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Article(id=1149741765978141645, tenantId=1146029695717560320, journalId=1146031787341344770, issueId=1149741761771258326, articleNumber=1003-3033(2024)02-0231-08, orderNo=null, doi=10.16265/j.cnki.issn1003-3033.2024.02.1184, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1691769600000, receivedDateStr=2023-08-12, revisedDate=1699632000000, revisedDateStr=2023-11-11, acceptedDate=null, acceptedDateStr=null, onlineDate=1752049398178, onlineDateStr=2025-07-09, pubDate=1709049600000, pubDateStr=2024-02-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1752049398178, onlineIssueDateStr=2025-07-09, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1752049398178, creator=13701087609, updateTime=1752049398178, updator=13701087609, issue=Issue{id=1149741761771258326, tenantId=1146029695717560320, journalId=1146031787341344770, year='2024', volume='34', issue='2', pageStart='1', pageEnd='252', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1752049397175, creator=13701087609, updateTime=1756468934610, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1168278645379440971, tenantId=1146029695717560320, journalId=1146031787341344770, issueId=1149741761771258326, language=EN, specialIssueTitle=, coverIllustrator=, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1168278645379440972, tenantId=1146029695717560320, journalId=1146031787341344770, issueId=1149741761771258326, language=CN, specialIssueTitle=, coverIllustrator=, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=231, endPage=238, ext={EN=ArticleExt(id=1149741766305297358, articleId=1149741765978141645, tenantId=1146029695717560320, journalId=1146031787341344770, language=EN, title=Effect of liver enzymes on association between metabolically healthy obesity and hyperuricemia in steelworkers, columnId=1149735805633081985, journalTitle=China Safety Science Journal, columnName=Occupational health, runingTitle=null, highlight=null, articleAbstract=

The association between MHO and HUA and whether liver enzyme abnormalities could modify this association were studied. The cross-sectional study was conducted using 6，868 steelworkers in Hebei Iron and Steel Company who participated in occupational medical examinations as the study population. The data were analyzed using logistic regression models and interaction effect model. The results show that，in a multiple adjusted logistic model，the risk of HUA is increased 2.13-fold (odds ratio (OR)=2.13，95% confidence interval (CI): 1.08-4.21) for metabolically healthy generalized obesity (MHGO). The risk of HUA is increased 2.25-fold (OR=2.25，95%CI: 1.14-4.45) for metabolically healthy abdominal obesity (MHAO). In stratified analysis，in the group with elevated liver enzymes，the prevalence of HUA in steelworkers with MHO(MHGO and MHAO) is significantly higher than that in the group with normal liver enzymes，and the interaction between obesity phenotypes and liver enzyme levels has a statistically significant effect on HUA (P<0.05). MHO is associated with a high prevalence of HUA. Liver enzyme levels may alter the relationship between MHO and HUA.

, correspAuthors=Juxiang YUAN, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, authorCompany=null, fund=null, authors=null, authorsList=Miao YU, Shengkui ZHANG, Lihua WANG, Juxiang YUAN), CN=ArticleExt(id=1149741776648450202, articleId=1149741765978141645, tenantId=1146029695717560320, journalId=1146031787341344770, language=CN, title=肝酶对钢铁工人代谢健康型肥胖与高尿酸血症关联影响, columnId=1149735805817631364, journalTitle=中国安全科学学报, columnName=职业卫生, runingTitle=null, highlight=null, articleAbstract=

为探讨代谢健康型肥胖(MHO)和高尿酸血症(HUA)之间的关系，以及肝酶相关异常对此关系的影响，采用横断面研究，以参加河北钢铁公司职业体检的6 868名钢铁工人为研究对象，采用logistic回归模型和交互效应模型进行数据分析。结果表明：在校正混杂因素后，代谢健康全身肥胖的钢铁工人患HUA的风险增加2.13倍(比值比OR=2.13，95%置信区间CI:1.08~4.21)；代谢健康腹型肥胖的钢铁工人患HUA的风险增加2.25倍(OR=2.25，95%CI:1.14~4.45)。在分层分析中，肝酶升高组MHO的钢铁工人HUA患病率显著高于肝酶正常组，不同肥胖表型和肝酶水平之间存在交互作用(P<0.05)。MHO与HUA的高患病率相关。肝酶升高可能改变MHO和HUA之间的关系。

, correspAuthors=袁聚祥, authorNote=null, correspAuthorsNote=
** 袁聚祥(1956—)，男，河北邢台人，博士，教授，主要从事职业流行病学等方面的研究。E-mail：。
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于 淼 (1993—)，女，河北唐山人，博士研究生，主要研究方向为职业人群慢性病流行病学。E-mail：。

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于 淼 (1993—)，女，河北唐山人，博士研究生，主要研究方向为职业人群慢性病流行病学。E-mail：。

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于 淼 (1993—)，女，河北唐山人，博士研究生，主要研究方向为职业人群慢性病流行病学。E-mail：。

