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Article(id=1241102735098049533, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102730337505325, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202402275, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1709049600000, receivedDateStr=2024-02-28, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773831550620, onlineDateStr=2026-03-18, pubDate=1721836800000, pubDateStr=2024-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773831550620, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773831550620, creator=13701087609, updateTime=1773831550620, updator=13701087609, issue=Issue{id=1241102730337505325, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='14', pageStart='2497', pageEnd='2688', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773831549486, creator=13701087609, updateTime=1773831697291, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241103350322745680, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102730337505325, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241103350322745681, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102730337505325, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2507, endPage=2512, ext={EN=ArticleExt(id=1241102735433592854, articleId=1241102735098049533, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Correlation between Serum Uric acid to high-density lipoprotein cholesterol ratio and chronic kidney disease in middle-aged and elderly population in China, columnId=1228016567443718970, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods Advances, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the correlation between UHR and CKD in middle-aged and elderly population.

Methods

The data of this study was obtained from 2015 China Health and Retirement Longitudinal Survey(CHARLS).A total of 9 204 people≥45 years old were included.Multivariate Logistics regression analysis was used to analyze the correlation between UHR and CKD.The receiver operating characteristic(ROC)curves was used to analyze the predictive value of UHR for the risk of CKD.

Results

The subjects who we included have the mean age of 60.78±9.32 years with the prevalence of CKD of 3.97%.The odd rations for the highest quartile group (Q4 group)of UHR was increased for CKD(OR=12.01, 95%CI:7.50-20.00).ROC curve analysis showed that the area under the ROC Curve(AUC) for UHR predicting CKD for middle-aged and elderly population was 0.76(95%CI:0.73-0.78),the AUC for UHR predicting CKD for male group was 0.74(95%CI:0.70-0.77)and the AUC for UHR predicting CKD for female group was 0.77(95%CI:0.73-0.81).

Conclusion

There was a positive correlation between the increased UHR level and risk of CKD among the middle-aged and elderly population in China.UHR might serve as a risk factor and demonstrated good predictive value for CKD in the middle-aged and elderly population in China.

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目的

探究我国中老年血清尿酸/高密度脂蛋白胆固醇比值（UHR）与慢性肾脏病（CKD）之间的关系。

方法

采用中国健康与养老追踪调查（CHARLS）数据，选取9 204名45岁及以上受访者为研究对象。多因素logistics回归分析用于评估UHR与CKD关系。利用受试者工作特征（ROC）曲线评估UHR对CKD的预测价值。

结果

研究对象平均年龄60.78±9.32岁，CKD患病率为3.97%。与UHR最低四分位组（Q1组）相比，最高四分位组（Q4组）患CKD风险增加（OR=12.01，95%CI:7.50~20.00）。ROC曲线分析中，中老年UHR预测CKD的ROC曲线下面积（AUC）为0.76（95%CI：0.73~0.78），男性UHR预测CKD的AUC为0.74（95%CI：0.70~0.77），女性UHR预测CKD的AUC为0.77（95%CI：0.73~0.81）。

结论

我国中老年UHR与CKD存在独立相关关系，UHR可能是中老年CKD的危险因素且对CKD预测具有良好价值。

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李文源，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=tXXCmHkBS2F7NCdtL4b88A==, magXml=GH4TBxzS4/Z0OHKLl77Afw==, pdfUrl=null, pdf=SAvCGKSVz4zylsbaNRtNLg==, pdfFileSize=725176, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=xM7SzBgJ2RSRWK4d0P/aow==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=tUp/HjvRdex+puIa+oB1KQ==, mapNumber=null, authorCompany=null, fund=null, authors=

卢周裕（1998—），男，硕士在读，研究方向：健康管理、慢性病流行病学

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卢周裕（1998—），男，硕士在读，研究方向：健康管理、慢性病流行病学

