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Article(id=1240651441606546042, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240651438955754377, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202308484, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1693324800000, receivedDateStr=2023-08-30, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773723953868, onlineDateStr=2026-03-17, pubDate=1719244800000, pubDateStr=2024-06-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773723953868, onlineIssueDateStr=2026-03-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773723953868, creator=13701087609, updateTime=1773723953868, updator=13701087609, issue=Issue{id=1240651438955754377, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='12', pageStart='2113', pageEnd='2912', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773723953236, creator=13701087609, updateTime=1773723953236, updator=13701087609, preIssue=null, nextIssue=null, ext=null, issueFiles=null}, startPage=2294, endPage=2299, ext={EN=ArticleExt(id=1240651441921118852, articleId=1240651441606546042, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Effects of interaction between overweight/obesity and dyslipidemia on hyperuricemia, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the interaction between overweight/obesity and dyslipidemia on hyperuricemia (HUA), and to provide scientific basis for the prevention and treatment of HUA.

Methods

The data were derived from the physical examination records of workers at the Xishan Coal and Electricity Group in 2018, encompassing a total of 38 615 study participants.SAS 9.3 software was used to conduct χ2 test and multivariate logistic regression analyses. Additive interaction model was used to analyze the interaction between overweight/obesity and dyslipidemia on HUA.

Results

The prevalence rate of HUA was 18.28%. After adjusting for gender, age, smoking, drinking, systolic blood pressure, diastolic blood pressure, fasting blood glucose and blood creatinine, the results of multivariate logistic regression analyses showed that overweight/obesity (OR=2.756, 95%CI: 2.584-2.939) and dyslipidemia (OR=2.221, 95%CI: 2.100-2.349) were associated with a higher risk of HUA, respectively. Interaction analyses showed a synergistic additive interaction between overweight/obesity and dyslipidemia on the prevalence of HUA, with those who were overweight/obese and dyslipidemic having a higher risk of HUA than those who had neither (OR=4.840,95%CI: 4.452-5.261), and the relative excess risk of interaction (RERI) was 0.4,the attributable proportion of interaction (API) was 0.083, and the synergy index (SI) was 1.116.

Conclusion

Overweight/obesity and dyslipidemia both increase the risk of HUA, and there is synergistic additive interaction between them.Controlling body mass index and lipid levels may prevent HUA.

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目的

了解超重/肥胖与血脂异常对高尿酸血症(Hyperuricemia，HUA)患病的交互作用，为HUA防治提供科学依据。

方法

数据来源于2018年西山煤电集团工人体检数据，共纳入38 615名研究对象。运用SAS 9.3软件进行χ2检验和多因素logistic回归分析，采用相加模型分析超重/肥胖与血脂异常对HUA患病的交互作用。

结果

研究对象HUA患病率为18.28%。调整性别、年龄、吸烟、饮酒、收缩压、舒张压、空腹血糖、血肌酐后，多因素logistic回归分析结果显示，超重/肥胖(OR=2.756, 95%CI: 2.584~2.939)和血脂异常(OR=2.221, 95%CI: 2.100~2.349)与HUA患病高风险相关。交互作用分析显示，超重/肥胖与血脂异常对HUA患病存在协同相加交互作用，超重/肥胖且血脂异常者患HUA的风险高于两者均不罹患者(OR=4.840, 95%CI: 4.452~5.261)，超额相对危险度(RERI)为0.4，交互作用归因百分比(API)为0.083，交互作用指数(SI)为1.116。

结论

超重/肥胖、血脂异常均增加了HUA患病风险，二者存在协同相加交互作用。防治HUA应着力改善患者的超重/肥胖和血脂异常状态。

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沈天然，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=zNBNkK18bKN9Pitc45pUGA==, magXml=UlOygXqc2k8D6kkUah7e3g==, pdfUrl=null, pdf=G8Jf2FhvYXKCSuNC8wQ1tg==, pdfFileSize=622189, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=xh4nhMzY19eSRECPKXdR9Q==, mapNumber=null, authorCompany=null, fund=null, authors=

