Article(id=1240977216838890261, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240977214964036360, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202412476, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1735228800000, receivedDateStr=2024-12-27, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773801624735, onlineDateStr=2026-03-18, pubDate=1748102400000, pubDateStr=2025-05-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773801624735, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773801624735, creator=13701087609, updateTime=1773801624735, updator=13701087609, issue=Issue{id=1240977214964036360, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='10', pageStart='1729', pageEnd='1920', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773801624289, creator=13701087609, updateTime=1773825591019, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241077738770068227, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240977214964036360, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241077738770068228, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240977214964036360, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1915, endPage=1920, ext={EN=ArticleExt(id=1240977217207989023, articleId=1240977216838890261, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Relationship between the ratio of serum uric acid to high-density lipoprotein cholesterol and abdominal aortic calcification, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the association between UHR and abdominal aortic calcification (AAC) in people aged≥40.

Methods

We used data from the 2013—2014 National Health and Nutrition Examination Survey (NHANES), including a total of 3 008 participants. Multiple logistic regression, subgroup analysis and restricted cubic spline (RCS) analysis were used to explore the correlation between UHR and AAC prevalence.

Results

UHR was positively associated with AAC risk in all participants. Compared with the lowest UHR quartile, the highest quartile had a 134.6% increased risk of AAC (OR=2.346, 95%CI: 1.594-3.453). Interaction analysis showed that there was no significant interaction between UHR grouping and gender or age. Gender stratification showed a 213.6% increase in AAC in the Q4 group of females compared with the Q1 group (OR=3.136, 95%CI: 1.884-5.221), while no statistical significance was achieved in males (P=0.113). Age stratification revealed that for those over 60 years old, the risk of AAC in the Q2, Q3, and Q4 groups increased by 118.6% (OR=2.186, 95%CI: 1.140-4.191), 147.4% (OR=2.474, 95%CI: 1.464-4.181), and 347.8% (OR=4.478, 95%CI: 2.580-7.773) compared with the Q1 group, respectively, while in the 40-60 years old group, it did not reach statistical significance (P=0.338). RCS analysis showed that there was a nonlinear relationship between UHR and AAC.

Conclusion

s UHR is an independent risk factor for AAC, and the higher level of UHR, the higher risk of AAC. The association between UHR and AAC is more significant in females and people over 60 years old.

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目的

本研究的目的是研究年龄≥40岁人群中血清尿酸与高密度脂蛋白胆固醇比值(UHR)与腹主动脉钙化(AAC)之间的关联。

方法

使用美国全国健康和营养调查(NHANES)2013—2014年的数据,共纳入3 008名参与者。采用多元逻辑回归、亚组分析、限制性立方样条图(RCS)分析探索UHR与AAC之间的相关性。

结果

在所有参与者中,UHR与AAC风险呈正相关。与UHR最低四分位数相比,最高四分位AAC风险增加了134.6%(OR=2.346,95% CI:1.594~3.453)。相互作用分析显示,UHR分组与性别和年龄无显著交互作用。性别分层显示,女性Q4组AAC风险比Q1组AAC风险增加了213.6%(OR=3.136, 95% CI:1.884~5.221),而男性中差异不具有统计学意义(P=0.113)。年龄分层显示,>60岁Q2、Q3、Q4组AAC风险比Q1组分别增加了118.6%(OR=2.186, 95% CI:1.140~4.191)、147.4%(OR=2.474, 95% CI:1.464~4.181)、347.8%(OR=4.478, 95% CI:2.580~7.773),而40~60岁中差异不具有统计学意义(P=0.338)。RCS分析中显示,UHR与AAC风险呈非线性关系。

结论

UHR是AAC的独立危险因素,UHR水平越高,AAC风险越高。在女性、>60岁人群中UHR与AAC的关联更为显著。

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陈晓甜,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=0e7njqxtcFi/Yb4fD4XgSQ==, magXml=WEDrdqmZSHA5cO35fzlDfA==, pdfUrl=null, pdf=wty4I5fkJQSvbDHghYsREA==, pdfFileSize=737019, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=+CbfhW1nRup4a7lRwIaYSg==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=plG/khynttPtACdY0Q5SBg==, mapNumber=null, authorCompany=null, fund=null, authors=

王真(1996—),女,硕士,住院医师,研究方向:动脉硬化与动脉瘤

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注:图中的阴影部分表示95%CI,展示UHR与AAC风险关系的不确定性范围。图中黑点代表拐点(UHR=15)。