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Arteriosclerosis, Thrombosis, and Vascular Biology, 2008, 28(11): 2071-2077., articleTitle=High-density lipoprotein reduces the human monocyte inflammatory response, refAbstract=null)], funds=[Fund(id=1241102744262603258, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735098049533, awardId=2020ZX09201-017, language=CN, fundingSource=国家科技重大专项(2020ZX09201-017), fundOrder=null, country=null), Fund(id=1241102744388432386, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735098049533, awardId=2019B020227004, language=CN, fundingSource=广东省重点领域研发计划项目(2019B020227004), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241102736847073417, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735098049533, xref=1., ext=[AuthorCompanyExt(id=1241102736855462026, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735098049533, companyId=1241102736847073417, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health，Southern Medical University，Guangzhou, Guangdong 510515，China), AuthorCompanyExt(id=1241102736868044940, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735098049533, companyId=1241102736847073417, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.南方医科大学公共卫生学院，广东 广州 510515)]), AuthorCompany(id=1241102737002262677, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735098049533, xref=2., ext=[AuthorCompanyExt(id=1241102737010651286, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735098049533, companyId=1241102737002262677, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.南方医科大学南方医院)]), AuthorCompany(id=1241102737111314590, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735098049533, xref=3., ext=[AuthorCompanyExt(id=1241102737119703200, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735098049533, companyId=1241102737111314590, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.南方医科大学卫生管理学院)])], figs=[ArticleFig(id=1241102741204955531, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735098049533, language=EN, label=Fig.1, caption=Dose-response relationship between UHR and the occurrence of CKD, figureFileSmall=2X7sigIeDBWIVsQd0cHWRQ==, figureFileBig=xM7SzBgJ2RSRWK4d0P/aow==, tableContent=null), ArticleFig(id=1241102741305618834, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735098049533, language=CN, label=图1, caption=UHR与CKD发生风险的剂量-反应关系, figureFileSmall=2X7sigIeDBWIVsQd0cHWRQ==, figureFileBig=xM7SzBgJ2RSRWK4d0P/aow==, tableContent=null), ArticleFig(id=1241102741561471395, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735098049533, language=EN, label=Fig.2, caption=ROC curve of UHR for the prediction of CKD, figureFileSmall=IRO2B2cgYV9XMObcu2eFzg==, figureFileBig=gbeAAM/DC48x1ioXhf07VQ==, tableContent=null), ArticleFig(id=1241102741645357482, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735098049533, language=CN, label=图2, caption=UHR预测CKD发生风险的ROC曲线, figureFileSmall=IRO2B2cgYV9XMObcu2eFzg==, figureFileBig=gbeAAM/DC48x1ioXhf07VQ==, tableContent=null), ArticleFig(id=1241102741754409394, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735098049533, language=EN, label=Table 1, caption=

Comparison of the basic situation of the subjects in the CKD group and the non-CKD group

, figureFileSmall=null, figureFileBig=null, tableContent=
组别CKD组非CKD组患病率（%）检验统计值P值
例数3658 8393.97
性别[例(%)]12.13a<0.001
男204(55.89)4 107(46.46)4.73
女161(44.11)4 732(53.54)3.29
年龄(岁)72.38±8.7660.39±9.0925.27<0.001
文化程度[例(%)]31.09a<0.001
小学以下188(51.51)3 553(40.20)5.29
小学96(26.30)2 157(24.40)4.26
中学及中专80(21.92)2 946(33.33)2.64
大专及以上1(0.27)183(2.07)0.54
婚姻状况[例(%)]76.03a<0.001
已婚269(73.70)7 784(88.06)3.34
离异2(0.55)63(0.71)3.07
丧偶92(25.21)933(10.56)8.97
未婚2(0.55)59(0.67)3.28
吸烟[例(%)]35.86a<0.001
吸烟104(28.49)2 424(27.42)4.11
戒烟96(26.30)1 355(15.33)6.61
从未吸烟165(45.21)5 060(57.25)3.16
饮酒[例(%)]41.86a<0.001
饮酒95(26.03)3 188(36.07)2.89
戒酒75(20.55)933(10.56)7.44
从不喝酒195(53.42)4 718(53.38)3.97
身体活动水平[例(%)]27.48a<0.001
低强度74(20.27)1 118(12.65)6.21
中强度58(15.89)1 033(11.69)5.32
高强度233(63.84)6 688(75.66)3.37
高血压史[例(%)]216(59.18)2 756(31.18)7.27124.40a<0.001
慢性肾脏病史[例(%)]72(19.73)578(6.54)11.1090.87a<0.001
血脂异常史[例(%)]81(22.19)1 352(15.30)5.6512.16a<0.001
糖尿病史[例(%)]60(16.44)803(9.08)6.9521.45a<0.001
降脂治疗用药史[例(%)]61(16.71)773(8.75)7.3126.04a<0.001
肾脏疾病用药史[例(%)]42(11.51)286(3.24)12.8067.39a<0.001
SUA(umol/l)384.79±98.50289.35±79.4918.27<0.001
HAB1C(%)6.14±0.955.98±0.983.030.003
SBP(mmHg)135.40±21.14128.34±19.536.27<0.001
DBP(mmHg)75.29±11.3875.88±11.36-0.970.333
WC(cm)87.05±14.1385.59±12.761.940.053
BMI(kg/m2)23.88±4.0023.98±3.67-0.480.631
CRP(mg/l)2.00(1.00, 3.90)1.30(0.70, 2.50)75.21b<0.001
TG(mmol/l)1.58±0.871.56±0.990.450.651
HDL-C(mmol/l)1.25±0.301.33±0.30-5.25<0.001
UHR(%)14.29±5.279.99±3.8915.40<0.001
), ArticleFig(id=1241102741880238521, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735098049533, language=CN, label=表1, caption=