郑秋潼(1997—)，女，硕士在读，研究方向：疾病预防控制

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郑秋潼(1997—)，女，硕士在读，研究方向：疾病预防控制

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郑秋潼(1997—)，女，硕士在读，研究方向：疾病预防控制

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Chinese Journal of Prevention and Control of Chronic Diseases, 2022, 30(11): 825-830., articleTitle=Analysis of dyslipidemia prevalence characteristics and related factors of 18-year-old people in Guangdong province in 2018, refAbstract=null)], funds=[Fund(id=1240651450297143366, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651441606546042, awardId=2019GCZX012, language=CN, fundingSource=广东省公共卫生检测与评价工程技术研究中心(2019GCZX012), fundOrder=null, country=null), Fund(id=1240651450406195278, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651441606546042, awardId=202201010545, language=CN, fundingSource=广州市基础与应用基础研究项目一般项目(202201010545), fundOrder=null, country=null), Fund(id=1240651450490081367, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651441606546042, awardId=A2020112, language=CN, fundingSource=广东省医学科学技术研究基金项目(A2020112), fundOrder=null, country=null), Fund(id=1240651450632687720, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651441606546042, awardId=2020SYF13, language=CN, fundingSource=中山市社会公益与基础研究项目(2020SYF13), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240651444563530432, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651441606546042, xref=1., ext=[AuthorCompanyExt(id=1240651444571919040, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651441606546042, companyId=1240651444563530432, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong 510006, China), AuthorCompanyExt(id=1240651444580307649, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651441606546042, companyId=1240651444563530432, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.广东药科大学公共卫生学院，广东 广州 510310)]), AuthorCompany(id=1240651444701942471, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651441606546042, xref=2., ext=[AuthorCompanyExt(id=1240651444718719688, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651441606546042, companyId=1240651444701942471, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.山西省太原市西山煤电集团职业病防治所)])], figs=[ArticleFig(id=1240651449282122735, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651441606546042, language=EN, label=Table 1, caption=

Basic characteristics of research objects (n=38 615)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人数non-HUA(n=31 556)HUA(n=7 059)Z/χ2P
年龄(岁)41.00(32.00,49.00)42.00(32.00,49.00)36.00(30.00,47.00)-23.387<0.001
性别511.681<0.001
男31 395(81.30)24 986(79.18)6 409(90.79)
女7 220(18.70)6 570(20.82)650(9.21)
吸烟21.368<0.001
否23 497(60.85)19 373(61.39)4 124(58.42)
是15 118(39.15)12 183(38.61)2 935(41.58)
饮酒136.498<0.001
否34 754(90.00)28 667(90.84)6 087(86.23)
是3 861(10.00)2 889(9.16)972(13.77)
BMI(kg/m2)24.65(22.39,26.99)24.24(22.06,26.49)26.45(24.26,28.73)47.566<0.001
收缩压(mm Hg)81.00(72.00,89.00)80.00(72.00,89.00)84.00(75.00,92.00)18.751<0.001
舒张压(mm Hg)123.00(113.00,136.00)122.00(112.00,135.00)127.00(116.00,138.00)17.726<0.001
空腹血糖(mmol/L)4.90(4.54,5.33)4.89(4.53,5.31)4.93(4.57,5.40)5.232<0.001
总胆固醇(mmol/L)4.30(3.80,4.87)4.25(3.76,4.80)4.57(4.03,5.14)27.872<0.001
甘油三酯(mmol/L)1.45(1.04,2.08)1.36(1.00,1.93)1.91(1.37,2.76)46.624<0.001
低密度脂蛋白(mmol/L)2.67(2.25,3.03)2.63(2.22,3.02)2.82(2.37,3.08)20.366<0.001
高密度脂蛋白(mmol/L)1.16(1.02,1.33)1.18(1.03,1.34)1.11(0.98,1.26)-23.385<0.001
肌酐(μmol/L)76.90(68.00,86.50)75.80(67.10,85.00)82.50(73.60,92.40)36.838<0.001
尿酸(μmol/L)329.26(274.22,391.89)309.49(263.00,354.97)461.00(435.26,50.39)129.431<0.001
超重/肥胖1 461.179<0.001
否16 307(42.23)14 760(46.77)1 547(21.92)
是22 308(57.77)16 796(53.23)5 512(78.08)
血脂异常1 158.104<0.001
否25 376(65.72)21 964(69.60)3 412(48.34)
是13 239(34.28)9 592(30.40)3 647(51.66)
), ArticleFig(id=1240651449416340470, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651441606546042, language=CN, label=表1, caption=