, figureFileSmall=f2o8dBl/ZEyA8HWTTD33Mw==, figureFileBig=RJNcA44yPsqw+1+e0A4naw==, tableContent=null), ArticleFig(id=1240996911830847844, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977216838890261, language=EN, label=Table 1, caption=

Weighted characteristics of the study population

, figureFileSmall=null, figureFileBig=null, tableContent=
特征非AAC(n=2 100)AAC(n=908)χ2/tP
性别(%)0.060.814
男性48.2048.77
女性51.8051.23
年龄(岁)54.85±10.4063.70±11.8210.98<0.001
种族(%)3.840.020
墨西哥裔7.874.83
其他拉美裔4.953.68
非拉美裔白人69.3576.76
非拉美裔黑人10.617.63
其他种族7.237.09
教育程度(%)5.800.008
高中以下14.7516.36
高中19.9726.40
高中以上65.2857.23
婚姻状况(%)30.72<0.001
已婚/同居71.4763.17
单身28.5336.83
BMI(kg/m228.84±5.7527.81±4.75-5.55<0.001
糖尿病(%)8.870.001
11.5016.51
85.2678.98
临界3.244.51
高血压(%)53.11<0.001
38.2058.59
61.8041.41
sUA(mg/L)53.52±13.4955.58±14.333.310.005
HDL-C(mg/L)553.68±178.73530.76±154.01-3.150.007
UHR10.84±4.8711.54±4.893.890.002
磷(mg/L)37.94±5.6338.07±5.670.490.634
钙(mg/L)94.40±3.5794.85±3.561.600.132
eGFR(mL/(min·1.73 m2))86.67±17.7578.03±20.19-8.19<0.001
), ArticleFig(id=1240996911956676981, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977216838890261, language=CN, label=表1, caption=

研究人群加权基线特征

, figureFileSmall=null, figureFileBig=null, tableContent=
特征非AAC(n=2 100)AAC(n=908)χ2/tP
性别(%)0.060.814
男性48.2048.77
女性51.8051.23
年龄(岁)54.85±10.4063.70±11.8210.98<0.001
种族(%)3.840.020
墨西哥裔7.874.83
其他拉美裔4.953.68
非拉美裔白人69.3576.76
非拉美裔黑人10.617.63
其他种族7.237.09
教育程度(%)5.800.008
高中以下14.7516.36
高中19.9726.40
高中以上65.2857.23
婚姻状况(%)30.72<0.001
已婚/同居71.4763.17
单身28.5336.83
BMI(kg/m228.84±5.7527.81±4.75-5.55<0.001
糖尿病(%)8.870.001
11.5016.51
85.2678.98
临界3.244.51
高血压(%)53.11<0.001
38.2058.59
61.8041.41
sUA(mg/L)53.52±13.4955.58±14.333.310.005
HDL-C(mg/L)553.68±178.73530.76±154.01-3.150.007
UHR10.84±4.8711.54±4.893.890.002
磷(mg/L)37.94±5.6338.07±5.670.490.634
钙(mg/L)94.40±3.5794.85±3.561.600.132
eGFR(mL/(min·1.73 m2))86.67±17.7578.03±20.19-8.19<0.001
), ArticleFig(id=1240996912048951676, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977216838890261, language=EN, label=Table 2, caption=

Association between UHR and AAC

, figureFileSmall=null, figureFileBig=null, tableContent=
UHROR值(95%CI)
模型1模型2模型3
连续变量1.029(1.015, 1.044)1.032(1.014, 1.051)1.047(1.026, 1.069)
Q1参考参考参考
Q21.206(0.853, 1.705)1.284(0.851, 1.938)1.475(0.938, 2.320)
Q31.222(0.849, 1.761)1.312(0.911, 1.892)1.539(1.097, 2.160)
Q41.630(1.259, 2.111)1.769(1.292, 2.422)2.346(1.594, 3.453)
P趋势0.0010.0020.016
), ArticleFig(id=1240996912166392201, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977216838890261, language=CN, label=表2, caption=