CKD组与非CKD组研究对象基本情况比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别CKD组非CKD组患病率（%）检验统计值P值
例数3658 8393.97
性别[例(%)]12.13a<0.001
男204(55.89)4 107(46.46)4.73
女161(44.11)4 732(53.54)3.29
年龄(岁)72.38±8.7660.39±9.0925.27<0.001
文化程度[例(%)]31.09a<0.001
小学以下188(51.51)3 553(40.20)5.29
小学96(26.30)2 157(24.40)4.26
中学及中专80(21.92)2 946(33.33)2.64
大专及以上1(0.27)183(2.07)0.54
婚姻状况[例(%)]76.03a<0.001
已婚269(73.70)7 784(88.06)3.34
离异2(0.55)63(0.71)3.07
丧偶92(25.21)933(10.56)8.97
未婚2(0.55)59(0.67)3.28
吸烟[例(%)]35.86a<0.001
吸烟104(28.49)2 424(27.42)4.11
戒烟96(26.30)1 355(15.33)6.61
从未吸烟165(45.21)5 060(57.25)3.16
饮酒[例(%)]41.86a<0.001
饮酒95(26.03)3 188(36.07)2.89
戒酒75(20.55)933(10.56)7.44
从不喝酒195(53.42)4 718(53.38)3.97
身体活动水平[例(%)]27.48a<0.001
低强度74(20.27)1 118(12.65)6.21
中强度58(15.89)1 033(11.69)5.32
高强度233(63.84)6 688(75.66)3.37
高血压史[例(%)]216(59.18)2 756(31.18)7.27124.40a<0.001
慢性肾脏病史[例(%)]72(19.73)578(6.54)11.1090.87a<0.001
血脂异常史[例(%)]81(22.19)1 352(15.30)5.6512.16a<0.001
糖尿病史[例(%)]60(16.44)803(9.08)6.9521.45a<0.001
降脂治疗用药史[例(%)]61(16.71)773(8.75)7.3126.04a<0.001
肾脏疾病用药史[例(%)]42(11.51)286(3.24)12.8067.39a<0.001
SUA(umol/l)384.79±98.50289.35±79.4918.27<0.001
HAB1C(%)6.14±0.955.98±0.983.030.003
SBP(mmHg)135.40±21.14128.34±19.536.27<0.001
DBP(mmHg)75.29±11.3875.88±11.36-0.970.333
WC(cm)87.05±14.1385.59±12.761.940.053
BMI(kg/m2)23.88±4.0023.98±3.67-0.480.631
CRP(mg/l)2.00(1.00, 3.90)1.30(0.70, 2.50)75.21b<0.001
TG(mmol/l)1.58±0.871.56±0.990.450.651
HDL-C(mmol/l)1.25±0.301.33±0.30-5.25<0.001
UHR(%)14.29±5.279.99±3.8915.40<0.001
), ArticleFig(id=1241102741989290434, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735098049533, language=EN, label=Table 2, caption=

Comparison of CKD detection and related indicators of CKD with different UHR levels

, figureFileSmall=null, figureFileBig=null, tableContent=
变量Q1组Q2组Q3组Q4组检验统计值P值
CKD[例(%)]24(1.05)41(1.77)77(3.35)223(9.70)281.01a<0.001
年龄（岁）60.83±9.3360.34±9.1660.43±9.2661.52±9.487.75<0.001
高血压史[例(%)]510(22.33)639(27.53)797(34.67)1 026(44.61)293.27a<0.001
慢性肾病史[例(%)]160(7.01)149(6.42)143(6.22)198(8.61)12.34a0.006
血脂异常史[例(%)]215(9.41)287(12.37)395(17.18)536(23.30)193.20a<0.001
糖尿病史[例(%)]151(6.61)187(8.06)227(9.87)298(12.96)60.67a<0.001
eGFR(ml/min/1.73 m2)103.35±15.7399.20±16.3695.82±16.9787.97±20.39319.90<0.001
TG(mmol/l)1.10±0.551.35±0.761.67±0.952.13±1.24541.50<0.001
Cr(umol/l)66.00±18.3169.46±19.5470.98±20.5477.38±35.8485.97<0.001
BUN(mmol/l)5.52±1.625.51±1.545.47±1.575.70±1.888.63<0.001
HDL-C(mmol/l)1.60±0.311.37±0.211.25±0.201.09±0.181983.00<0.001
LDL-C(mmol/l)2.66±0.722.74±0.752.72±0.732.53±0.7636.12<0.001
TC(mmol/l)4.86±0.884.79±0.934.80±0.954.65±0.9921.31<0.001
FPG(mmol/l)5.40±1.645.48±1.565.67±1.765.78±1.6425.52<0.001
SUA(umol/l)223.33±54.09269.77±53.65306.66±56.87372.49±79.372374.00<0.001
CRP(mg/l)0.90 (0.50,1.80)1.10 (0.70,2.00)1.50 (0.80,2.60)2.00 (1.20,3.70)809.92b<0.001
HAB1C(%)5.91±1.005.93±0.916.03±1.026.09±1.0018.46<0.001
SBP(mmHg)126.58±19.54128.19±20.09129.06±19.64130.64±19.0617.14<0.001
DBP(mmHg)74.49±11.2375.58±11.1176.35±11.7376.99±11.2220.58<0.001
WC(cm)80.31±13.1283.88±12.3287.46±11.8390.92±11.46321.90<0.001
BMI(kg/m2)22.36±3.2923.45±3.3324.51±3.5725.57±3.73360.90<0.001
Cys C(umol/l)0.77±0.190.81±0.160.86±0.180.96±0.31299.40<0.001
), ArticleFig(id=1241102742136091082, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735098049533, language=CN, label=表2, caption=