研究对象的基本特征(n=38 615)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人数non-HUA(n=31 556)HUA(n=7 059)Z/χ2P
年龄(岁)41.00(32.00,49.00)42.00(32.00,49.00)36.00(30.00,47.00)-23.387<0.001
性别511.681<0.001
男31 395(81.30)24 986(79.18)6 409(90.79)
女7 220(18.70)6 570(20.82)650(9.21)
吸烟21.368<0.001
否23 497(60.85)19 373(61.39)4 124(58.42)
是15 118(39.15)12 183(38.61)2 935(41.58)
饮酒136.498<0.001
否34 754(90.00)28 667(90.84)6 087(86.23)
是3 861(10.00)2 889(9.16)972(13.77)
BMI(kg/m2)24.65(22.39,26.99)24.24(22.06,26.49)26.45(24.26,28.73)47.566<0.001
收缩压(mm Hg)81.00(72.00,89.00)80.00(72.00,89.00)84.00(75.00,92.00)18.751<0.001
舒张压(mm Hg)123.00(113.00,136.00)122.00(112.00,135.00)127.00(116.00,138.00)17.726<0.001
空腹血糖(mmol/L)4.90(4.54,5.33)4.89(4.53,5.31)4.93(4.57,5.40)5.232<0.001
总胆固醇(mmol/L)4.30(3.80,4.87)4.25(3.76,4.80)4.57(4.03,5.14)27.872<0.001
甘油三酯(mmol/L)1.45(1.04,2.08)1.36(1.00,1.93)1.91(1.37,2.76)46.624<0.001
低密度脂蛋白(mmol/L)2.67(2.25,3.03)2.63(2.22,3.02)2.82(2.37,3.08)20.366<0.001
高密度脂蛋白(mmol/L)1.16(1.02,1.33)1.18(1.03,1.34)1.11(0.98,1.26)-23.385<0.001
肌酐(μmol/L)76.90(68.00,86.50)75.80(67.10,85.00)82.50(73.60,92.40)36.838<0.001
尿酸(μmol/L)329.26(274.22,391.89)309.49(263.00,354.97)461.00(435.26,50.39)129.431<0.001
超重/肥胖1 461.179<0.001
否16 307(42.23)14 760(46.77)1 547(21.92)
是22 308(57.77)16 796(53.23)5 512(78.08)
血脂异常1 158.104<0.001
否25 376(65.72)21 964(69.60)3 412(48.34)
是13 239(34.28)9 592(30.40)3 647(51.66)
), ArticleFig(id=1240651449512809472, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651441606546042, language=EN, label=Table 2, caption=

Analysis of the association between overweight/obesity or dyslipidemia and the risk of HUA

, figureFileSmall=null, figureFileBig=null, tableContent=
变量变量分类模型1模型2模型3
OR (95%CI)POR (95%CI)POR (95%CI)P
超重/肥胖否1.001.001.00
是3.131(2.947~3.326)<0.0013.079(2.894~3.276)<0.0012.756(2.584~2.939)<0.001
血脂异常否1.001.001.00
是2.448(2.322~2.579)<0.0012.405(2.278~2.539)<0.0012.221(2.100~2.349)<0.001
), ArticleFig(id=1240651449651220490, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651441606546042, language=CN, label=表2, caption=