UHR与AAC之间的关系

, figureFileSmall=null, figureFileBig=null, tableContent=
UHROR值(95%CI)
模型1模型2模型3
连续变量1.029(1.015, 1.044)1.032(1.014, 1.051)1.047(1.026, 1.069)
Q1参考参考参考
Q21.206(0.853, 1.705)1.284(0.851, 1.938)1.475(0.938, 2.320)
Q31.222(0.849, 1.761)1.312(0.911, 1.892)1.539(1.097, 2.160)
Q41.630(1.259, 2.111)1.769(1.292, 2.422)2.346(1.594, 3.453)
P趋势0.0010.0020.016
), ArticleFig(id=1240996912254472596, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977216838890261, language=EN, label=Table 3, caption=

Subgroup analysis and interaction test of UHR and AAC

, figureFileSmall=null, figureFileBig=null, tableContent=
UHRQ1
OR值(95%CI)
Q2
OR值(95%CI)
Q3
OR值(95%CI)
Q4
OR值(95%CI)
P趋势P相互
性别0.147
男性参考0.975(0.523, 1.815)0.892(0.431, 1.847)1.447(0.905, 2.314)0.113
女性参考1.532(0.900, 2.607)1.747(1.179, 2.588)3.136(1.884, 5.221)0.011
年龄0.108
40~60参考1.001(0.550, 1.821)0.970(0.614, 1.533)1.276(0.778, 2.092)0.338
>60参考2.186(1.140, 4.191)2.474(1.464, 4.181)4.478(2.580, 7.773)0.012
), ArticleFig(id=1240996912367718812, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977216838890261, language=CN, label=表3, caption=

UHR与AAC的亚组分析及相互作用检验

, figureFileSmall=null, figureFileBig=null, tableContent=
UHRQ1
OR值(95%CI)
Q2
OR值(95%CI)
Q3
OR值(95%CI)
Q4
OR值(95%CI)
P趋势P相互
性别0.147
男性参考0.975(0.523, 1.815)0.892(0.431, 1.847)1.447(0.905, 2.314)0.113
女性参考1.532(0.900, 2.607)1.747(1.179, 2.588)3.136(1.884, 5.221)0.011
年龄0.108
40~60参考1.001(0.550, 1.821)0.970(0.614, 1.533)1.276(0.778, 2.092)0.338
>60参考2.186(1.140, 4.191)2.474(1.464, 4.181)4.478(2.580, 7.773)0.012
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血清尿酸与高密度脂蛋白胆固醇比值与腹主动脉钙化的关系
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王真 1 , 王小倩 1 , 张灵维 2 , 陈晓甜 1
现代预防医学 | 临床与预防 2025,52(10): 1915-1920
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现代预防医学 | 临床与预防 2025, 52(10): 1915-1920
血清尿酸与高密度脂蛋白胆固醇比值与腹主动脉钙化的关系
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王真1, 王小倩1, 张灵维2, 陈晓甜1
作者信息
  • 1.南京大学医学院附属鼓楼医院 临床营养科,江苏 南京 210000
  • 2.南京航空航天大学 信息化处
  • 王真(1996—),女,硕士,住院医师,研究方向:动脉硬化与动脉瘤

通讯作者:

陈晓甜,E-mail:
Relationship between the ratio of serum uric acid to high-density lipoprotein cholesterol and abdominal aortic calcification
Zhen WANG1, Xiao-qian WANG1, Ling-wei ZHANG2, Xiao-tian CHEN1
Affiliations
  • Department of Clinic Nutrition, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210000, China
出版时间: 2025-05-25 doi: 10.20043/j.cnki.MPM.202412476
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目的

本研究的目的是研究年龄≥40岁人群中血清尿酸与高密度脂蛋白胆固醇比值(UHR)与腹主动脉钙化(AAC)之间的关联。

方法

使用美国全国健康和营养调查(NHANES)2013—2014年的数据,共纳入3 008名参与者。采用多元逻辑回归、亚组分析、限制性立方样条图(RCS)分析探索UHR与AAC之间的相关性。

结果

在所有参与者中,UHR与AAC风险呈正相关。与UHR最低四分位数相比,最高四分位AAC风险增加了134.6%(OR=2.346,95% CI:1.594~3.453)。相互作用分析显示,UHR分组与性别和年龄无显著交互作用。性别分层显示,女性Q4组AAC风险比Q1组AAC风险增加了213.6%(OR=3.136, 95% CI:1.884~5.221),而男性中差异不具有统计学意义(P=0.113)。年龄分层显示,>60岁Q2、Q3、Q4组AAC风险比Q1组分别增加了118.6%(OR=2.186, 95% CI:1.140~4.191)、147.4%(OR=2.474, 95% CI:1.464~4.181)、347.8%(OR=4.478, 95% CI:2.580~7.773),而40~60岁中差异不具有统计学意义(P=0.338)。RCS分析中显示,UHR与AAC风险呈非线性关系。

