳，100 mg/片，2片溶于100 ml水，0.1 ml/d)及多种维生素(商品名：善存，480 mg/片，1片溶于200 ml水，0.1 ml/d)，每天1次；噪声暴露开始后，于每天暴露前采用小鼠灌胃针给药，每天1次，持续7 d。
1.2.4 HBO处理
每天噪声暴露完成后1 h，将小鼠置于45 cm×45 cm×75 cm的动物高压氧舱(DWC450-1150，上海杨园高压氧舱有限公司)中，不麻醉。用100% O2将舱室压力升高至2.5 ata(绝对大气压，1 ata=98.1 kPa)，作用1 h后，再在10 min内将压力降至1 ata，取出小鼠。如此处理每天1次，持续7 d。
1.2.5 血清尿酸水平检测
将小鼠用3.5%水合氯醛麻醉(0.1 ml/10 g)，于眼眶后静脉丛采血10 ml，脊椎脱臼法处死小鼠。全血常温静置2 h后放入4 ℃冰箱过夜，4000 r/min离心10 min，取上层血清。用血清尿酸检测试剂盒(酶比色法，南京建成生物工程研究所)及Multiskan Ascent酶标仪(美国Thermo Fisher Scientific公司)进行检测。
1.3 统计学处理
采用SPSS 17.0软件进行统计分析。计量资料以$\bar{x}±s$表示，两组间比较采用独立样本t检验；多组间比较采用单因素方差分析，进一步两两比较采用LSD-t检验；计数资料以例(%)表示，组间比较采用χ2检验，对于频数小于1的组间比较采用确切概率法。计算比值比(OR)及其95%置信区间(CI)量化HUA的发生风险。P<0.05为差异有统计学意义。
2 结果
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2.1 问卷调查结果
参与本调查的186名飞行员中，自述有HUA者17例(HUA组)，占9.14%；自述正常尿酸(NUA)169名(NUA组)。两组的年龄、身高、体重指数及高血糖比例差异无统计学意义。HUA组的高血脂及脂肪肝比例明显高于NUA组，差异有统计学意义(P<0.05，表4)。
2.2 两组问卷各维度得分比较
HUA组的噪声暴露及振动暴露得分高于NUA组，差异有统计学意义(P<0.05)；两组其余8个维度得分差异无统计学意义(P>0.05，表5)。
2.3 两组噪声暴露及防护情况
2.3.1 噪声暴露程度
HUA组主观认为噪声暴露程度很大或极大的人数比例[94.1%(16/17)]高于NUA组[66.3%(112/169)]，差异有统计学意义(χ2=4.360，P<0.05)；暴露程度大或极大的受试者患HUA的风险是暴露程度小的8.1(1.1~58.3)倍。
2.3.2 噪声暴露年限及每日暴露时长
HUA组中累计噪声暴露超过5年的人数比例为64.7%(11/17)，NUA组为44.4%(75/169)，两组间差异无统计学意义(χ2=2.567，P>0.05)。HUA组每日噪声暴露>5 h的人数比例[47.1%(8/17)]高于NUA组[17.2%(29/169)]，差异有统计学意义(χ2=8.665，P<0.05)；每日噪声暴露>5 h的受试者患HUA的风险是<5 h者的4.3(1.5~12.1)倍。
2.3.3 噪声暴露对情绪的影响
HUA组中主观认为噪声暴露对工作能力、听力、睡眠等有很大影响并产生烦躁、焦虑等负面情绪的人数比例[35.29%(6/17)]高于NUA组[14.20%(24/169)]，差异有统计学意义(χ2=5.080，P<0.05)，对情绪有很大影响的受试者患HUA的风险是无明显影响者的3.3(1.1～9.7)倍。
2.3.4 噪声防护情况
186名受试者中，有噪声防护措施者147名，占79.03%；HUA组与NUA组无防护措施比例差异无统计学意义(χ2=0.805，P>0.05)。有防护措施的147名受试者中，很少使用防护措施的人数比例HUA组[66.67%(8/12)]高于NUA组[11.11%(15/135)]，差异有统计学意义(χ2=25.771，P<0.01)，很少防护者的患病风险是经常防护者的16.0(4.3~59.6)倍；防护措施效果差的人数比例HUA组[91.67%(11/12)]高于NUA组[15.56%(21/135)]，差异有统计学意义(χ2=33.151，P<0.01)；防护效果差的受试者患病风险是防护效果良好者的59.7(7.3~487.3)倍。
2.4 两组振动暴露及防护情况比较
2.4.1 振动暴露程度
HUA组中振动暴露程度大或极大的人数比例[58.82%(10/17)]与NUA组[39.51%(64/162)]比较差异无统计学意义(χ2=2.368，P>0.05)。
2.4.2 振动暴露年限及每日暴露时长
HUA组中累计振动暴露超过5年的人数比例[64.71%(11/17)]与NUA组[41.36%(67/162)]比较差异无统计学意义(χ2=3.411，P>0.05)。HUA每日振动暴露大于5 h的人数比例为41.2%(7/17)，高于NUA组的14.2%(23/162)，差异有统计学意义(χ2=8.027，P<0.05)，每日振动暴露大于5 h的受试者患HUA的风险是小于5 h者的4.2(1.5~12.2)倍。