不同UHR组别CKD检出情况和CKD相关指标比较

, figureFileSmall=null, figureFileBig=null, tableContent=
变量Q1组Q2组Q3组Q4组检验统计值P值
CKD[例(%)]24(1.05)41(1.77)77(3.35)223(9.70)281.01a<0.001
年龄（岁）60.83±9.3360.34±9.1660.43±9.2661.52±9.487.75<0.001
高血压史[例(%)]510(22.33)639(27.53)797(34.67)1 026(44.61)293.27a<0.001
慢性肾病史[例(%)]160(7.01)149(6.42)143(6.22)198(8.61)12.34a0.006
血脂异常史[例(%)]215(9.41)287(12.37)395(17.18)536(23.30)193.20a<0.001
糖尿病史[例(%)]151(6.61)187(8.06)227(9.87)298(12.96)60.67a<0.001
eGFR(ml/min/1.73 m2)103.35±15.7399.20±16.3695.82±16.9787.97±20.39319.90<0.001
TG(mmol/l)1.10±0.551.35±0.761.67±0.952.13±1.24541.50<0.001
Cr(umol/l)66.00±18.3169.46±19.5470.98±20.5477.38±35.8485.97<0.001
BUN(mmol/l)5.52±1.625.51±1.545.47±1.575.70±1.888.63<0.001
HDL-C(mmol/l)1.60±0.311.37±0.211.25±0.201.09±0.181983.00<0.001
LDL-C(mmol/l)2.66±0.722.74±0.752.72±0.732.53±0.7636.12<0.001
TC(mmol/l)4.86±0.884.79±0.934.80±0.954.65±0.9921.31<0.001
FPG(mmol/l)5.40±1.645.48±1.565.67±1.765.78±1.6425.52<0.001
SUA(umol/l)223.33±54.09269.77±53.65306.66±56.87372.49±79.372374.00<0.001
CRP(mg/l)0.90 (0.50,1.80)1.10 (0.70,2.00)1.50 (0.80,2.60)2.00 (1.20,3.70)809.92b<0.001
HAB1C(%)5.91±1.005.93±0.916.03±1.026.09±1.0018.46<0.001
SBP(mmHg)126.58±19.54128.19±20.09129.06±19.64130.64±19.0617.14<0.001
DBP(mmHg)74.49±11.2375.58±11.1176.35±11.7376.99±11.2220.58<0.001
WC(cm)80.31±13.1283.88±12.3287.46±11.8390.92±11.46321.90<0.001
BMI(kg/m2)22.36±3.2923.45±3.3324.51±3.5725.57±3.73360.90<0.001
Cys C(umol/l)0.77±0.190.81±0.160.86±0.180.96±0.31299.40<0.001
), ArticleFig(id=1241102742257725908, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735098049533, language=EN, label=Table 3, caption=

Results of correlation analysis between UHR and related indicators of CKD

, figureFileSmall=null, figureFileBig=null, tableContent=
项目r（rs）P值
eGFR-0.37<0.001
Cr0.31<0.001
Cys C0.37<0.001
TG0.36<0.001
BUN0.11<0.001
LDL-C-0.12<0.001
TC-0.13<0.001
FPG0.07<0.001
CRP0.16<0.001
HBA1C0.05<0.001
SBP0.08<0.001
DBP0.11<0.001
WC0.26<0.001
BMI0.25<0.001
), ArticleFig(id=1241102743763481055, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735098049533, language=CN, label=表3, caption=

UHR与CKD相关指标的相关性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
项目r（rs）P值
eGFR-0.37<0.001
Cr0.31<0.001
Cys C0.37<0.001
TG0.36<0.001
BUN0.11<0.001
LDL-C-0.12<0.001
TC-0.13<0.001
FPG0.07<0.001
CRP0.16<0.001
HBA1C0.05<0.001
SBP0.08<0.001
DBP0.11<0.001
WC0.26<0.001
BMI0.25<0.001
), ArticleFig(id=1241102744006750693, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735098049533, language=EN, label=Table 4, caption=

Multivariate logistic regression analysis of the association between UHR and CKD

, figureFileSmall=null, figureFileBig=null, tableContent=
组别模型1模型2模型3模型4
OR（95%CI）P值OR（95%CI）P值OR（95%CI）P值OR（95%CI）P值
UHR1.21（1.18, 1.24）<0.0011.20（1.17, 1.23）<0.0011.21（1.17, 1.23）<0.0011.21（1.17, 1.25）<0.001
Q11.00-1.00-1.00-1.00-
Q21.96（1.17, 3.34）0.0111.99（1.19, 3.41）0.0102.05（1.22, 3.51）0.0082.075（1.22, 3.09）0.008
Q33.86（2.43, 6.34）<0.0013.77（2.36, 6.24）<0.0014.00（2.48, 6.64）<0.0014.40（2.63, 7.43）<0.001
Q412.12（7.96, 19.30）<0.00110.61（6.89, 17.04）<0.00111.59（7.42, 18.85）<0.00112.01（7.50, 20.01）<0.001
), ArticleFig(id=1241102744132579826, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735098049533, language=CN, label=表4, caption=