超重/肥胖或血脂异常对HUA患病风险关联性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量变量分类模型1模型2模型3
OR (95%CI)POR (95%CI)POR (95%CI)P
超重/肥胖否1.001.001.00
是3.131(2.947~3.326)<0.0013.079(2.894~3.276)<0.0012.756(2.584~2.939)<0.001
血脂异常否1.001.001.00
是2.448(2.322~2.579)<0.0012.405(2.278~2.539)<0.0012.221(2.100~2.349)<0.001
), ArticleFig(id=1240651449764466708, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651441606546042, language=EN, label=Table 3, caption=

Qualitative analysis of the additive interaction between overweight/obesity and dyslipidemia on the risk of HUA

, figureFileSmall=null, figureFileBig=null, tableContent=
超重/肥胖血脂异常总人数/病例模型1模型2模型3
OR(95%CI)POR(95%CI)POR(95%CI)P
否否13 007/9751.001.001.00
否是3 300/5722.588(2.315~2.892)<0.0012.664(2.378~2.983)<0.0012.616(2.331~2.936)<0.001
是否12 369/2 3473.028(2.798~3.277)0.0133.048(1.057~1.498)<0.0012.823(2.600~3.066)<0.001
是是9 939/3 0755.528(5.114~5.976)<0.0015.472(5.050~5.929)<0.0014.840(4.452~5.261)<0.001
), ArticleFig(id=1240651449902878752, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651441606546042, language=CN, label=表3, caption=

超重/肥胖与血脂异常对HUA患病风险相加交互作用的定性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
超重/肥胖血脂异常总人数/病例模型1模型2模型3
OR(95%CI)POR(95%CI)POR(95%CI)P
否否13 007/9751.001.001.00
否是3 300/5722.588(2.315~2.892)<0.0012.664(2.378~2.983)<0.0012.616(2.331~2.936)<0.001
是否12 369/2 3473.028(2.798~3.277)0.0133.048(1.057~1.498)<0.0012.823(2.600~3.066)<0.001
是是9 939/3 0755.528(5.114~5.976)<0.0015.472(5.050~5.929)<0.0014.840(4.452~5.261)<0.001
), ArticleFig(id=1240651450028707886, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651441606546042, language=EN, label=Table 4, caption=

Quantitative analysis of the additive interaction between overweight/obesity and dyslipidemia on the risk of HUA

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评价指标模型1模型2模型3
RERI (95%CI)0.913(0.556~1.270)0.760(0.391~1.129)0.400(0.044~0.756)
API (95%CI)0.165(0.104~0.227)0.139(0.074~0.204)0.083(0.011~0.155)
SI (95%CI)1.253(1.141~1.375)1.205(1.205~1.325)1.116(1.013~1.235)
), ArticleFig(id=1240651450162925623, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651441606546042, language=CN, label=表4, caption=

超重/肥胖与血脂异常对HUA患病风险相加交互作用的定量分析

, figureFileSmall=null, figureFileBig=null, tableContent=
评价指标模型1模型2模型3
RERI (95%CI)0.913(0.556~1.270)0.760(0.391~1.129)0.400(0.044~0.756)
API (95%CI)0.165(0.104~0.227)0.139(0.074~0.204)0.083(0.011~0.155)
SI (95%CI)1.253(1.141~1.375)1.205(1.205~1.325)1.116(1.013~1.235)
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超重/肥胖与血脂异常的交互作用对高尿酸血症的影响
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郑秋潼 1 , 陈青松 1 , 蒋柳权 2 , 谢灵香 1 , 梁宝怡 1 , 沈天然 1
现代预防医学 | 临床与预防 2024,51(12): 2294-2299
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现代预防医学 | 临床与预防 2024, 51(12): 2294-2299
超重/肥胖与血脂异常的交互作用对高尿酸血症的影响
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郑秋潼1, 陈青松1, 蒋柳权2, 谢灵香1, 梁宝怡1, 沈天然1
作者信息
  • 1.广东药科大学公共卫生学院，广东 广州 510310
  • 2.山西省太原市西山煤电集团职业病防治所

    • 郑秋潼(1997—)，女，硕士在读，研究方向：疾病预防控制

通讯作者:

沈天然，E-mail：
Effects of interaction between overweight/obesity and dyslipidemia on hyperuricemia
Qiu-tong ZHENG1, Qing-song CHEN1, Liu-quan JIANG2, Ling-xiang XIE1, Bao-yi LIANG1, Tian-ran SHEN1
Affiliations
  • School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong 510006, China
出版时间: 2024-06-25 doi: 10.20043/j.cnki.MPM.202308484
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摘要
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目的

了解超重/肥胖与血脂异常对高尿酸血症(Hyperuricemia，HUA)患病的交互作用，为HUA防治提供科学依据。

方法

数据来源于2018年西山煤电集团工人体检数据，共纳入38 615名研究对象。运用SAS 9.3软件进行χ2检验和多因素logistic回归分析，采用相加模型分析超重/肥胖与血脂异常对HUA患病的交互作用。

结果

研究对象HUA患病率为18.28%。调整性别、年龄、吸烟、饮酒、收缩压、舒张压、空腹血糖、血肌酐后，多因素logistic回归分析结果显示，超重/肥胖(OR=2.756, 95%CI: 2.584~2.939)和血脂异常(OR=2.221, 95%CI: 2.100~2.349)与HUA患病高风险相关。交互作用分析显示，超重/肥胖与血脂异常对HUA患病存在协同相加交互作用，超重/肥胖且血脂异常者患HUA的风险高于两者均不罹患者(OR=4.840, 95%CI: 4.452~5.261)，超额相对危险度(RERI)为0.4，交互作用归因百分比(API)为0.083，交互作用指数(SI)为1.116。

结论

超重/肥胖、血脂异常均增加了HUA患病风险，二者存在协同相加交互作用。防治HUA应着力改善患者的超重/肥胖和血脂异常状态。

超重  /  肥胖  /  血脂异常  /  高尿酸血症  /  交互作用
Objective

To investigate the interaction between overweight/obesity and dyslipidemia on hyperuricemia (HUA), and to provide scientific basis for the prevention and treatment of HUA.

Methods

The data were derived from the physical examination records of workers at the Xishan Coal and Electricity Group in 2018, encompassing a total of 38 615 study participants.SAS 9.3 software was used to conduct χ2 test and multivariate logistic regression analyses. Additive interaction model was used to analyze the interaction between overweight/obesity and dyslipidemia on HUA.

Results

The prevalence rate of HUA was 18.28%. After adjusting for gender, age, smoking, drinking, systolic blood pressure, diastolic blood pressure, fasting blood glucose and blood creatinine, the results of multivariate logistic regression analyses showed that overweight/obesity (OR=2.756, 95%CI: 2.584-2.939) and dyslipidemia (OR=2.221, 95%CI: 2.100-2.349) were associated with a higher risk of HUA, respectively. Interaction analyses showed a synergistic additive interaction between overweight/obesity and dyslipidemia on the prevalence of HUA, with those who were overweight/obese and dyslipidemic having a higher risk of HUA than those who had neither (OR=4.840,95%CI: 4.452-5.261), and the relative excess risk of interaction (RERI) was 0.4,the attributable proportion of interaction (API) was 0.083, and the synergy index (SI) was 1.116.

Conclusion

Overweight/obesity and dyslipidemia both increase the risk of HUA, and there is synergistic additive interaction between them.Controlling body mass index and lipid levels may prevent HUA.