2.4.3 振动暴露对情绪影响
HUA组中主观认为振动暴露对工作能力、听力、睡眠等有很大影响并产生烦躁、焦虑等负面情绪的人数比例[29.41%(5/17)]高于NUA组[10.49%(17/162)]，差异有统计学意义(χ2=5.108，P<0.05)，对情绪有很大影响的受试者患HUA的风险是无明显影响受试者的3.6(1.1~11.3)倍。
2.4.4 振动防护情况
在179名受试者中，有噪声防护措施者34名，占18.99%；HUA组的无防护措施比例为94.1%(16/17)，NUA组为79.6%(129/162)，两组比较差异无统计学意义(χ2=1.263，P>0.05)。
2.5 各处理组小鼠血清尿酸水平比较
与对照组的血清尿酸水平[(38.710±10.201) μmol/L]相比，噪声组小鼠的血清尿酸水平[(191.935±9.542) μmol/L]明显增高，差异有统计学意义(P<0.05)；噪声+Vit C组[(127.419±5.349) μmol/L]、噪声+Multi Vit组[(111.290±7.030) μmol/L]、噪声+HBO组[(53.226±11.518) μmol/L]、噪声+HBO+Vit C组[(61.290±7.213) μmol/L]及噪声+HBO+Multi Vit组[(69.355±13.968) μmol/L]的小鼠血清尿酸水平均低于噪声组，差异有统计学意义(P<0.05)；噪声+Vit C组、噪声+Multi Vit组、噪声+HBO+Vit C组及噪声+HBO+Multi Vit组的尿酸水平仍高于对照组，差异有统计学意义(P<0.05)，而噪声+HBO组的尿酸水平与对照组比较差异无统计学意义(P>0.05，图1)。
3 讨论
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近年来，陆航直升机飞行员中罹患HUA的比例逐年上升，且有年轻化趋势，本横断面研究采用自行设计的调查问卷对其原因进行调查，结果发现，陆航直升机飞行员的HUA与高脂血症及脂肪肝发生率相关，原因涉及噪声、振动暴露及防护不足，动物实验提示HBO及膳食维生素补充可有效降低噪声暴露所致的血尿酸水平增高。
我国成人HUA患者约1.7亿，患病率为5.46%~19.30%，其中男性为9.2%~26.2%，女性为0.7%~10.5%，且随年龄增长而增高，城市高于农村，沿海高于内陆[5]。在航空兵部队，空军飞行员2008—2010年的HUA发生率分别为8.2%、14.2%、14.6%，与普通人群基本一致[5-6]。本调查中，直升机飞行员平均年龄为30.3岁，HUA发生率为9.1%，低于文献报道的同年龄中国成人男性HUA发生率(19.1%)，并低于民航飞行员的HUA发生率(23.1%)[7]。原因可能为：军事飞行员身体素质好，体能训练要求高，体重控制有要求，同时飞行员饮食由空勤灶保障，较少在外就餐及饮酒等。
大量研究表明，HUA与高血压、糖尿病、肥胖等传统心血管危险因素有关[8]。空军飞行员中，HUA组的高血压、高胆固醇、高三酰甘油发生率明显高于NUA组[9]。海军飞行员中HUA组的体重指数、三酰甘油水平及非酒精性脂肪肝发生率明显高于对照组[10]。本研究结果显示，在直升机飞行员中，HUA组的高脂血症和脂肪肝发生率明显高于NUA组，与上述研究一致，提示HUA与胰岛素抵抗(insulin resistance，IR)存在相互促进作用，可能使尿酸盐结晶沉积于胰岛，损害β细胞功能，导致糖代谢紊乱，而IR继发的高胰岛素血症可刺激肾小管Na+-H+交换，在增加H+排泌的同时，促进尿酸重吸收[11]。
HUA的高危因素有遗传、肥胖、疾病、药物、创伤与手术及不良饮食习惯等[12]，但在本调查中，HUA组与NUA组的饮食习惯、体育锻炼、吸烟饮酒、遗传因素、心情状态、工作绩效、睡眠情况、疾病情况评分差异无统计学意义。两组间噪声及振动暴露与防护存在差异，与HUA的发生密切相关，其中，噪声的暴露程度强、每日暴露时间长、对情绪影响大、防护措施效果差、防护措施使用频率低都会显著增加HUA的发生风险；在振动方面，每日暴露时间长、对情绪影响大亦会增加患HUA的可能。噪声和振动是陆航直升机飞行环境对人员的重要影响[13]。噪声主要来自发动机，其次是传动装置、旋翼、尾桨齿轮箱及尾桨、武器装备系统，采取的综合防护措施包括使用个人防护器具、改善外场休息室的条件、定期检查飞行员听觉功能、合理安排飞行时间等[14]。振动约占直升机整个飞行时间的90%~98%，目前主要通过在飞机设计中应用减振技术进行防护。本研究结果提示，噪声和振动暴露及对飞行员情绪的影响是HUA发生的重要原因，因此，提高飞行员防护意识，正确使用防护装备及加强降噪减振技术研发是降低HUA发生率的关键措施[15]。噪声及振动引发的心理应激反应可能通过神经内分泌调节影响嘌呤代谢及尿酸排泄，使其水平升高[16]，还可通过激活黄嘌呤氧化酶促进尿酸生成，或导致内皮功能障碍影响尿酸排泄[17]。研究证实，噪声暴露可促进脂肪肝的发生[18]，本研究亦发现HUA组中高脂血症和脂肪肝比例显著高于NUA组，提示不良环境因素的影响可能是多种代谢相关疾病的共同原因。