UHR与CKD的多因素logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
组别模型1模型2模型3模型4
OR（95%CI）P值OR（95%CI）P值OR（95%CI）P值OR（95%CI）P值
UHR1.21（1.18, 1.24）<0.0011.20（1.17, 1.23）<0.0011.21（1.17, 1.23）<0.0011.21（1.17, 1.25）<0.001
Q11.00-1.00-1.00-1.00-
Q21.96（1.17, 3.34）0.0111.99（1.19, 3.41）0.0102.05（1.22, 3.51）0.0082.075（1.22, 3.09）0.008
Q33.86（2.43, 6.34）<0.0013.77（2.36, 6.24）<0.0014.00（2.48, 6.64）<0.0014.40（2.63, 7.43）<0.001
Q412.12（7.96, 19.30）<0.00110.61（6.89, 17.04）<0.00111.59（7.42, 18.85）<0.00112.01（7.50, 20.01）<0.001
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我国中老年血清尿酸/高密度脂蛋白胆固醇比值与慢性肾脏病的相关性研究
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卢周裕 1, 2 , 吴瑞鹏 2, 3 , 章梦君 1, 2 , 李文源 1, 2
现代预防医学 | 流行病与统计方法 2024,51(14): 2507-2512
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现代预防医学 | 流行病与统计方法 2024, 51(14): 2507-2512
我国中老年血清尿酸/高密度脂蛋白胆固醇比值与慢性肾脏病的相关性研究
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卢周裕1, 2, 吴瑞鹏2, 3, 章梦君1, 2, 李文源1, 2
作者信息
  • 1.南方医科大学公共卫生学院，广东 广州 510515
  • 2.南方医科大学南方医院
  • 3.南方医科大学卫生管理学院

    • 卢周裕（1998—），男，硕士在读，研究方向：健康管理、慢性病流行病学

通讯作者:

李文源，E-mail：
Correlation between Serum Uric acid to high-density lipoprotein cholesterol ratio and chronic kidney disease in middle-aged and elderly population in China
Zhou-yu LU1, 2, Rui-peng WU2, 3, Meng-jun ZHANG1, 2, Wen-yuan LI1, 2
Affiliations
  • School of Public Health，Southern Medical University，Guangzhou, Guangdong 510515，China
出版时间: 2024-07-25 doi: 10.20043/j.cnki.MPM.202402275
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摘要
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目的

探究我国中老年血清尿酸/高密度脂蛋白胆固醇比值（UHR）与慢性肾脏病（CKD）之间的关系。

方法

采用中国健康与养老追踪调查（CHARLS）数据，选取9 204名45岁及以上受访者为研究对象。多因素logistics回归分析用于评估UHR与CKD关系。利用受试者工作特征（ROC）曲线评估UHR对CKD的预测价值。

结果

研究对象平均年龄60.78±9.32岁，CKD患病率为3.97%。与UHR最低四分位组（Q1组）相比，最高四分位组（Q4组）患CKD风险增加（OR=12.01，95%CI:7.50~20.00）。ROC曲线分析中，中老年UHR预测CKD的ROC曲线下面积（AUC）为0.76（95%CI：0.73~0.78），男性UHR预测CKD的AUC为0.74（95%CI：0.70~0.77），女性UHR预测CKD的AUC为0.77（95%CI：0.73~0.81）。

结论

我国中老年UHR与CKD存在独立相关关系，UHR可能是中老年CKD的危险因素且对CKD预测具有良好价值。

慢性肾脏病  /  血清尿酸  /  血清高密度脂蛋白胆固醇  /  中国健康与养老追踪调查  /  预测  /  Logistic回归
Objective

To investigate the correlation between UHR and CKD in middle-aged and elderly population.

Methods

The data of this study was obtained from 2015 China Health and Retirement Longitudinal Survey(CHARLS).A total of 9 204 people≥45 years old were included.Multivariate Logistics regression analysis was used to analyze the correlation between UHR and CKD.The receiver operating characteristic(ROC)curves was used to analyze the predictive value of UHR for the risk of CKD.

Results

The subjects who we included have the mean age of 60.78±9.32 years with the prevalence of CKD of 3.97%.The odd rations for the highest quartile group (Q4 group)of UHR was increased for CKD(OR=12.01, 95%CI:7.50-20.00).ROC curve analysis showed that the area under the ROC Curve(AUC) for UHR predicting CKD for middle-aged and elderly population was 0.76(95%CI:0.73-0.78),the AUC for UHR predicting CKD for male group was 0.74(95%CI:0.70-0.77)and the AUC for UHR predicting CKD for female group was 0.77(95%CI:0.73-0.81).

Conclusion

There was a positive correlation between the increased UHR level and risk of CKD among the middle-aged and elderly population in China.UHR might serve as a risk factor and demonstrated good predictive value for CKD in the middle-aged and elderly population in China.