Overweight  /  Obesity  /  Dyslipidemia  /  Hyperuricemia  /  Interaction
郑秋潼, 陈青松, 蒋柳权, 谢灵香, 梁宝怡, 沈天然. 超重/肥胖与血脂异常的交互作用对高尿酸血症的影响. 现代预防医学, 2024 , 51 (12) : 2294 -2299 . DOI: 10.20043/j.cnki.MPM.202308484
Qiu-tong ZHENG, Qing-song CHEN, Liu-quan JIANG, Ling-xiang XIE, Bao-yi LIANG, Tian-ran SHEN. Effects of interaction between overweight/obesity and dyslipidemia on hyperuricemia[J]. Modern Preventive Medicine, 2024 , 51 (12) : 2294 -2299 . DOI: 10.20043/j.cnki.MPM.202308484
正文
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高尿酸血症(Hyperuricemia，HUA)是由于尿酸盐分泌过多或排出不足引起的，是痛风、糖尿病、高血压和代谢综合征的危险因素[1-4]。随着中国经济水平的提高，高嘌呤食物摄入增加导致HUA的发生率急剧攀升，且发病率有年轻化的趋势[5]。目前，中国HUA的总体患病率介于14.4%~17.7%之间[6-8]，已成为继糖尿病之后又一常见代谢性疾病。研究调查表明，肥胖是HUA的危险因素之一[9]。既往研究发现多个肥胖指标对HUA都有良好的预测性，包括身体质量指数(body mass index, BMI)、腰围、腰高比、内脏肥胖指数和脂质蓄积指数等指标[10]。已知肥胖引起的胰岛素抵抗和脂肪因子介导的尿酸排泄抑制可提高血尿酸水平[11]。此外，HUA往往与脂代谢紊乱的发生有关[12-15]。一项前瞻性研究表明，血脂谱的变化是与HUA发生相关的独立因素，尤其是甘油三酯和高密度脂蛋白[16]。另一项随访6年的前瞻性研究表明[17]，在基线时甘油三酯>1 600 mg/L的人中HUA的发病率比基线甘油三酯<790 mg/L的人高一倍多，在调整了年龄、体重指数、血压、饮酒和总胆固醇等混杂因素后发现，基线甘油三酯是新发HUA的独立预测因素。一些用于治疗血脂异常的药物，如非诺贝特，可有效降低血清尿酸浓度[18]。超重/肥胖和血脂异常均与HUA有关，二者对HUA患病可能存在交互作用，但国内有关的超重/肥胖和血脂异常的交互作用对HUA的影响尚缺乏流行病学资料。
本研究利用2018年西山煤电集团工人体检数据，了解超重/肥胖、血脂异常与HUA患病的关系，探讨超重/肥胖与血脂异常之间的交互作用，为HUA防治提供参考依据。
1　对象与方法
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1.1　对象
以2018年西山煤电集团(山西太原)进行体检的员工为研究对象，包括体检基本信息体格检查和临床生化检测。2018年体检人数共53 530人，首先排除了妊娠的妇女和严重基础疾病患者，其次排除BMI、血脂4项和尿酸重要变量缺失者，最终38 616名研究对象纳入分析。本课题研究已获得广东药科大学伦理委员会的批准(广药大公卫医伦[2023]第5号)，所有研究对象均自愿参加并签署知情同意书。
1.2　方法
本研究通过西山煤电职业病防治所授权获取体检数据，由西山煤电职业病防治所体检中心的专业医师进行体检，检查内容包括:一般人口学资料(年龄、性别、吸烟和饮酒)、体格检查(身高、体重、BMI、血压)和影像学检查(心电图、B超和胸片等)；所有体检者要求空腹8小时以上，专业的医师和护士采集空腹静脉采血后由医院临床检测中心进行血糖、血脂四项、肝肾功能、生化全项等检测。
1.3　指标定义
超重/肥胖：BMI≥24 kg/m2[19]。HUA：男性血清尿酸水平>420 μmol/L，女性血清尿酸水平>360 μmol/L[20]。血脂异常：总胆固醇≥6.2 mmol/L，或甘油三酯≥2.3 mmol/L，或高密度脂蛋白<1.0 mmol/L，或低密度脂蛋白≥4.1 mmol/L[21]。
1.4　统计学分析