结论

UHR是AAC的独立危险因素,UHR水平越高,AAC风险越高。在女性、>60岁人群中UHR与AAC的关联更为显著。

AAC  /  UHR  /  NHANES  /  横断面研究
Objective

To investigate the association between UHR and abdominal aortic calcification (AAC) in people aged≥40.

Methods

We used data from the 2013—2014 National Health and Nutrition Examination Survey (NHANES), including a total of 3 008 participants. Multiple logistic regression, subgroup analysis and restricted cubic spline (RCS) analysis were used to explore the correlation between UHR and AAC prevalence.

Results

UHR was positively associated with AAC risk in all participants. Compared with the lowest UHR quartile, the highest quartile had a 134.6% increased risk of AAC (OR=2.346, 95%CI: 1.594-3.453). Interaction analysis showed that there was no significant interaction between UHR grouping and gender or age. Gender stratification showed a 213.6% increase in AAC in the Q4 group of females compared with the Q1 group (OR=3.136, 95%CI: 1.884-5.221), while no statistical significance was achieved in males (P=0.113). Age stratification revealed that for those over 60 years old, the risk of AAC in the Q2, Q3, and Q4 groups increased by 118.6% (OR=2.186, 95%CI: 1.140-4.191), 147.4% (OR=2.474, 95%CI: 1.464-4.181), and 347.8% (OR=4.478, 95%CI: 2.580-7.773) compared with the Q1 group, respectively, while in the 40-60 years old group, it did not reach statistical significance (P=0.338). RCS analysis showed that there was a nonlinear relationship between UHR and AAC.

Conclusion

s UHR is an independent risk factor for AAC, and the higher level of UHR, the higher risk of AAC. The association between UHR and AAC is more significant in females and people over 60 years old.