Chronic kidney disease  /  Serum Uric acid  /  Serum High density lipoprotein cholesterol  /  China Health and Retirement Longitudinal Study  /  Forecasting  /  Logistic regression
卢周裕, 吴瑞鹏, 章梦君, 李文源. 我国中老年血清尿酸/高密度脂蛋白胆固醇比值与慢性肾脏病的相关性研究. 现代预防医学, 2024 , 51 (14) : 2507 -2512 . DOI: 10.20043/j.cnki.MPM.202402275
Zhou-yu LU, Rui-peng WU, Meng-jun ZHANG, Wen-yuan LI. Correlation between Serum Uric acid to high-density lipoprotein cholesterol ratio and chronic kidney disease in middle-aged and elderly population in China[J]. Modern Preventive Medicine, 2024 , 51 (14) : 2507 -2512 . DOI: 10.20043/j.cnki.MPM.202402275
正文
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慢性肾脏病（Chronic kidney disease，CKD）已成为影响我国居民健康的重要公共卫生问题，目前全球患病率接近10%[1]，据估计我国有超过8 200万CKD患者，对我国乃至全球造成严重负担[2]。中老年人群是慢性肾脏病的高危人群[3]，同时肾小球滤过率随年龄增加而降低[4]。估算肾小球滤过率(Estimated glomerular filtration rate，eGFR)可以反应肾脏功能变化，对于早期CKD的防治具有重要意义[5]。血清尿酸（Serum uric acid，SUA）是人体嘌呤分解代谢终产物，过多导致高尿酸血症[6]。研究显示，SUA有促炎促氧化刺激肾素-血管紧张素系统，是CKD的危险因素，同时引起高血压、代谢综合征等疾病[7]。大量研究显示了尿酸水平与CKD之间存在关联，尿酸水平的升高会导致CKD风险的增加和肾小球滤过率下降[8]。但也有研究显示降尿酸治疗并不能延缓CKD的发生[9]。有研究表明较低水平高密度脂蛋白胆固醇（High density lipoprotein cholesterol，HDL-C）与低eGFR相关[10]。一项研究显示血脂异常会增加肾脏疾病风险，而较低的HDL-C会增加蛋白尿的风险[11]。最近有学者对其比值SUA/HDL-C（UHR）进行研究结果显示高UHR与CKD呈正相关。但该研究只局限于体检人群进行，目前关于中老年UHR与CKD相关性的全国性研究较少[12]。因此，了解我国中老年人群UHR与CKD之间的关系，对CKD病因探索以及科学防治具有重大意义。基于中国健康与养老追踪调查（CHARLS）数据，利用其大样本量、数据类型丰富及较强代表性的优势，分析中老年人群UHR与CKD之间的关系，为CKD病因探索及科学防治提供依据。
1　对象与方法
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1.1　资料来源
本研究数据来源于中国健康与养老追踪调查（CHARLS）公开数据中第三期数据，该数据于2011年开始进行全国范围多阶段分层抽样，抽取28省共450个村（居），调查对象为45岁及以上居住者[13]。第三期调查规模达20 248人。本研究选取完成血清尿酸（SUA）、高密度脂蛋白胆固醇（HDL-C）、肌酐（Cr）、胱抑素C（Cystatin C,Cys C）测定调查对象，排除人口学数据、行为生活方式、体格检查、血检数据、慢性病史（糖尿病、慢性肾脏病、高血压、血脂异常）和既往服药史缺失者，最终纳入研究对象9 204名。
1.2　资料收集
从CHARLS中的提取问卷调查数据、血检数据、体格检查数据。
问卷调查数据：人口学数据包括年龄、性别、婚姻状况、居住地、文化程度，行为生活方式包括饮酒、吸烟、身体活动水平，慢性病史包括高血压、慢性肾脏病、血脂异常、糖尿病，既往服药史包括肾脏疾病用药、降脂治疗用药。
血检数据：甘油三酯（TG）、肌酐（Cr）、尿素氮（BUN）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、总胆固醇（TC）、空腹血糖（FPG）、血清尿酸（SUA）、C反应蛋白（CRP）、糖化血红蛋白（HAB1C）。
体格检查数据：腰围(WC)、体重、身高、收缩压(SBP)、舒张压(DBP)。
1.3　分组
研究对象以是否患有CKD将分为CKD组和非CKD组。将研究对象按UHR四分位数进行分组，同时保持不同性别间的平衡：Q1组（男：UHR≤8.633%，n=1 060；女：UHR≤6.647%，n=1 224）、Q2组（男：8.633%<UHR≤10.927%，n=1 096；女：6.647%<UHR≤8.355%，n=1 225）、Q3组（男：10.927%<UHR≤13.854%，n=1 077；女：8.355%<UHR≤10.552%，n=1 222）、Q4组（男：UHR>13.854%，n=1 078；女：UHR>10.552%，n=1 222）。
1.4　相关定义
慢性肾脏病：本研究定义eGFR<60（ml/min/1.73m2）为CKD组，eGFR>=60（ml/min/1.73 m2）为非CKD组。