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Arthritis Research & Therapy, 2021, 23(1):DOI:10.1186/s13075-020-02385-8., articleTitle=Independent and interactive effect of sitting time and physical activity on prevalence of hyperuricemia: the Henan rural cohort study, refAbstract=null)], funds=[Fund(id=1168128796273160285, tenantId=1146029695717560320, journalId=1146031787341344770, articleId=1149741765978141645, awardId=2016YFC0900605, language=CN, fundingSource=国家重点研发计划项目(2016YFC0900605), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1168128792741556267, tenantId=1146029695717560320, journalId=1146031787341344770, articleId=1149741765978141645, xref=1, ext=[AuthorCompanyExt(id=1168128792758333484, tenantId=1146029695717560320, journalId=1146031787341344770, articleId=1149741765978141645, companyId=1168128792741556267, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1 School of Public Health，North China University of Science and Technology，Tangshan Hebei 063210，China), AuthorCompanyExt(id=1168128792770916397, tenantId=1146029695717560320, journalId=1146031787341344770, articleId=1149741765978141645, companyId=1168128792741556267, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1 华北理工大学 公共卫生学院，河北 唐山 063210)]), AuthorCompany(id=1168128792829636654, tenantId=1146029695717560320, journalId=1146031787341344770, articleId=1149741765978141645, xref=2, ext=[AuthorCompanyExt(id=1168128792850608175, tenantId=1146029695717560320, journalId=1146031787341344770, articleId=1149741765978141645, companyId=1168128792829636654, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2 School of Social Sciences，Tsinghua University，Beijing 100084，China), AuthorCompanyExt(id=1168128792863191088, tenantId=1146029695717560320, journalId=1146031787341344770, articleId=1149741765978141645, companyId=1168128792829636654, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2 清华大学 社会科学学院，北京 100084)])], figs=[ArticleFig(id=1168128795019063377, tenantId=1146029695717560320, journalId=1146031787341344770, articleId=1149741765978141645, language=EN, label=Fig.1, caption=BMI and odds of HUA from RCS models, figureFileSmall=DcAGQdNgFj38RalwzedJXA==, figureFileBig=pMu12qLVEtAqH20yyIWKZw==, tableContent=null), ArticleFig(id=1168128795077783634, tenantId=1146029695717560320, journalId=1146031787341344770, articleId=1149741765978141645, language=CN, label=图1, caption=BMI与HUA的限制性立方样条模型, figureFileSmall=DcAGQdNgFj38RalwzedJXA==, figureFileBig=pMu12qLVEtAqH20yyIWKZw==, tableContent=null), ArticleFig(id=1168128795170058323, tenantId=1146029695717560320, journalId=1146031787341344770, articleId=1149741765978141645, language=EN, label=Fig.2, caption=WC and odds of HUA from RCS models, figureFileSmall=OvxXYiHS0Wfv/1z+qnRJyw==, figureFileBig=xBHoKOuA3F+qqyWqD+mEeg==, tableContent=null), ArticleFig(id=1168128795237167188, tenantId=1146029695717560320, journalId=1146031787341344770, articleId=1149741765978141645, language=CN, label=图2, caption=WC与HUA的限制性立方样条模型, figureFileSmall=OvxXYiHS0Wfv/1z+qnRJyw==, figureFileBig=xBHoKOuA3F+qqyWqD+mEeg==, tableContent=null), ArticleFig(id=1168128795300081749, tenantId=1146029695717560320, journalId=1146031787341344770, articleId=1149741765978141645, language=EN, label=Tab.1, caption=

Characteristic distribution of HUA disease groups of steelworkers

, figureFileSmall=null, figureFileBig=null, tableContent=
变量 总计 非HUA HUA P
n=6 868 n=4 595 n=2 273
年龄/岁，n/% 22~29 334 (4.9) 187 (4.1) 147 (6.5) < 0.001
30~39 1 582 (23.0) 910 (19.8) 672 (29.6)
40~49 2 757 (40.1) 1 884 (41.0) 873 (38.4)
50~60 2 195 (32.0) 1 614 (35.1) 581 (25.6)
教育程度，n/% 高中及以下 5 305 (77.2) 3 614 (79.2) 1 664 (73.2) < 0.001
大专及以上 1 563 (22.8) 954 (20.8) 609 (26.8)
吸烟，n/% 从不 2 842 (41.4) 1 975 (43.0) 867 (38.1) < 0.001
曾经 460 (6.7) 305 (6.6) 155 (6.8)
现在 3 566 (51.9) 2 315 (50.4) 1 251 (55.1)
饮酒，n/% 从不 3 954 (57.5) 2 709 (59.0) 1 245 (54.8) 0.002
曾经 245 (3.6) 167 (3.6) 78 (3.4)
现在 2 669 (38.9) 1 719 (37.4) 950 (41.8)
体力活动，n/% 低 1 247 (18.2) 785 (17.1) 462 (20.3) < 0.001
中 3 447 (50.2) 2 371 (51.6) 1 076 (47.3)
高 2 174 (31.6) 1 439 (31.3) 735 (32.3)
GO，n/% 否 3 138 (45.7) 2 395 (52.1) 743 (32.7) < 0.001
是 3 730 (54.3) 2 200 (47.9) 1 530 (67.3)
AO，n/% 否 2 302 (33.5) 1 746 (38.0) 556 (24.5) < 0.001
是 4 566 (66.5) 2 849 (62.0) 1 717 (75.5)
倒班作业，n/% 否 1 316 (19.2) 922 (20.1) 394 (17.3) 0.007
是 5 552 (80.8) 3 673 (79.9) 1 879 (82.7)
粉尘作业，n/% 否 2 595 (37.8) 1 783 (38.8) 812 (35.7) 0.013
是 4 273 (62.2) 2 812 (61.2) 1 461 (64.3)
噪声作业，n/% 否 3 367 (49.0) 2 273 (49.5) 1 094 (48.1) 0.297
是 3 501 (51.0) 2 322 (50.5) 1 179 (51.9)
高温作业，n/% 否 3 481 (50.7) 2 412 (52.5) 1 069 (47.0) < 0.001
是 3 387 (49.3) 2 183 (47.5) 1 204 (53.0)
CO作业，n/% 否 3 952 (57.5) 2 660 (57.9) 1 292 (56.8) 0.408
是 2 916 (42.5) 1 935 (42.1) 981 (43.2)
年龄/岁，( χ -±S) 44.6±8.1 45.5±7.8 42.9±8.3 < 0.001
DASH评分，( χ -±S) 25.4±5.8 25.5±5.8 25.2±5.6 0.039
SBP/mmHg，( χ -±S) 129.0±15.9 128.0±16.0 130.8±15.6 < 0.001
DBP/mmHg，( χ -±S) 82.5±10.4 82.0±10.2 83.7±10.5 < 0.001
TC/(mmol·L-1)，( χ -±S) 5.1±1.0 5.1±0.9 5.2±1.0 < 0.001
TG/(mmol·L-1)，M (IQR) 1.3 (0.9-2.0) 1.2 (0.8-1.7) 1.6 (1.1-2.4) < 0.001
HDL-C/(mmol·L-1)，( χ -±S) 1.3±0.3 1.3±0.3 1.2±0.3 < 0.001
LDL-C/(mmol·L-1)，( χ -±S) 3.2±0.9 3.2±0.8 3.3±0.9 < 0.001
FBG/(mmol·L-1)，( χ -±S) 6.1±1.3 6.1±1.5 6.0±1.0 < 0.001
ALT/(U·L-1)，M (IQR) 23 (17-31) 21 (16-28) 26 (20-37) < 0.001
AST/(U·L-1)，M (IQR) 20 (17-23) 19 (17-22) 21 (18-25) < 0.001
GGT/(U·L-1)，M (IQR) 26 (19-41) 24 (17-36) 32 (23-51) < 0.001
), ArticleFig(id=1168128795400745046, tenantId=1146029695717560320, journalId=1146031787341344770, articleId=1149741765978141645, language=CN, label=表1, caption=