HUA的一般治疗包括饮食控制、碱化尿液等[19]。虽然维生素C被认为可促进HUA的发生[20]，但多种维生素有减轻HUA的作用[21]。基于问卷调查的结果，本研究利用动物实验探寻噪声所致HUA的非药物干预方法。首先将小鼠在90~150 dB噪声环境中暴露7 d，结果小鼠血尿酸水平增加了3.56倍，验证了急性噪声暴露导致HUA的现象。接着分别采用维生素C和多种维生素灌胃，其中多种维生素除维生素A、维生素C、维生素E之外，还包含维生素B1、维生素B2及叶酸。服用多种维生素更接近机体的生理状态，便于客观分析维生素对尿酸的影响。结果显示，维生素C可使噪声暴露小鼠血尿酸水平降低1/3，多种维生素可使其降低1/3~1/2，但仍然高于对照组。提示补充维生素可抑制噪声暴露所致尿酸水平的升高，但单纯采用这一措施并不能使尿酸恢复至正常水平。补充多种维生素使尿酸水平下降的机制可能与改善IR，增强抗氧化酶活力，降低脂质过氧化物含量，以及降低炎性因子表达有关[22]。由于低压、缺氧、噪声、振动及精神紧张等因素影响，飞行员对各种维生素的消耗量增加，因此，在我军军人日膳食食物定量标准(GJB 826B-2010)中，要求飞行员每日服用1粒空勤专用多种维生素片。本调查发现，72.0%的直升机飞行员几乎不吃或几周才吃一次维生素片，其中HUA组中无人有服用维生素片的习惯。因此，应加强陆航直升机飞行员服用多种维生素片的卫生宣教。
HBO是指在高于1个大气压的环境中，吸入纯氧或高浓度氧来治疗疾病的方法，各种缺血缺氧性疾病、减压病及厌氧菌感染是其主要适应证，治疗机制主要是纠正细胞缺氧、增加血氧弥散距离、减轻水肿、广谱抗菌及调节免疫功能等[23]。本课题组以往研究发现，噪声可导致肝细胞中黄嘌呤氧化酶活性增高，而HBO可明显抑制此变化[24]。本研究发现，在噪声暴露前给予大鼠HBO预处理，HBO干预组大鼠尿酸水平明显低于噪声暴露组，且其降低程度明显大于维生素干预组，几乎恢复至正常水平，提示HBO预处理可有效避免噪声所致HUA。本研究的不足在于样本量较少，且由于条件限制，数据来源于参与者的自述，并未进行检测，后续有必要对陆航直升机飞行员HUA的现况进行更大样本的人群调查。
综上所述，陆航直升机飞行员HUA的发生与噪声及振动暴露有关，需加强防护装备的使用，同时督促飞行员每日服用多种维生素片，并重视HBO在HUA防护中的应用。
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  • 空军军医大学军事医学“珠峰工程”资助项目(2019ZFC002)
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2021年第46卷第2期
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doi: 10.11855/j.issn.0577-7402.2021.02.08
  • 接收时间：2020-07-20
  • 首发时间：2025-12-26
  • 出版时间：2021-02-28
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  • 收稿日期：2020-07-20
  • 修回日期：2020-10-20
基金
Military Medical "Everest Project" Funded by Air Force Military Medical University(2019ZFC002)
空军军医大学军事医学“珠峰工程”资助项目(2019ZFC002)
作者信息
    1空军军医大学基础医学院，西安 710032
    2解放军95926部队卫生队，长春 130000
    3解放军32145部队卫生连，河南 新乡 453000
    4空军军医大学航空航天卫生学教研室，西安 710032
    5空军航空大学初级飞行训练基地门诊部，长春 130000

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
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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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