AAC  /  UHR  /  NHANES  /  Cross-sectional study
王真, 王小倩, 张灵维, 陈晓甜. 血清尿酸与高密度脂蛋白胆固醇比值与腹主动脉钙化的关系. 现代预防医学, 2025 , 52 (10) : 1915 -1920 . DOI: 10.20043/j.cnki.MPM.202412476
Zhen WANG, Xiao-qian WANG, Ling-wei ZHANG, Xiao-tian CHEN. Relationship between the ratio of serum uric acid to high-density lipoprotein cholesterol and abdominal aortic calcification[J]. Modern Preventive Medicine, 2025 , 52 (10) : 1915 -1920 . DOI: 10.20043/j.cnki.MPM.202412476
腹主动脉钙化(Abdominal Aortic Calcification , AAC)是指在腹主动脉壁内发生钙和磷酸盐等矿物质的异常沉积,是一种常见的血管疾病[1]。研究发现,随着年龄的增长,AAC的发病率和严重程度都有逐渐增加的趋势,目前已知与AAC发病率密切相关的因素包括年龄、糖尿病、高血压等[2]。AAC的存在与冠心病、心肌梗死、心力衰竭和中风的风险增加有关,是心血管疾病死亡和全因死亡的独立预测因子[3]。因此,寻找一个有效、经济、快速的标志物尽早识别AAC尤为重要。
血管钙化是一个复杂的动态过程,它的机制与炎性反应、钙磷代谢紊乱、氧化应激等相关[4]。研究发现,尿酸(serum Uric Acid , sUA)可以通过促进血管平滑肌细胞钙化、诱发炎症反应、增加氧化应激、损害血管内皮功能等机制促进动脉粥样硬化的形成[5]。高密度脂蛋白胆固醇(High-Density Lipoprotein Cholesterol , HDL-C)是一种具有极佳抗炎和抗氧化作用的血浆脂蛋白,可以将胆固醇从肝外组织转运到肝内代谢,能够降低动脉粥样硬化和心脑血管疾病的风险[6]。血清尿酸与高密度脂蛋白胆固醇比值(serum Uric Acid-to-High-Density Lipoprotein Cholesterol Ratio , UHR)是新型的炎症与代谢指标。有研究表明,UHR升高与多种慢性疾病的风险增加密切相关,包括非酒精性脂肪肝、缺血性心肌病、动脉粥样硬化性心血管疾病、自身免疫性甲状腺疾病[7]。但目前尚无关于UHR与AAC的关系研究。
本研究分析的数据来自美国全国健康和营养调查(National Health and Nutrition Examination Survey,NHANES),NHANES是一项基于人群的横断面调查,包含了通过问卷调查、定期体检和实验室检测收集的人口统计、营养和医疗信息。本研究收集NHANES 数据库2013—2014年研究对象共10 175人,排除年龄小于40岁6 360人,排除缺失AAC数据675人,排除缺失sUA和HDL-C数据124人,排除缺少关于婚姻状况、教育状况、高血压、糖尿病共8人,最终共3 008名参与者被纳入本研究。研究对象流程图见图1。本研究经国家卫生统计中心伦理审查委员会批准。每位参与者均提供了知情书面许可。
本研究中,参与者在早晨空腹状态下抽取血液样本,以测量sUA和HDL-C。通过公式(1)计算得出sUA与HDL-C比值(UHR,%)[8-9]
根据总人数,按UHR从小到大进行四分位分类,第1四分位组UHR≤7.576,第2四分位组7.576<UHR≤10.408,第3四分位组10.408<UHR≤13.846,第4四分位组UHR>13.846。
Kauppila AAC评分数据来源于双能x线吸收测定法对腰椎侧位的扫描。这一评分是评估AAC严重程度的指标,得分越高表示钙化程度越明显。该评分方法将腹主动脉的前壁和后壁划分为与腰椎区域L1至L4相对应的节段,使用0~3分的评分来量化八个节段的钙化程度。总的AAC得分范围是0到24分,当总AAC评分超过0时,即认为存在AAC。这一阈值在先前的研究中被广泛用来评估腹主动脉的钙化[10-11]
参考之前研究,本研究纳入一些潜在的协变量,包括人口统计信息(年龄、性别、种族)、社会经济状况(婚姻状况、教育水平)、体质指数(Body Mass Index, BMI)、健康状况(高血压、糖尿病)、骨代谢标志物(血清钙、磷)、估计肾小球滤过率(estimated Glomerular Filtration Rate, eGFR)[12-13]。使用慢性肾脏病流行病学合作研究方程估计eGFR,其中考虑了年龄、性别、种族和肌酐水平[14]。糖尿病和高血压的诊断基于个人自我报告的健康记录。
根据疾病控制和预防中心的指导方针,所有统计分析均采用适当的 NHANES 抽样权重进行,以解决多阶段整群调查设计中固有的复杂性。这种方法确保了对更广泛人群的准确代表。分类变量缺失较少,直接删除缺失值;使用“mice”包进行多重插补,采用预测均值匹配(Predictive Mean Matching, PMM)方法来处理协变量中连续变量的缺失。描述统计中,连续数据以加权平均值±标准差(Standard Deviation,SD)表示,分类变量以加权百分比表示。连续变量采用t检验,分类变量采用卡方检验。按照四分位数将UHR转化为四分位数,使用加权Logistics回归探究UHR与AAC之间的关系,通过调整协变量,进行三次分析,计算趋势P值;在模型中使用比值比(Odds Ratio, OR)和95%置信区间(Confidence Interval, CI)评估UHR和AAC关联。根据性别、年龄分组进行亚组分析,并做交互作用检验。最后,使用限制性立方样条图(Restricted Cubic Spline, RCS)探讨了UHR与AAC之间潜在的非线性关系。所有统计分析使用R 4.2.0软件进行,检验水准α=0.05。