钢铁工人HUA患病分组的特征分布

, figureFileSmall=null, figureFileBig=null, tableContent=
变量 总计 非HUA HUA P
n=6 868 n=4 595 n=2 273
年龄/岁，n/% 22~29 334 (4.9) 187 (4.1) 147 (6.5) < 0.001
30~39 1 582 (23.0) 910 (19.8) 672 (29.6)
40~49 2 757 (40.1) 1 884 (41.0) 873 (38.4)
50~60 2 195 (32.0) 1 614 (35.1) 581 (25.6)
教育程度，n/% 高中及以下 5 305 (77.2) 3 614 (79.2) 1 664 (73.2) < 0.001
大专及以上 1 563 (22.8) 954 (20.8) 609 (26.8)
吸烟，n/% 从不 2 842 (41.4) 1 975 (43.0) 867 (38.1) < 0.001
曾经 460 (6.7) 305 (6.6) 155 (6.8)
现在 3 566 (51.9) 2 315 (50.4) 1 251 (55.1)
饮酒，n/% 从不 3 954 (57.5) 2 709 (59.0) 1 245 (54.8) 0.002
曾经 245 (3.6) 167 (3.6) 78 (3.4)
现在 2 669 (38.9) 1 719 (37.4) 950 (41.8)
体力活动，n/% 低 1 247 (18.2) 785 (17.1) 462 (20.3) < 0.001
中 3 447 (50.2) 2 371 (51.6) 1 076 (47.3)
高 2 174 (31.6) 1 439 (31.3) 735 (32.3)
GO，n/% 否 3 138 (45.7) 2 395 (52.1) 743 (32.7) < 0.001
是 3 730 (54.3) 2 200 (47.9) 1 530 (67.3)
AO，n/% 否 2 302 (33.5) 1 746 (38.0) 556 (24.5) < 0.001
是 4 566 (66.5) 2 849 (62.0) 1 717 (75.5)
倒班作业，n/% 否 1 316 (19.2) 922 (20.1) 394 (17.3) 0.007
是 5 552 (80.8) 3 673 (79.9) 1 879 (82.7)
粉尘作业，n/% 否 2 595 (37.8) 1 783 (38.8) 812 (35.7) 0.013
是 4 273 (62.2) 2 812 (61.2) 1 461 (64.3)
噪声作业，n/% 否 3 367 (49.0) 2 273 (49.5) 1 094 (48.1) 0.297
是 3 501 (51.0) 2 322 (50.5) 1 179 (51.9)
高温作业，n/% 否 3 481 (50.7) 2 412 (52.5) 1 069 (47.0) < 0.001
是 3 387 (49.3) 2 183 (47.5) 1 204 (53.0)
CO作业，n/% 否 3 952 (57.5) 2 660 (57.9) 1 292 (56.8) 0.408
是 2 916 (42.5) 1 935 (42.1) 981 (43.2)
年龄/岁，( χ -±S) 44.6±8.1 45.5±7.8 42.9±8.3 < 0.001
DASH评分，( χ -±S) 25.4±5.8 25.5±5.8 25.2±5.6 0.039
SBP/mmHg，( χ -±S) 129.0±15.9 128.0±16.0 130.8±15.6 < 0.001
DBP/mmHg，( χ -±S) 82.5±10.4 82.0±10.2 83.7±10.5 < 0.001
TC/(mmol·L-1)，( χ -±S) 5.1±1.0 5.1±0.9 5.2±1.0 < 0.001
TG/(mmol·L-1)，M (IQR) 1.3 (0.9-2.0) 1.2 (0.8-1.7) 1.6 (1.1-2.4) < 0.001
HDL-C/(mmol·L-1)，( χ -±S) 1.3±0.3 1.3±0.3 1.2±0.3 < 0.001
LDL-C/(mmol·L-1)，( χ -±S) 3.2±0.9 3.2±0.8 3.3±0.9 < 0.001
FBG/(mmol·L-1)，( χ -±S) 6.1±1.3 6.1±1.5 6.0±1.0 < 0.001
ALT/(U·L-1)，M (IQR) 23 (17-31) 21 (16-28) 26 (20-37) < 0.001
AST/(U·L-1)，M (IQR) 20 (17-23) 19 (17-22) 21 (18-25) < 0.001
GGT/(U·L-1)，M (IQR) 26 (19-41) 24 (17-36) 32 (23-51) < 0.001
), ArticleFig(id=1168128795526574167, tenantId=1146029695717560320, journalId=1146031787341344770, articleId=1149741765978141645, language=EN, label=Tab.2, caption=

