摘要
背景:近年来研究发现,高尿酸血症和痛风与糖尿病、冠心病、高血压及脑血管疾病的发生和发展关系密切。对其进行深入研究和早期干预,对上述疾病一级和二级预防均有重要意义。目的:明确山东沿海20岁以上居民高尿酸血症与痛风的患病情况及其影响因素。设计:随机、分层、整群抽样调查。单位:青岛大学医学院附属医院内分泌科。对象:调查范围为山东省沿海城市,包括青岛、日照、烟台、威海、东营。抽取年龄20～80岁本地常住(≥5年)居民,以家庭为单位的自然人群为调查对象。方法:采用随机、分层、整群抽样的方法,入户调查青岛、烟台、威海、日照、东营长住居民约5000人高尿酸血症与痛风的患病情况。采用Sysmexchemix-180型全自动生化分析仪测定血尿酸、血脂、血糖、血肌酐,试剂购自日本西斯美康公司,其中血尿酸批内和批间CV分别为1.77%和2.32%。尿酸值高于正常者,在第3天再次抽空腹血进行复查。率的比较采用χ2检验,两组间均数比较用t检验,多组间均数比较用方差分析,因变量与自变量的相关分析用logistic回归分析。主要观察指标:高尿酸血症患病率、血尿酸水平、高尿酸血症患者痛风发生率,以及高尿酸血症影响因素分析结果。结果:计划调查5500人,实调查5003人,应答率为90.96%,其中男性2395人(47.87%);女性2608人(52.13%)。①高尿酸血症的患病率13.19%,按照2000年山东人口标化率为13.27%;其中男性患病率高于女性(18.32%,8.56%,χ2=108.52,P<0.01),男性发病风险为女性2.5倍(OR=2.5)。痛风的患病率为1.14%,标化率为1.10%;其中男性患病率高于女性(1.94%,0.42%,χ2=30.38,P<0.01),男性发病风险为女性5.3倍(OR=5.3)。②正常人群男性血尿酸水平高于女性[(343.40±84.54),(258.90±70.90)μmol/L,t=48.03,P<0.01]。男性高尿酸血症患者血尿酸水平明显高于女性[(469.43±48.08),(399.73±104.91)μmol/L,t=11.70,P<0.01]。男性痛风患者血尿酸水平高于女性[(502.44±106.76),(403.48±52.72)μmol/L,t=2.07,P<0.05]。③高尿酸血症患者痛风的发生率为8.64%。④女性50岁以后高尿酸血症和痛风的患病率随年龄的增加而增高,70岁以上为高发年龄;而男性60岁以前随年龄的增加而增高,50～59岁为高发年龄段,60岁以后又随年龄的增加而增高。且女性高尿酸血症和痛风的平均年龄比男性分别晚7.5和8.5岁。⑤非条件logistic多元逐步回归分析显示饮酒频率、饮酒量、食贝类量及频率、尿素氮、血肌酐、三酰甘油、总胆固醇、体质量指数、腰臀比为男性高尿酸血症独立的危险因子,OR=1.016～30.217,95%CI(1.010～1.023)～(9.955～214.869);而高密度脂蛋白胆固醇和重体力劳动为保护因素,OR=0.492,95%CI0.339～0.713,OR=0.755,95%CI0.575～0.991。年龄、高血压、食贝类量、尿素氮、血肌酐、三酰甘油、腰臀比、轻体力活动为女性高尿酸血症独立的危险因子,OR=1.022～27.34,95%CI(1.006～1.040)～(9.955～214.869);同样高密度脂蛋白胆固醇为保护因素,OR=0.428,95%CI0.223～0.820。结论:①高尿酸血症和痛风患病率存在性别差异。②山东沿海居民高尿酸血症和痛风患病危险因素包括贝类等海产品高摄入、低体力活动、腹型肥胖、肾功能减退、代谢综合征有关,其中男性还与饮酒情况,女性还与年龄有关。③男性在各年龄段均是高尿酸血症和痛风患病的危险阶段,而女性则重点在50岁以后。
BACKGROUND： Recent studies have found that hyperuricemia and gout are closely correlated with the occurrence and development of diabetes, coronary heart disease, hypertension and cerebrovascular diseases. It is of significance to investigate their prevalence so as to find way of early interventions.OBJECTIVE： To determine the prevalence and risk factors of gout and hyperuricemia among residents above 20 years old in Shandong coastal area.DESIGN： A randomized, stratified cluster sampling survey.SETTING： Department of Endocrinology, Affiliated Hospital of Qingdao University Medical College.PARTICIPANTS： A random, stratified cluster sampling was conducted in Shandong coastal area including Qingdao,Yantai, Weihai, Rizhao and Dongying. Residents lived in these areas for 5 years or more, aged between 20 to 80 years, were selected, and they were surveyed by family as a unit.METHODS： A randomized, stratified cluster sampling survey was conducted. The prevalence of gout and hyperuricemia were investigated among about 5 000 residents in Qingdao, Yantai, Weihai, Rizhao and Dongying. The serum uric acid, lipids, glucose and creatinine were detected with Sysmex chemix-180 total automatic biochemical analyzer. Those with uric acid higher than reference level were reexamined by collecting fasting blood sample on the third day. The comparison between rates was taken with the Chi-square test, means between two groups with the t test, means between multiple groups with analysis of variance, correlation between dependent and independent variables with logistic regression analysis.MATN OUTCOME MEASURES： Prevalance of hyperuricemia; Level of serum uric acid; Prevalence of gout in patients with hyperuricemia; Influencing factor of