根据患者是否有AAC进行分组,人群加权基线特征如表1所示。本研究共纳入3 008名40岁及以上参与者。与无AAC参与者相比,有AAC的参与者年纪更大、非西班牙裔白人的比例更高、教育水平更低、婚姻状态更不稳定(P<0.05)。有AAC的参与者患有糖尿病、高血压的比例更大,sUA、UHR更高,HDL-C、eGFR更低(P<0.05)。性别、血清磷、钙在有无AAC参与者中无统计学差异(P>0.05)。
表2显示了UHR作为连续变量和分类变量与AAC之间的关系。当UHR为连续变量时,UHR每增加一个单位,AAC的风险就升高4.7%(模型3:OR=1.047,95%CI:1.026~1.069,P<0.05)。当UHR为分类变量时,在未调整任何变量的模型1中,与Q1组相比,Q4组AAC的风险明显增加(OR=1.630, 95% CI:1.259~2.111)。在调整全部变量的模型3中,Q4组AAC风险比Q1组AAC风险增加了134.6%(模型3:OR=2.346,95% CI:1.594~3.453)。目前的结果表明,较高的UHR与AAC的风险增加有关,AAC风险随着UHR等级增加而增加(P趋势=0.016)。
性别差异在尿酸代谢、血脂代谢、心血管疾病风险及临床预防措施采纳方面显著影响健康结局;而年龄是腹主动脉钙化的强相关因素,老年人的血管病理机制可能更为复杂。因此本研究根据性别、年龄进行亚组分析,以检验UHR与AAC之间的关系。该分析调整了所有协变量,结果显示在女性、>60岁参与者中,UHR与AAC的关系仍然显著。性别分层显示,女性Q4组AAC风险比Q1组AAC风险增加了213.6%(OR=3.136, 95%CI:1.884~5.221),而男性中差异不具有统计学意义(P=0.113)。年龄分层显示,>60岁Q2、Q3、Q4组AAC风险比Q1组分别增加了118.6%(OR=2.186, 95% CI:1.140~4.191)、147.4%(OR=2.474, 95% CI:1.464~4.181)、347.8%(OR=4.478, 95% CI:2.580~7.773),而40~60岁中差异不具有统计学意义(P=0.338)。相互作用分析显示,性别和年龄并不显著影响UHR水平与结果之间关联的强度和方向(P>0.05)。
图2,在调整了所有协变量之后,RCS分析显示了UHR与AAC之间显著的非线性关系(P-non-linearity=0.002)。进一步计算得出拐点为15,UHR<15,UHR每增加一个单位,AAC风险增加7.1%(OR:1.071,95% CI:1.022~1.123);UHR>15时,未观察到UHR与AAC风险有显著相关性(OR:0.971,95% CI:0.887~1.062)。
本研究基于NHANES数据库2013—2014年的数据,探索了美国≥40岁人群中AAC风险与UHR之间的关联。本研究结果表明,UHR值升高与AAC风险增加显著相关。值得关注的是,亚组分析中统计学显著关系只存在于女性参与者和>60岁的参与者中,而不存在于男性和40~60岁参与者中。总之,这一发现为UHR作为一种在AAC风险评估中的新的炎症和代谢指标提供了证据,具有潜在临床价值。
AAC风险与sUA之间的关联已在文献中得到广泛认可。2020年一项纳入5 920名>45岁参与者的横断面研究显示,sUA是AAC存在的独立预测因素[15]。此后的研究也进一步证实了sUA 水平升高与AAC风险升高有关[16]。低HDL-C是一种常见的脂质紊乱类型,流行病学研究表明HDL-C与动脉硬化呈负相关,HDL-C具有抗动脉硬化的功能[17]。关于HDL-C抗动脉粥样硬化功能最广泛的研究是胆固醇逆向转运,这一过程有助于减少血管壁内脂质沉积,从而降低动脉粥样硬化的风险;此外,炎症反应和氧化应激也是动脉钙化的关键因素,HDL-C能够防止细胞氧化应激,减少炎症反应[18]。最近,血清尿酸与高密度脂蛋白胆固醇比值UHR被认为是一种新的更敏感的炎症和代谢指标。邱文辉等发现了UHR是新发动脉粥样硬化性心血管疾病的危险因素,尤其是在女性和中老年群体中[7]。鉴于AAC和动脉粥样硬化性心血管疾病密切相关,两者均涉及血管壁的病理改变,且与心血管事件风险增加相关[19],推测UHR增加,也会导致AAC风险增加。目前尚无关于UHR与AAC风险相关的文献研究。本文在这项针对美国40岁及以上的大规模人群研究中,证实了UHR与AAC的正相关关系。UHR升高可作为AAC风险的独立危险因素,因此UHR有望成为AAC风险的评估指标。我们的研究可能对AAC的预防和治疗提供新思路。