Effect of obesity and metabolism indicators on HUA by logistic analysis

, figureFileSmall=null, figureFileBig=null, tableContent=
变量 模型1 模型2 模型3 模型4
GO 否 1.00 1.00 1.00 1.00
是 2.24(2.02~2.49) 2.14 (1.92~2.38) 2.34 (1.90~2.89) 2.15 (1.74 ~2.66)
AO 否 1.00 1.00 1.00 1.00
是 1.89 (1.69 - 2.12) 1.88 (1.68~2.11) 2.35 (1.86~2.97) 2.15 (1.69~2.72)
代谢异常组分 BP 1.47(1.33~1.63) 1.58 (1.42~1.76) 1.57 (1.27~1.94) 1.49 (1.20~1.84)
FBG 1.05 (0.95~1.17) 1.12 (1.00~1.25) 1.18 (0.94~1.48) 1.14 (0.91~1.43)
TG 2.59 (2.33~2.88) 2.51 (2.26~2.80) 2.62 (2.13 ~3.22) 2.36 (1.91 ~2.92)
HDL-C 1.66 (1.47~1.89) 1.69 (1.48~1.92) 1.36 (1.05~1.75) 1.31 (1.01~1.70)
代谢异常数量 0 1.00 1.00 1.00 1.00
1 1.13 (0.94~1.37) 0.93 (0.71~1.20) 1.08 (0.73~1.59) 1.03 (0.70~1.52)
2 1.62 (1.35~1.95) 1.25 (0.97~1.60) 1.64 (1.12~2.40) 1.50 (1.03~2.21)
3 2.88 (2.37~3.50) 1.41 (1.08~1.85) 2.96 (1.98~4.43) 2.53 (1.68~3.81)
4 3.14 (2.43~4.07) 1.68 (1.19~2.37) 3.11 (1.87~5.19) 2.70 (1.61~4.52)
), ArticleFig(id=1168128795627237464, tenantId=1146029695717560320, journalId=1146031787341344770, articleId=1149741765978141645, language=CN, label=表2, caption=

肥胖和代谢指标对HUA的影响

, figureFileSmall=null, figureFileBig=null, tableContent=
变量 模型1 模型2 模型3 模型4
GO 否 1.00 1.00 1.00 1.00
是 2.24(2.02~2.49) 2.14 (1.92~2.38) 2.34 (1.90~2.89) 2.15 (1.74 ~2.66)
AO 否 1.00 1.00 1.00 1.00
是 1.89 (1.69 - 2.12) 1.88 (1.68~2.11) 2.35 (1.86~2.97) 2.15 (1.69~2.72)
代谢异常组分 BP 1.47(1.33~1.63) 1.58 (1.42~1.76) 1.57 (1.27~1.94) 1.49 (1.20~1.84)
FBG 1.05 (0.95~1.17) 1.12 (1.00~1.25) 1.18 (0.94~1.48) 1.14 (0.91~1.43)
TG 2.59 (2.33~2.88) 2.51 (2.26~2.80) 2.62 (2.13 ~3.22) 2.36 (1.91 ~2.92)
HDL-C 1.66 (1.47~1.89) 1.69 (1.48~1.92) 1.36 (1.05~1.75) 1.31 (1.01~1.70)
代谢异常数量 0 1.00 1.00 1.00 1.00
1 1.13 (0.94~1.37) 0.93 (0.71~1.20) 1.08 (0.73~1.59) 1.03 (0.70~1.52)
2 1.62 (1.35~1.95) 1.25 (0.97~1.60) 1.64 (1.12~2.40) 1.50 (1.03~2.21)
3 2.88 (2.37~3.50) 1.41 (1.08~1.85) 2.96 (1.98~4.43) 2.53 (1.68~3.81)
4 3.14 (2.43~4.07) 1.68 (1.19~2.37) 3.11 (1.87~5.19) 2.70 (1.61~4.52)
), ArticleFig(id=1168128795702734937, tenantId=1146029695717560320, journalId=1146031787341344770, articleId=1149741765978141645, language=EN, label=Tab.3, caption=

Effects of different obesity phenotypes on HUA

, figureFileSmall=null, figureFileBig=null, tableContent=
肥胖表型 患病人数/% OR (95% CI)值
模型1 模型2 模型3 模型4
BMI
分类		 MHNGO 105 (18.1) 1.00 1.00 1.00 1.00
MUNGO 638 (24.9) 1.50(1.20~1.90) 1.67 (1.32~2.11) 1.40 (0.87~2.27) 1.28 (0.79~2.08)
MHGO 88 (35.3) 2.47 (1.77~3.46) 2.36 (1.68~3.32) 2.41 (1.23~4.73) 2.13 (1.08~4.21)
MUGO 1442 (41.4) 3.20 (2.56~3.99) 3.37(2.69~4.24) 3.18 (1.99 ~5.06) 2.70 (1.69~4.32)
WC
分类		 MHNAO 91/456 (20.0) 1.00 1.00 1.00 1.00
MUNAO 465/1 846 (26.9) 1.35 (1.05~1.74) 1.45 (1.12~1.87) 1.50 (0.85~2.63) 1.38 (0.79~2.42)
MHAO 102/373 (27.4) 1.51 (1.09~3.19) 1.44(1.03~2.00) 2.46 (1.25~4.85) 2.25 (1.14~4.45)
MUAO 1 615/4 193 (38.5) 2.51 (1.98~3.19) 2.70(2.11~3.45) 3.38 (1.98~5.78) 2.87 (1.68~4.93)
), ArticleFig(id=1168128795774038106, tenantId=1146029695717560320, journalId=1146031787341344770, articleId=1149741765978141645, language=CN, label=表3, caption=