吸烟情况：（1）吸烟：研究对象第三轮调查时仍在吸烟。（2）戒烟：研究对象有过吸烟史，第三轮调查时没有吸烟。（3）未吸烟：研究对象从未有过吸烟行为。
饮酒情况：（1）饮酒：研究对象第三轮调查时仍在饮酒。（2）戒酒：研究对象有过饮酒史，第三轮调查时没有饮酒行为。（3）未饮酒：研究对象从未饮酒行为。
身体活动水平：根据国际体力活动问卷评判标准，轻度、中等强度、高强度活动赋值3.3、4.0、8.0。身体活动评分（METs/周）=8.0×高强度活动时间+4.0×中度活动时间+3.3×轻度活动时间，将体力活动水平分为低强度(<600)、中强度(600~3 000)和高强度(>3 000)。
采用基于Cys C和Cr的慢性肾脏病流行病学合作（CKD-EPI2021）公式计算eGFR:eGFRcr-cys c(ml/min/1.73 m2)=135×MIN(Scr/k，1)α×MAX(Scr/k，1)-0.544×MIN(Scys C/0.8，1)-0.323×MAX(Scys C/0.8，1)-0.778×0.996 1age×0.963[if female]；
其中，Scr为血清肌酐，单位为mg/dl；Scys C为血清胱抑素C，单位为mg/l；女性k为0.7，男性k为0.9；女性α为-0.219，男性α为-0.144[5]。
1.5　统计学方法
采用R 4.2.2软件进行统计学处理，连续变量资料采用（）或M（P25，P75）表示，分类变量资料采用相对数（%）描述，利用t检验、One-Way Anova、Mann-Whitney U检验、Kruskal-Wallis H检验或χ2检验进行组间比较。使用皮尔森相关分析UHR与CKD相关指标的相关性。在此基础上利用二元logistic回归分析探讨UHR与CKD的关系，以CKD为因变量，UHR四分位数分组为自变量进行多因素logistics回归分析，构建4个模型，模型1调整了性别、年龄、居住地、文化程度、婚姻状况，模型2进一步调整吸烟行为、饮酒行为、糖尿病史、血脂异常史、高血压史、慢性肾病史、降脂治疗用药情况、肾脏疾病用药情况，模型3进一步调整了SBP、DBP、BMI、WC后，模型4进一步调整了TG、LDL-C、FPG、BUN、HAB1C、C反应蛋白，利用限制性立方样条（RCS）进行曲线拟合，并可视化UHR与CKD之间的剂量-反应关系。使用受试者工作特征（ROC）曲线探究总体及不同性别研究对象UHR对CKD发生风险的预测价值，计算曲线下面积（AUC）。检验水准为0.05。
2　结果
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2.1　研究对象基本情况
本研究纳入9 204名受访者，平均年龄60.78±9.32岁，CKD患病率为3.97%。CKD组的UHR、男性比例、平均年龄、高血压史比例、慢性肾病史比例、血脂异常史比例、降脂治疗用药史比例、糖尿病史比例、HAB1C、Cr、Cys C、BUN、FPG、SUA、CRP、SBP高于非CKD组（P<0.05），HDL-C低于非CKD组（P<0.001）。CKD组与非CKD组文化程度、吸烟行为、饮酒行为、身体活动水平分布有差异（P<0.05），见表1。
2.2　不同UHR分组CKD检出情况及CKD相关指标比较
随着UHR水平上升，CKD的检出率、高血压史比例、血脂异常史比例、糖尿病史比例呈现上升趋势（P<0.01）。四组在BUN、LDL-C、TC的差异有统计学意义（P<0.001）。随着UHR水平上升，四个组别在eGFR呈下降趋势（P<0.001）。TG、Cr、Cys C、FPG、SUA、CRP、HAB1C、SBP、DBP、WC、BMI呈上升趋势（P<0.001），见表2。
2.3　UHR与CKD相关指标的相关性分析
相关性研究显示UHR与eGFR（ml/min/1.73 m2）呈负相关关系，相关系数为-0.37（P<0.001）。UHR与血清肌酐呈正相关关系，相关系数为0.31（P<0.001）。UHR与Cys C呈正相关关系，相关系数为0.37（P<0.001），见表3。
2.4　UHR与CKD的多因素logistic回归分析
模型1结果显示，与最低四分位数Q1组相比，各组CKD患病风险均增加（P<0.01），最高四分位数Q4组，中老年人群患有CKD的OR为12.12（95%CI：7.96~19.30）。调整了所有混杂因素的模型4中，与Q1组相比，各组CKD患病风险均增加（P<0.01），Q4组患CKD的OR为12.01（95%CI：7.50~20.01），见表4。将UHR作为连续变量引入模型并进行RCS曲线拟合，结果显示UHR与CKD呈非线性关系（Pnon-linearity<0.001），随着UHR升高，患CKD风险升高，见图1。
2.5　UHR对CKD发生风险的预测价值
绘制UHR预测CKD风险的ROC曲线，结果显示研究对象UHR预测CKD的AUC为0.76（95%CI：0.73~0.78），最佳截断值为11.295%，灵敏度0.701，特异度0.695。其中，男性群体UHR预测CKD的AUC为0.74（95%CI：0.70~0.77），最佳截断值为12.462%，灵敏度0.711，特异度0.660；女性群体UHR预测CKD的AUC为0.777（95%CI0.731~0.809），最佳截断值为10.135%，灵敏度0.714，特异度0.726，见图2。
3　讨论
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随着CKD患病率升高，CKD与各种代谢产物和血脂等的关系越来越受关注。本研究是关于中老年人群UHR与CKD之间关系的全国性研究，在本研究中，中老年CKD患病率为3.97%，与既往研究结果类似[14]，但既往研究中CKD患病率差异较大[15-16]，这可能是受到不同研究CKD判断标准的影响，以及不同地区不同人群使用不同公式计算eGFR[1]。