此外,本文还对不同性别与年龄段进行了亚组分析,以探讨这些因素对研究结果的影响。数据结果表明,UHR与女性参与者的AAC风险相关,与男性参与者无关。在其他涉及sUA和AAC的研究中也发现了类似的结果。Yan W等人在一项针对中国成年人的大规模研究中,通过横断面研究评估了性别特异性sUA水平与AAC之间的相关性[15]。他们证实了sUA与AAC正相关关系只在女性群体中显著。然而另一项横断面研究显示sUA与AAC在男性、女性中均无显著相关[20]。该结果潜在的原因可能是激素的差异,受雌激素的影响,女性的UA和HDL-C水平一般较低[21]。然而女性一旦进入更年期,雌激素水平快速下降加剧了代谢性疾病和心血管疾病风险[22]。激素也在代谢、炎症反应、氧化应激等各种生理活动中起着至关重要的作用,这些过程与AAC的发展密切相关[4,23]。这能解释本研究中女性参与者UHR与AAC风险更相关。年龄分层显示在>60岁人群中,高UHR与AAC风险显著相关;然而在40~60岁人群中UHR与AAC差异不具有统计学意义。出现这一结果的原因尚不清晰,考虑可能的原因是AAC风险随着年龄的增长而增加,≤60岁人群患者AAC的比例相对较低,因此差异不具有统计学意义。
本研究发现,UHR与AAC呈非线性关系,拐点为15。这种关系的机制可能是sUA通过促进氧化应激和血管平滑肌细胞钙化驱动钙化进程,而HDL-C通过抗炎、胆固醇逆向转运来减少脂质沉积以起到保护作用[4-5]。当UHR<15时,HDL-C可能部分抵消sUA的负面影响,此时UHR的微小升高即可显著打破平衡,导致AAC风险快速上升。当UHR>15时,参与者可能伴随更严重的代谢紊乱,AAC的进展可能更多依赖于其他机制(如钙磷代谢异常等)导致UHR的独立贡献减弱[24]。此外,NHANES数据中UHR>15的样本量较小,仅占Q4组的一部分,可能导致统计效力不足,需更大规模验证。在临床中,当UHR<15时,通过控制sUA(如低嘌呤饮食、使用降尿酸药物)或提升HDL-C(如运动、他汀类药物)可能有效延缓AAC进展。而UHR>15的人群可能需要综合管理其他危险因素如血压、血糖等,这一发现为分层干预提供了理论依据。
本研究有以下几个优势。首先,据现有文献显示,这是首次探讨和建立UHR与AAC关系的研究,突显了本文的新颖性。其次,在临床中生化是常规检查,UHR是轻易可以获取的指标,具有广泛的实用性也可以降低成本。最后,本研究分析的样本量较大,具有全国代表性,并全面考虑了潜在的混杂因素,如性别、年龄、BMI、糖尿病、高血压等。但是本研究也存在一些局限性。首先,横断面研究虽然有助于进行初步的探索性分析和假设生成,但无法提供因果关系的确凿证据。其次,虽然本研究包含了BMI、糖尿病、高血压等协变量,但仍无法完全排除所有可能影响结果的潜在混杂因素。最后,sUA和HDL-C均为单次测量结果,容易受到饮食、药物等因素影响,不足以长期准确的反应UHR对AAC的影响。总之,本研究证明了UHR是AAC的独立危险因素,UHR水平越高,AAC风险越高。在女性、>60岁人群中UHR与AAC的关联更为显著。这些结果凸显了UHR作为识别AAC风险较高的个体的相关生物标记的潜力,并可能有助于AAC的早期检测和干预。
  • 南京市医疗保险研究会资助项目(NJYB2023JC017)
  • 南京鼓楼医院2023年度成果转化专项基金项目(No.11)
  • 南京鼓楼医院资助项目(2022-LCYJ-ZX-09)
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2025年第52卷第10期
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doi: 10.20043/j.cnki.MPM.202412476
  • 接收时间:2024-12-27
  • 首发时间:2026-03-18
  • 出版时间:2025-05-25
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  • 收稿日期:2024-12-27
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南京市医疗保险研究会资助项目(NJYB2023JC017)
南京鼓楼医院2023年度成果转化专项基金项目(No.11)
南京鼓楼医院资助项目(2022-LCYJ-ZX-09)
作者信息
    1.南京大学医学院附属鼓楼医院 临床营养科,江苏 南京 210000
    2.南京航空航天大学 信息化处

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2种不同金属材料的力学参数

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属数
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genus
种数
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species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
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
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
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
栓菌属 Trametes 5 2.39
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