不同肥胖表型对HUA的影响

, figureFileSmall=null, figureFileBig=null, tableContent=
肥胖表型 患病人数/% OR (95% CI)值
模型1 模型2 模型3 模型4
BMI
分类		 MHNGO 105 (18.1) 1.00 1.00 1.00 1.00
MUNGO 638 (24.9) 1.50(1.20~1.90) 1.67 (1.32~2.11) 1.40 (0.87~2.27) 1.28 (0.79~2.08)
MHGO 88 (35.3) 2.47 (1.77~3.46) 2.36 (1.68~3.32) 2.41 (1.23~4.73) 2.13 (1.08~4.21)
MUGO 1442 (41.4) 3.20 (2.56~3.99) 3.37(2.69~4.24) 3.18 (1.99 ~5.06) 2.70 (1.69~4.32)
WC
分类		 MHNAO 91/456 (20.0) 1.00 1.00 1.00 1.00
MUNAO 465/1 846 (26.9) 1.35 (1.05~1.74) 1.45 (1.12~1.87) 1.50 (0.85~2.63) 1.38 (0.79~2.42)
MHAO 102/373 (27.4) 1.51 (1.09~3.19) 1.44(1.03~2.00) 2.46 (1.25~4.85) 2.25 (1.14~4.45)
MUAO 1 615/4 193 (38.5) 2.51 (1.98~3.19) 2.70(2.11~3.45) 3.38 (1.98~5.78) 2.87 (1.68~4.93)
), ArticleFig(id=1168128795841146971, tenantId=1146029695717560320, journalId=1146031787341344770, articleId=1149741765978141645, language=EN, label=Tab.4, caption=

Effect of liver enzyme levels on relationship between obesity phenotypes and HUA

, figureFileSmall=null, figureFileBig=null, tableContent=
肥胖表型 分组1a P 分组2b P
肝酶正常 肝酶异常 肝酶正常 肝酶异常
BMI
分类		 MHNGO 1.00 1.00 <0.001 1.00 1.00 <0.001
MUNGO 1.04 (0.49~2.20) 1.30 (0.69~2.46) 0.96 (0.58~1.59) 1.06 (0.65~1.74)
MHGO 1.80 (0.79~4.14) 3.52 (1.05~11.81) 1.91 (0.87~4.19) 2.19 (1.51~3.19)
MUGO 2.41 (1.15~5.04) 2.50 (1.35~4.63) 2.10 (1.29~3.43) 2.92 (2.28~3.74)
WC
分类		 MHNAO 1.00 1.00 <0.001 1.00 1.00 <0.001
MUNAO 0.65 (0.28~1.51) 1.78 (0.81~3.92) 1.03 (0.57~1.85) 1.09 (0.54~2.17)
MHAO 1.57 (0.51~4.85) 2.50 (1.02~6.17) 2.02 (0.96~4.27) 1.33 (0.56~3.17)
MUAO 2.01 (0.95~4.27) 3.14 (1.47~6.72) 2.19 (1.26~3.82) 1.93 (1.13~3.37)
), ArticleFig(id=1168128795937615964, tenantId=1146029695717560320, journalId=1146031787341344770, articleId=1149741765978141645, language=CN, label=表4, caption=

肝酶对不同肥胖表型与HUA关系的影响

, figureFileSmall=null, figureFileBig=null, tableContent=
肥胖表型 分组1a P 分组2b P
肝酶正常 肝酶异常 肝酶正常 肝酶异常
BMI
分类		 MHNGO 1.00 1.00 <0.001 1.00 1.00 <0.001
MUNGO 1.04 (0.49~2.20) 1.30 (0.69~2.46) 0.96 (0.58~1.59) 1.06 (0.65~1.74)
MHGO 1.80 (0.79~4.14) 3.52 (1.05~11.81) 1.91 (0.87~4.19) 2.19 (1.51~3.19)
MUGO 2.41 (1.15~5.04) 2.50 (1.35~4.63) 2.10 (1.29~3.43) 2.92 (2.28~3.74)
WC
分类		 MHNAO 1.00 1.00 <0.001 1.00 1.00 <0.001
MUNAO 0.65 (0.28~1.51) 1.78 (0.81~3.92) 1.03 (0.57~1.85) 1.09 (0.54~2.17)
MHAO 1.57 (0.51~4.85) 2.50 (1.02~6.17) 2.02 (0.96~4.27) 1.33 (0.56~3.17)
MUAO 2.01 (0.95~4.27) 3.14 (1.47~6.72) 2.19 (1.26~3.82) 1.93 (1.13~3.37)
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肝酶对钢铁工人代谢健康型肥胖与高尿酸血症关联影响
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于淼 1 , 张生奎 2 , 王利华 1 , 袁聚祥 1, **
中国安全科学学报 | 职业卫生 2024,34(2): 231-238
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中国安全科学学报 | 职业卫生 2024, 34(2): 231-238
肝酶对钢铁工人代谢健康型肥胖与高尿酸血症关联影响
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于淼1 , 张生奎2, 王利华1, 袁聚祥1, **
作者信息
  • 1 华北理工大学 公共卫生学院，河北 唐山 063210
  • 2 清华大学 社会科学学院，北京 100084

    • 于 淼 (1993—)，女，河北唐山人，博士研究生，主要研究方向为职业人群慢性病流行病学。E-mail：。

通讯作者:

** 袁聚祥(1956—)，男，河北邢台人，博士，教授，主要从事职业流行病学等方面的研究。E-mail：。
Effect of liver enzymes on association between metabolically healthy obesity and hyperuricemia in steelworkers
Miao YU1 , Shengkui ZHANG2, Lihua WANG1, Juxiang YUAN1, **
Affiliations
  • 1 School of Public Health，North China University of Science and Technology，Tangshan Hebei 063210，China
  • 2 School of Social Sciences，Tsinghua University，Beijing 100084，China
出版时间: 2024-02-28 doi: 10.16265/j.cnki.issn1003-3033.2024.02.1184
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摘要
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为探讨代谢健康型肥胖(MHO)和高尿酸血症(HUA)之间的关系，以及肝酶相关异常对此关系的影响，采用横断面研究，以参加河北钢铁公司职业体检的6 868名钢铁工人为研究对象，采用logistic回归模型和交互效应模型进行数据分析。结果表明：在校正混杂因素后，代谢健康全身肥胖的钢铁工人患HUA的风险增加2.13倍(比值比OR=2.13，95%置信区间CI:1.08~4.21)；代谢健康腹型肥胖的钢铁工人患HUA的风险增加2.25倍(OR=2.25，95%CI:1.14~4.45)。在分层分析中，肝酶升高组MHO的钢铁工人HUA患病率显著高于肝酶正常组，不同肥胖表型和肝酶水平之间存在交互作用(P<0.05)。MHO与HUA的高患病率相关。肝酶升高可能改变MHO和HUA之间的关系。