本研究证实了中老年人群UHR水平与CKD之间的关系，在调整相关混杂因素之后，CKD与UHR水平独立相关，且随着UHR水平升高，中老年人群CKD患病率也升高，非线性检验结果显示UHR与CKD之间存在非线性关系。本研究研究除了发现UHR与CKD之间的联系外，还发现其与SBP、DBP、WC、BMI、FPG、CRP、HAB1C存在正相关关系，与既往研究结果相同[11]。同时我们绘制了利用UHR预测CKD的ROC曲线，结果显示UHR对于不同性别研究对象CKD均有较好的预测价值（AUC>0.7），这也提示UHR指标在CKD防治中的重要意义。
SUA作为嘌呤代谢的终产物，被证实是多种慢性疾病的危险因素，其导致慢性疾病的机制可能与炎症、活性氧的产生、氧化应激等有关[17]。HDL-C是心血管疾病的保护因素，具有抗炎、抗氧化和抗血栓形成的特性[18]。考虑到两者在慢性疾病中的作用，许多研究用其比值（UHR），以更精确反映慢性炎症、氧化应激等对慢性疾病发生发展中的影响。
现阶段国内外对于UHR与CKD关系研究相对不足。一项研究显示，健康体检人群中，UHR与CKD风险呈正向关联，UHR升高可能是评估临床前阶段CKD风险的有用指标[12]。Liu等人在一项前瞻性队列研究中发现利用UHR与随访时间计算的UHR累计暴露值可以作为CKD发生与进展的预测指标，但该研究受限于研究对象代表性较差，其主要研究对象为开滦集团员工且男性性别比例远高于女性而导致研究结果无法进一步推广[19]。
Dikker等人在一项关于尿酸及其衍生比值指标与肥胖关系研究中发现UHR可作为监测青少年肥胖的指标[20]。肥胖为常见流行病，同时伴有全身轻度炎症，可从神经内分泌、营养物质代谢、炎症与免疫反应、缺氧、心理应激-微循环、衰老等途径促进糖尿病、CKD等多种慢病发生发展[21]。Aktas的研究发现UHR可用于预测糖尿病导致的肾脏功能损伤[22]，李新、尤玉青等也在糖尿病患者中观察到UHR对于糖尿病肾病的预测价值[23-24]。目前糖尿病已成为我国CKD的主要病因[25]。Aktas等人研究显示较高的UHR水平与不良血压控制相关[26]，肾脏是高血压损害的主要器官之一，高血压与CKD两者常互为因果并存[27]，这与本研究中观察到的CKD组有更高水平的SBP以及更高比例研究对象有高血压病史相一致。因此使用UHR可以较好解释CKD复杂病因。
SUA与CKD的关系可由以下机制解释：（1）肾脏为SUA主要排泄器官，尿酸晶体沉积引起肾脏功能下降。（2）SUA抑制一氧化氮（nitric oxide, NO）生成和促进其降解以降低NO水平，致内皮细胞（endothelial cells, ECs）、平滑肌细胞、肾小管细胞受损，激活肾素血管紧张素系统。（3）损害传入小动脉自身调节[28]。HDL-C的抗血栓活性通过其对增强前列腺素活性和减弱各种细胞因子表达以抑制血栓形成[29]；HDL-C的抗炎作用则通过其减弱单核细胞的活化增殖，从而降低其促炎作用，同时可以减弱LDL-C的氧化作用抑制其炎症激活作用[30]。CKD往往伴有机体氧化应激、促炎微环境及累积较多尿毒素，这些因素会导致HDL-C结构修饰：改变HDL-C原有蛋白质和脂质的组成、HDL-C转运蛋白转录后修饰、以共价结合形式修饰HDL-C分子[31-32]。因此，以上两种机制可以较好的解释本研究中UHR与CKD之间的相关性。
本研究也存在以下不足：（1）本研究为横断面研究，只能够确定UHR与CKD之间的相关性，而不能确定其因果关系。（2）本研究SUA水平易受饮食因素影响。
综上，本研究表明中老年人群UHR与CKD相关。CKD患病风险随UHR水平上升显著增加。此外UHR对CKD有较好预测价值，可能是中老年人群CKD发生的危险因素。因此，对于CKD早期防控，应加强对UHR定期监测、评估，必要时予以控制。
基金
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  • 国家科技重大专项(2020ZX09201-017)
  • 广东省重点领域研发计划项目(2019B020227004)
文献
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2024年第51卷第14期
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doi: 10.20043/j.cnki.MPM.202402275
  • 接收时间：2024-02-28
  • 首发时间：2026-03-18
  • 出版时间：2024-07-25
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  • 收稿日期：2024-02-28
基金
国家科技重大专项(2020ZX09201-017)
广东省重点领域研发计划项目(2019B020227004)
作者信息
    1.南方医科大学公共卫生学院，广东 广州 510515
    2.南方医科大学南方医院
    3.南方医科大学卫生管理学院

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李文源，E-mail：
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
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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