hyperuricemia.RESULTS： This investigation planned to include 5 500 subjects while in fact 5 003 subjects were investigated and the response rate was 91%, in which males were 2 395 （47.87%） and females were 2 608 （52.13%）. ① The prevalence of hyperuricemia was 13.19% with standardized rate of 13.27% according to the Shandong population in 2000; The pevalence was higher in males than in females （18.32%, 8.56%, x^2=108.52, P〈 0.01）. The risk in males was 2.5 times higher than that in females （OR =2.5）. The prevalence of gout was 1.14% with standardized rate of 1.10%; and the prevalence in males was higher than that in females （1.94%, 0.42%, x^2=30.38, P 〈 0.01）. The risk in males was 5.3 times higher than that in females （OR =5.3）. ②The average value of serum uric acid in normal males was higher than in normal females [（343.40±84.54）, （258.90±70.90） μmol/L, t =48.03, P 〈 0.01]. It was obviously higher in male patients with hyperuricemia than in female ones [（469.43±48.08）, （399.73±104.91） μmol/L, t =11.70, P 〈 0.01]. It was higher in male patients with gout than in female ones [（502.44±106.76）, （403.48±52.72） μmol/L, t =2.07, P 〈 0.05]. ③The prevalence of gout in patients with hyperuricemia was 8.34%. ④ The prevalence of hyperuricemia and gout were climbing up with age after 40 years old in females and those elder than 70 years old were of high risk; while in males,the prevalence of hyperuricemia and gout increased with age before 60 years old and those aged 50-59 years were of high risk, yet after 60 years, it climbed up with age again. Nevertheless, the mean ages of hyperuricemia and gout in females were older than male. The average episode ages of hyperuricemia and gout in females were later than in males respectively by 7.5 and 8.5 years. ⑤ Non-conditional Logistic regression analysis showed that drinking frequency,drinking quantity, the quantity and frequency of seashell intake, BUN, Cr, TG, TC, BMI and WHR were the independent risk factors of male patients with hyperuricemia [OR =1.016-30.217, 95%C/ （1.010-1.023）-（9.955-214.869）]; while HDL-C and heavy physical labour were the protective factors （OR =0.492, 95%C/ 0.339-0.713; OR =0.755, 95% CI 0.575-0.991）.As for females, age, hypertension, the quantity of seashell food intake, BUN, Cr, TG, WHR and light physical labour were the independent risk factors of hyperuricemia [OR =1.022-27.34, 95%CI （1.006-1.040）-（9.955-214.869）]. Similarly, HDL-C was a protective factor （OR =0.428, 95%CI0.223-0.820）.CONCLUSION： ① The prevalence of hyperuricemia and gout are different between genders： ② The risk factors of hyperuricemia and gout among residents in Shandong coastal area include the high intake of marine products such as seashell foods, less physical activity, abdominal obesity and kidney insufficiency, as well as the existence of metabolic syndrome. Drinking is also involved in the increased prevalence in males, and age in females. ③ Higher risk for hyperuricemia and gout are noticed in all age groups in males, whereas in females after 50 years old.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第30期6087-6091,共5页
Journal of Clinical Rehabilitative Tissue Engineering Research
基金
青岛市科技局攻关课题( 03-1-NY-14-1) 资助
国家自然科学基金课题的资助( 30470821)~~
作者简介
苗志敏,男,1952年生,山东省青岛市人,1976年青岛医学院毕业,教授,主要从事代谢综合征的研究.胜利,青岛大学医学院附属医院内分泌科,山东省青岛市 266003
闫胜利,青岛大学医学院附属医院内分泌科,山东省青岛市 266003 通讯作者