肝酶  /  钢铁工人  /  代谢健康型肥胖(MHO)  /  高尿酸血(HUA)  /  全身肥胖(GO)  /  腹型肥胖(AO)

The association between MHO and HUA and whether liver enzyme abnormalities could modify this association were studied. The cross-sectional study was conducted using 6，868 steelworkers in Hebei Iron and Steel Company who participated in occupational medical examinations as the study population. The data were analyzed using logistic regression models and interaction effect model. The results show that，in a multiple adjusted logistic model，the risk of HUA is increased 2.13-fold (odds ratio (OR)=2.13，95% confidence interval (CI): 1.08-4.21) for metabolically healthy generalized obesity (MHGO). The risk of HUA is increased 2.25-fold (OR=2.25，95%CI: 1.14-4.45) for metabolically healthy abdominal obesity (MHAO). In stratified analysis，in the group with elevated liver enzymes，the prevalence of HUA in steelworkers with MHO(MHGO and MHAO) is significantly higher than that in the group with normal liver enzymes，and the interaction between obesity phenotypes and liver enzyme levels has a statistically significant effect on HUA (P<0.05). MHO is associated with a high prevalence of HUA. Liver enzyme levels may alter the relationship between MHO and HUA.

liver enzymes  /  steelworkers  /  metabolically healthy obesity (MHO)  /  hyperuricemia (HUA)  /  generalized obesity(GO)  /  abdominal obesity(AO)
于淼, 张生奎, 王利华, 袁聚祥. 肝酶对钢铁工人代谢健康型肥胖与高尿酸血症关联影响. 中国安全科学学报, 2024 , 34 (2) : 231 -238 . DOI: 10.16265/j.cnki.issn1003-3033.2024.02.1184
Miao YU, Shengkui ZHANG, Lihua WANG, Juxiang YUAN. Effect of liver enzymes on association between metabolically healthy obesity and hyperuricemia in steelworkers[J]. China Safety Science Journal, 2024 , 34 (2) : 231 -238 . DOI: 10.16265/j.cnki.issn1003-3033.2024.02.1184
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0 引言
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高尿酸血症(Hyperuricemia，HUA)是嘌呤代谢异常的结果，不仅直接导致痛风，而且与心血管疾病和慢性肾脏疾病的发生发展密切相关[1-2]。由于HUA早期无症状，往往不引起重视，大多数HUA患者未能得到及时合理的治疗，HUA的严重并发症进一步增加了患者的疾病负担[3]。近年来，中国的流行病学数据显示，HUA患病率在过去20年中稳步上升至14.0%左右，实际上已达到与西方国家相似的水平[4]。但在前期研究中发现，钢铁工人HUA的总体患病率为36.2%，远高于一般人群[5]。此外，职业安全与健康问题已成为我国在现代化工业建设中共同面临和亟待解决的重大问题[6]。因此，在病因链的远端寻找HUA的危险因素，既能为改善钢铁工人职业健康提供重要机会，保证工人的安全健康，也可确保企业的安全稳定运行[7]。
有学者通过大规模流行病学调查，发现代谢健康的肥胖者在HUA的风险中可能存在一定的差异性，这表明肥胖相关疾病风险评估需要更为细致的划分，而且，不仅依赖于体质量指数(Body Mass Index，BMI)[8]。近年来，研究者开始关注肝酶与代谢健康型肥胖(Metabolically Healthy Obesity，MHO)和代谢不健康肥胖(Metabolically Unhealthy Obesity，MUHO)的关联，并发现肝酶对不同肥胖代谢表型具有显著识别能力[9]。因此，肝酶水平可能成为理解MHO与HUA关联的重要窗口。一项流行病学研究表明：血清尿酸水平与丙氨酸转氨酶(Alanine Aminotransferase，ALT)和天冬氨酸转氨酶(Aspartate Transaminase，AST)呈正相关[10]。由此推断，肝酶可能在MHO和HUA的关联中起作用。肝酶作为一种容易检测的生物标志物，其水平的监测可能有助于识别患有MHO的个体中HUA的患病风险[11]。
目前，MHO对HUA的影响仍有待证实，尚不确定代谢健康全身肥胖(Metabolically Healthy Generalized Obesity，MHGO)或代谢健康的腹型肥胖(Metabolically Healthy Abdominal Obesity，MHAO)是否与HUA相关。此外，尚未有研究证明肝酶对MHO和HUA的关联产生影响。肝酶是否会改变这一关联以及在多大程度上改变这一关联仍存在疑问。鉴于此，笔者拟基于钢铁工人的横断面研究数据，检验MHO与HUA之间的关联，并进一步探讨肝酶对上述关联的影响，以期提高对于肥胖相关代谢紊乱的认知，以及为钢铁工人制定更精准的预防和治疗HUA的策略。