对定量资料，若是正态分布一般统计描述采用，组间比较采用两独立样本t检验；若是非正态分布则使用M(P25，P75)进行统计描述，组间比较采用两独立样本秩和检验。对定性资料，使用百分比进行一般统计描述，采用χ2检验分析组间差异。研究变量与结局变量之间的关联采用二元logistic回归。相加交互作用采用聂志强等编写的SAS宏程序[22]，相加交互判断定律[23]：若AB两因素存在相加交互作用，则交互作用超额相对危险度(relative excess risk of interaction, RERI)和交互作用归因比(attributable proportion of interaction, API)的95%置信区间不含0，且协同指数(synergy index, SI) 95%置信区间不含1。若SI>1，提示AB两因素可能存在协同作用；若SI<1，则提示可能存在拮抗作用。采用SAS 9.3软件进行数据管理和分析，检验水准α=0.05。
2　结果
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2.1　基本情况
本研究共纳入38 615名研究对象，包括31 395名(81.30%)男性和7 220名(18.70%)女性，年龄中位数为41岁，其中HUA患者7 059例(18.28%)，超重/肥胖22 308例(57.77%)，血脂异常13 239例(34.28%)，非HUA者和HUA患者超重/肥胖、血脂异常分布差异均有统计学意义(P<0.05)，见表1。
2.2　超重/肥胖、血脂异常与HUA的关联分析
为了探索超重/肥胖、血脂异常与HUA的关联，以HUA的存在为二元结局进行logistic回归分析，结果显示，超重/肥胖、血脂异常均是HUA患病的危险因素(均P<0.001)；在完全调整模型中(调整性别、年龄、吸烟、饮酒、空腹血糖、收缩压、舒张压、肌酐)，这种关联依旧显著，超重/肥胖人群比非超重/肥胖者患HUA的风险高2.756倍，而血脂异常患者比血脂正常者发生HUA的风险高2.221倍(均有P<0.05)，见表2。
2.3　超重/肥胖与血脂异常对HUA的交互作用
将是否患HUA作为因变量，以BMI正常且血脂正常组为参照，将超重/肥胖与血脂异常转化成虚拟变量纳入模型分析二者对HUA的交互作用，结果显示在完全调整模型中，以BMI正常且血脂正常者作为参照，超重/肥胖单独存在时发生HUA的风险是其2.823倍，血脂异常单独存在时发生HUA的风险是其2.616倍，超重/肥胖和血脂异常同时存在时患HUA的风险是其4.840倍(均P<0.001)。相加交互作用结果显示，超重/肥胖与血脂异常对HUA患病存在协同相加交互作用，完全调整混杂变量后，RERI为0.400(95%CI: 0.044~0.756)，表示超重/肥胖与血脂异常相加交互作用和其单独作用之和的差值为0.400；API是0.083(95%CI: 0.011~0.155)，表示超重/肥胖与血脂异常同时存在的情况下，HUA患病风险8.3%是由于两者的交互效应造成的，SI值是1.116(95%CI: 1.010~1.235)，即超重/肥胖与血脂异常同时存在的风险比二者独立风险总和大1.116倍。见表3、4。
3　讨论
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在这项横断面分析中，我们发现超重/肥胖和血脂异常对HUA患病风险存在正向的相加交互作用，这意味着超重/肥胖和血脂异常是HUA的协同危险因素，这两个因素结合起来的风险大于独立风险的总和。
我们目前的研究发现，调整性别、年龄、吸烟、饮酒、空腹血糖、收缩压、舒张压和血清肌酐后，超重/肥胖与HUA之间呈显著的正相关。这与吴子瑜等人[24]的研究结果相似，该研究发现超重/肥胖与HUA高患病风险独立相关。王雪洁[25]同样发现HUA与高脂血症、体重指数相关。肥胖可能由以下机制导致HUA：肥胖加速磷酸核糖焦磷酸的合成，进一步增加尿酸的生成[26]；大量脂肪分解引起的酸性代谢产物的累积抑制了尿酸的排泄[11,27]；脂肪组织分泌的瘦素、脂联素等多种脂肪因子，可使得尿酸排泄减少或生成增加[28]；肥胖损伤胰岛素受体系统，进一步促进尿酸重吸收，产生HUA[11,29]。此外，减肥饮食也有助于降低尿酸浓度[30]。