1 钢铁工人HUA和肝酶指标统计
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1.1 钢铁工人信息采集
2017年，以参加职业健康体检的河北钢铁集团唐钢公司7 661名钢铁工人为研究对象；将签署知情同意书且工龄在1年以上的钢铁工人纳入研究，排除包括未采血者和问卷信息缺失及异常者，共有符合要求的钢铁工人6 868名。
1.2 肥胖表型的评估
根据世界卫生组织建议的截断值，全身肥胖(Generalized Obesity，GO)诊断标准为：18.5 kg/m2≤BMI<25 kg/m2为体重正常，BMI≥25 kg/m2为肥胖[12]。考虑到只有66名研究对象(0.9%)的BMI<18.5 kg/m2，因此，将该组与正常体重组合并。腹型肥胖(Abdominal Obesity，AO)的诊断标准参照国际糖尿病联合会代谢综合征全球共识，男性腰围(Waist Circumference，WC)<90 cm，女性WC<80 cm为正常，男性WC≥90 cm，女性WC≥80 cm为腹型肥胖[13]。
根据2009年国际糖尿病联合会流行病学和预防工作组联合临时声明中包含的代谢指标，定义代谢状态，如果以下指标均无异常，则认为代谢健康。①收缩压(Systolic Blood Pressure，SBP)≥130 mmHg或舒张压(Diastolic Blood Pressure，DBP)≥85 mmHg或有高血压病史或接受过高血压治疗；②甘油三酯(Triglyceride，TG)≥1.7 mmol/L;③男性高密度脂蛋白胆固醇(High Density Lipoprotein Cholesterol，HDL-C)<1.0 mmol/L或女性HDL-C<1.3 mmol/L;④空腹血糖(Fasting Blood Glucose，FBG)≥5.6 mmol/L[14]。若上述任何一项或多项指标异常，则认为是代谢不健康。
根据BMI及代谢状态是否正常，将研究人群分为代谢健康非全身肥胖(Metabolically Healthy Non-Generalized Obesity，MHNGO)、代谢不健康型非全身肥胖(Metabolically Unhealthy Non-Generalized Obesity，MUNGO)、MHGO和代谢不健康全身肥胖(Metabolically Unhealthy Generalized Obesity，MUGO)4类。
根据WC和代谢状态是否正常分为：代谢健康非腹型肥胖(Metabolically Healthy Non-Abdominal Obesity，MHNAO)、代谢不健康非腹型肥胖(Metabolically Unhealthy Non-abdominal Obesity，MUNAO)、MHAO和代谢不健康腹型肥胖(Metabolically Unhealthy Abdominal Obesity，MUAO)[15]4类。
1.3 HUA的定义
血清尿酸作为HUA的诊断指标，诊断标准为：男性血清尿酸质量浓度>417 μmol/L(7.0 mg/dL)，女性>357 μmol/L(6.0 mg/dL)定义为HUA[16]。
1.4 肝酶异常的诊断标准
肝酶异常的定义为符合以下任意一项：ALT>33 U/L(男性)，ALT>25 U/L(女性)；AST>33 U/L(男性)，AST>25 U/L(女性)；谷酰转肽酶(Gamma-Glutamyl Transpeptidase，GGT)>60 U/L(男性)，GGT>40 U/L(女性)。此外，根据ALT(23 U/L)、AST(20 U/L)和GGT(26 U/L)的中位数进行分组，任意一种肝酶大于中位数则为肝酶异常[17]。
1.5 质量控制及相关变量的定义
问卷在正式使用前进行预调查和专家咨询。调查人员按照统一的标准和方法与研究对象进行面对面访谈，以收集资料。问卷内容包括性别、年龄、吸烟和饮酒情况、体育活动、饮食(根据阻止高血压饮食方法计算(Dietary Approaches to Stop Hypertension，DASH))、倒班作业、粉尘作业、噪声作业、高温作业和一氧化碳(CO)作业情况。相关变量的定义见文献[18]。
1.6 统计学方法
正态分布的连续变量采用均数±标准差( χ -±S)表示，偏态分布采用中位数(Median，M)和四分位间距(Inter Quartile Range，IQR)表示。组间比较采用t检验或方差分析(偏态分布采用Kruskal-Wallis检验)。计数资料以频数或占比表示，组间比较采用χ2检验。采用Logistic回归模型计算HUA的比值比(Odds Ratio，OR)及其95%置信区间(Confidence Interval，CI)。采用限制性立方样条(Restricted Cubic Spline，RCS)模型，其节点位于第25、50和75百分位进行趋势检验，校正潜在混杂因素，以检验BMI/WC(连续变量)和HUA(分类变量)之间的剂量-反应关系。数据分析采用SAS V.9.4软件。采用双侧检验，检验水准α=0.05。
2 肝酶对MHO与HUA的影响
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2.1 钢铁工人基本特征及HUA患病情况
6 868名钢铁工人按HUA分类的基本特征见表1，其中，最小年龄为22岁，最大年龄为60岁，平均年龄为44.6岁。这些工人的HUA患病率为33.1%，且按BMI和WC分类的肥胖率分别为54.3%和66.5%。
2.2 不同肥胖代谢表型与HUA之间的关系
在多因素Logistic回归分析中，模型1未校正；模型2校正年龄、性别；模型3进一步校正受教育程度、吸烟状况、饮酒状况、体力活动、DASH评分、倒班作业、粉尘作业、噪声作业、高温作业和CO作业；模型4进一步校正肝酶水平。结果显示，GO、AO、高血压、高TG、低HDL-C、2个代谢异常组分、3个代谢异常组分、4个代谢异常组分与HUA患病风险增加相关，肥胖和代谢指标对HUA的影响见表2。
不同肥胖表型(BMI和WC类别)对HUA的影响见表3。校正的混杂变量与表2相同。由表3可知：代谢健康全身肥胖和代谢不健康全身肥胖与HUA患病风险增加相关；代谢健康腹型肥胖和代谢不健康腹型肥胖与HUA患病风险增加相关。