脂代谢与HUA关系密切。一项针对中国多民族队列(CMEC)中30至79岁的16 092名参与者的研究发现，侗族、苗族和布依族成年人的高尿酸水平与血脂异常有关[31]。在本研究中同样发现血脂异常是HUA的独立危险因素。此外，在孟加拉国成人和美国青少年中也观察到血清尿酸水平和血清低密度脂蛋白、总胆固醇和甘油三酯水平呈正相关，而与高密度脂蛋白水平呈负相关[32-33]；伊朗人群的研究结果显示，血脂谱与尿酸水平有关，尤其是甘油三酯的相关性最高[34]。一项针对中国老年人6年的随访研究表明，高水平的甘油三酯和低水平的高密度脂蛋白增加了该前瞻性队列的高尿酸血症发生率[35]。HUA的发病机制可能与脂代谢紊乱有关。临床上认为，炎症因子参与了HUA的发生发展过程，而高密度脂蛋白对促炎细胞因子介导的炎性反应具有负向调节作用，当高密度脂蛋白水平降低时，可能会加重炎症反应[36-37]。此外，还有研究认为脂肪代谢过程中产生的酮体会抑制血清尿酸的排泄，从而增加血尿酸水平[11]。
许多研究报道，超重/肥胖不仅是HUA的诱发因素，也是影响血脂异常的重要因素[38-39]。一项针对湖南省60岁以上老年人的研究中，BMI是血脂异常的最强预测指标[40]。许多研究表明，肥胖是血脂异常的危险因素[41-42]。因此超重/肥胖、血脂异常和HUA三者互有关联。在这里，我们发现了即超重/肥胖、血脂异常和HUA之间存在协同相加交互作用，即超重/肥胖、血脂异常两种暴露因素同时存在对HUA事件的风险大于两种因素单独暴露的风险及其总和，该协同相加交互风险是两者单独产生风险之和的1.116倍，二者协同交互作用所导致的罹患HUA的风险与二者单独作用之和的差值为0.400，全部HUA患者中8.3%的病例归因于该协同作用。未来需要进一步研究这些因素之间的相互作用机制。因此，建议临床医生在对HUA患者进行常规药物治疗的同时，应关注改善患者超重/肥胖，积极干预血脂水平。
我们的研究优势在于以下几个方面。首先以前的研究表明，超重/肥胖、血脂异常是HUA的独立危险因素，但很少有研究表明它们与HUA之间存在相互作用。在这里，我们发现超重/肥胖、血脂异常对HUA的协同作用。第二，本研究的样本量较大，能在一定程度上真实反映数据的准确性，更具有说服力。
这项研究存在一些潜在的局限性。首先这是一项横断面调查，准确性和泛化性较差，因此我们无法确定因果关系或排除双向关系。其次，虽然本研究在分析过程中调整了混杂因素，但作为观察性研究，可能存在潜在的残余混杂因素。在目前的研究中，我们没有考虑药物和饮食。最后，样本来自是西山煤电集团工人，不一定能较好的代表全人群，外推性受限。
综上所述，超重/肥胖、血脂异常均增加对HUA患病风险，且二者对HUA患病存在协同相加交互作用。提示对于HUA的防治，除积极有效地控制原发性疾病外，还应着力改善患者的超重/肥胖和血脂异常状态。
基金
收起
  • 广东省公共卫生检测与评价工程技术研究中心(2019GCZX012)
  • 广州市基础与应用基础研究项目一般项目(202201010545)
  • 广东省医学科学技术研究基金项目(A2020112)
  • 中山市社会公益与基础研究项目(2020SYF13)
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2024年第51卷第12期
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doi: 10.20043/j.cnki.MPM.202308484
  • 接收时间：2023-08-30
  • 首发时间：2026-03-17
  • 出版时间：2024-06-25
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  • 收稿日期：2023-08-30
基金
广东省公共卫生检测与评价工程技术研究中心(2019GCZX012)
广州市基础与应用基础研究项目一般项目(202201010545)
广东省医学科学技术研究基金项目(A2020112)
中山市社会公益与基础研究项目(2020SYF13)
作者信息
    1.广东药科大学公共卫生学院，广东 广州 510310
    2.山西省太原市西山煤电集团职业病防治所

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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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