在校正BMI、WC、年龄、性别、教育水平、吸烟状况、饮酒状况、身体活动、DASH评分、倒班作业、粉尘作业、噪声作业、高温作业和CO作业和肝酶水平后，BMI、WC与HUA的限制性立方样条模型如图1和图2所示。由图1和图2可知：BMI(P<0.05)/WC(P<0.001)与HUA存在非线性剂量-反应关系。
2.3 肝酶对不同肥胖表型与HUA关系的影响
肝酶对不同肥胖表型与HUA关系的影响见表4。根据肝酶中位数分类，肝酶正常的参与者中，MUGO(OR=2.41，95%CI:1.15~5.04)与HUA患病风险增加相关；肝酶异常的参与者中，代谢健康全身肥胖(MHGO:OR=3.52，95%CI:1.05~11.81)、代谢不健康全身肥胖(MUGO:OR=2.50，95%CI:1.35~4.63)、代谢健康腹型肥胖(MHAO:OR=2.50，95%CI:1.02~6.17)、代谢不健康腹型肥胖(MUAO:OR=3.14，95%CI:1.47~6.72)与HUA患病风险增加相关。不同肥胖表型与肝酶水平存在交互作用。
根据诊断标准分类：肝酶正常的参与者中，代谢不健康全身肥胖(MUGO:OR=2.10，95%CI:1.29~3.43)和代谢不健康腹型肥胖(MUAO:OR=2.19，95%CI:1.26~3.82)与HUA患病风险增加相关；肝酶异常的参与者中，代谢健康全身肥胖(MHGO:OR=2.19，95%CI:1.51~3.19)、代谢不健康全身肥胖(MUGO:OR=2.92，95%CI:2.28~3.74)和代谢不健康腹型肥胖(MUAO:OR=1.93，95%CI:1.13~3.37)与HUA患病风险增加相关。不同肥胖表型与肝酶水平存在交互作用。
3 MHO与HUA的关联影响分析
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在基于《京津冀职业人群健康状况队列研究》的钢铁工人人群基线资料研究中，MHO个体患HUA的风险显著增加。此外，GO仍然是独立于代谢不健康表型的HUA患病危险因素。肝酶水平可能改变MHO与HUA之间的关系，MHGO、MHAO对HUA的风险效应在肝酶升高的人群中更为明显。与此前研究结果一致，MHO与HUA之间存在显著关联[19]。此外，BMI/WC与HUA之间存在非线性的剂量反应关系。
肝酶水平可能改变肥胖表型与HUA之间的关系，MHGO、MHAO对HUA的风险影响在肝酶升高的人群中更为明显。以往研究表明：高肝酶水平与血清尿酸水平相关。MOLLA等[20]的横断面研究收集了410名孟加拉国成年人的血液样本，发现ALT和GGT与血清尿酸呈正相关。另一项研究也表明：在美国20岁及以上人群(非西班牙裔黑人除外)中，血清尿酸水平与ALT和AST显著相关[10]。此外，台湾一项基于人群的队列研究发现，肝功能参数血清总胆红素水平与新发HUA呈负相关[11]。肝酶正常组的MUGO钢铁工人发生HUA的风险高于肝酶异常组。因此，GO的钢铁工人代谢异常组分可能与肝酶存在交互作用。在未来，需要更多的研究探讨这些可能存在的机制。值得注意的是，文中还提供了新的证据，表明肝酶水平可能改变MHGO表型与HUA的关系，肝酶升高可能加剧MHGO导致HUA的风险。将肝酶纳入HUA肥胖表型的研究为医疗保健提供者提供更准确的信息来预测HUA的风险。
肝酶异常与不同肥胖表型之间的相互作用机制尚不清楚。一种可能的解释是，这2种疾病的共存可能共同诱发胰岛素抵抗，而胰岛素抵抗参与了HUA的发病机制[21]。越来越多的证据表明：代谢紊乱可双向诱导胰岛素抵抗，代谢健康/不健康的肥胖与胰岛素抵抗密切相关[22]。此外，肝酶水平和胰岛素抵抗之间的关系已经被证明。据报道，肝酶可能通过脂肪细胞因子谱诱导胰岛素抵抗[23]。也有证据表明：活跃的脂肪代谢引起脂肪细胞因子水平升高，导致氧化应激的发生。高水平的氧化应激反应会直接导致肝损伤的发生[24]。因此，氧化应激是肝酶和胰岛素抵抗之间的潜在机制之一。
本文存在以下优势：首先，使用BMI和WC来判定肥胖，相对全面地反映了钢铁工人的肥胖情况；其次，文中包含详细的人口统计学和临床指标信息，并以此作为可以校正的潜在混杂因素；最后，这是第一个证实肝酶水平可能改变MHO和HUA之间关系的研究，具有重要的临床和公共卫生学意义。尽管如此，还需要考虑到几个局限性。①这是一项横断面研究，肥胖表型与HUA的因果关系无法确定。②将代谢综合征与胰岛素抵抗相结合可以更精确地区分代谢健康和不健康的个体。但文中未评估胰岛素抵抗或胰岛素分泌水平，这导致一些没有代谢异常但仅有胰岛素抵抗的钢铁工人可能被忽略。但文中使用的是在临床中常见的代谢指标，并且该定义的有效性也已被证明[25]。③此前研究表明：体力活动对健康状况有益[26]。由于钢铁工人的劳动强度高，虽然已经对体力活动的信息进行了定量评估，但很难确定这2组体力活动的影响。④文中被试是北方的钢铁工人，将研究结果推广到其他人群时需要谨慎。
4 结论
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1) MHO表型，即MHGO和MHAO均与HUA的高患病风险相关。
2) 肝酶水平的升高常可能改变MHO与HUA之间的关系。
3) MHO对HUA的风险效应在肝酶升高的人群中更为明显。结果提示，MHO个体对肝酶的早期检测和干预将有利于降低HUA的患病风险。
基金
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  • 国家重点研发计划项目(2016YFC0900605)
文献
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doi: 10.16265/j.cnki.issn1003-3033.2024.02.1184
  • 接收时间：2023-08-12
  • 首发时间：2025-07-09
  • 出版时间：2024-02-28
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  • 收稿日期：2023-08-12
  • 修回日期：2023-11-11
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国家重点研发计划项目(2016YFC0900605)
作者信息
    1 华北理工大学 公共卫生学院，河北 唐山 063210
    2 清华大学 社会科学学院，北京 100084

通讯作者:

** 袁聚祥(1956—)，男，河北邢台人，博士，教授，主要从事职业流行病学等方面的研究。E-mail：。
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