血尿酸肌酐比值累积暴露与颈动脉斑块发生风险的前瞻性队列研究

doi:10.3969/j.issn.1006-7795.2024.02.016

首都医科大学学报 ›› 2024, Vol. 45 ›› Issue (2): 281-288.doi: 10.3969/j.issn.1006-7795.2024.02.016

血尿酸肌酐比值累积暴露与颈动脉斑块发生风险的前瞻性队列研究

金瑞^1,2，王金麒^1,2，许宗锴^1,2，刘玥叡静^1,2，赵小雨^1,2，陶丽新^1,2*

1.首都医科大学公共卫生学院流行病与卫生统计学系，北京 100069；2.北京市临床流行病学重点实验室，北京 100069

收稿日期:2023-08-29 出版日期:2024-04-21 发布日期:2024-04-25
通讯作者: 陶丽新 E-mail:taolixin@ccmu.edu.cn
基金资助:
国家自然科学基金项目（82073668， 81872708）。

Cumulative exposure of serum uric acid to serum creatinine ratio and the risk of carotid plaque： a prospective cohort study

Jin Rui1,2, Wang Jinqi1,2, Xu Zongkai1,2, Liu Yueruijing1,2, Zhao Xiaoyu1,2, Tao Lixin1,2*

1.Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing 100069, China； 2. Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China

Received:2023-08-29 Online:2024-04-21 Published:2024-04-25
Supported by:
This study was supported by the National Natural Science Foundation of China (82073668, 81872708).

摘要/Abstract

摘要： 目的探究血清尿酸肌酐比值（serum uric acid to serum creatinine ratio，SUA/Scr）累积暴露指标与颈动脉斑块发生的关联。方法选取北京健康管理队列的体检者作为研究对象，纳入符合纳排标准者共计9 228例。以2010年至2011年（体检1）、2012年至2013年（体检2）、2014-2015年（体检3）3次体检的SUA/Scr值计算累积暴露量、累积暴露负担和高暴露时间。随访中通过颈动脉超声诊断颈动脉斑块，随访至2021年12月31日。应用Logistic回归模型分析SUA/Scr累积暴露指标与颈动脉斑块发生的关联，而后排除服用降压药或降糖药或降脂药的人群进行敏感性分析。结果本研究人群平均年龄（48.89±10.22）岁，其中男性5 846（63.35%）例，将其按SUA/Scr累积暴露四分位数分组，分别为Q1~Q4组。矫正协变量后，与Q1相比，Q2、Q3、Q4组发生颈动脉斑块的比值比分别为1.221 （95%CI：1.066~1.400）、1.255（95%CI：1.095~1.439）、1.478 （95%CI：1.287~1.697）。累积暴露负担大于0（OR=1.223，95%CI：1.109~1.349）和高暴露时间为6年（OR=1.332，95%CI：1.171~1.515）均与颈动脉斑块发生风险的增加相关。排除服用降压药或降糖药或降脂药的人群进行敏感性分析后，上述结论仍然成立。结论 SUA/Scr累积暴露、累积暴露负担和高暴露时间均与颈动脉斑块的发生风险增加存在关联。颈动脉斑块的一级预防不仅要关注单一时点的SUA/Scr值，而且要对SUA/Scr值展开长期监测。

关键词: 血尿酸肌酐比值, 累积暴露, 颈动脉斑块, 队列研究

Abstract: Objective To explore the association between cumulative exposure indicators of serum uric acid to serum creatinine ratio (SUA/Scr) and incident carotid plaque. Methods This study included 9 228 individuals who met the inclusion and exclusion criteria from the Beijing Health Management Cohort. The cumulative exposure, cumulative exposure burden and high exposure time of SUA/Scr were calculated based on the values of SUA/Scr in three physical examinations in 2010 to 2011 (visit 1), 2012 to 2013 (visit 2), and 2014 to 2015 (visit 3). Carotid plaque was diagnosed by carotid ultrasound, and the follow-up was until December 31, 2021. Logistic regression model was used to analyze the association between SUA/Scr cumulative exposure indicators and carotid plaque occurrence, and sensitivity analysis was performed by excluding the participants with the usage of antihypertensive drugs, or glucose-lowering drugs, or lipid-lowering drugs. Results The mean age of the study population was (48.89±10.22) years, and 5 846(63.35%) participants were males. The participants were divided into four groups according to the quartiles of SUA/Scr cumulative exposure, namely Q1-Q4 groups. After adjusting for covariates in models, compared with Q1 group, the ORs (95%CIs) of incident carotid plaque in Q2, Q3 and Q4 groups were 1.221 (95%CI：1.066-1.400), 1.255(95%CI： 1.095-1.439) and 1.478 (95%CI：1.287-1.697). Cumulative exposure burden greater than 0 (OR=1.223，95%CI：1.109-1.349) and high exposure time of 6 years (OR=1.332，95%CI：1.171-1.515) were both associated with increased risk of carotid plaque occurrence. Sensitivity analysis excluded participants with the usage of any antihypertensive drugs, glucose-lowering drugs, or lipid-lowering drugs. The results were similar to those in main analysis. Conclusion Cumulative exposure, cumulative exposure burden and high exposure time of SUA/Scr were associated with increased risk of incident carotid plaque. In the primary prevention of carotid plaque, we should focus not only on SUA/Scr value at a single point time, but also on long-term monitoring of SUA/Scr values.

Key words: serum uric acid to serum creatinine ratio, cumulative exposure, carotid plaque, cohort study

中图分类号:

金瑞, 王金麒, 许宗锴, 刘玥叡静, 赵小雨, 陶丽新. 血尿酸肌酐比值累积暴露与颈动脉斑块发生风险的前瞻性队列研究[J]. 首都医科大学学报, 2024, 45(2): 281-288.

Jin Rui, Wang Jinqi, Xu Zongkai, Liu Yueruijing, Zhao Xiaoyu, Tao Lixin. Cumulative exposure of serum uric acid to serum creatinine ratio and the risk of carotid plaque： a prospective cohort study[J]. Journal of Capital Medical University, 2024, 45(2): 281-288.

参考文献

［1］ Bao X, Xu B, Lind L, et al. Carotid ultrasound and systematic coronary risk assessment 2 in the prediction of cardiovascular events［J］. Eur J Prev Cardiol, 2023, 30(10): 1007-1014.
［2］ Noubiap J J, Thomas G, Kamtchum-Tatuene J, et al. High-risk carotid plaques and incident ischemic stroke in patients with atrial fibrillation in the Cardiovascular Health Study［J］. Eur J Neurol, 2023, 30(7): 2042-2050.
［3］王晓君. 中国40岁及以上人群颈动脉粥样硬化流行病学特征及其与心血管疾病关系研究［D］. 武汉: 华中科技大学, 2018.
［4］ Valdivielso J M, Rodríguez-Puyol D, Pascual J, et al. Atherosclerosis in chronic kidney disease: more, less, or just different?［J］. Arterioscler Thromb Vasc Biol, 2019, 39(10): 1938-1966.
［5］ Li W, Wang Y, Ouyang S R, et al. Association between serum uric acid level and carotid atherosclerosis and metabolic syndrome in patients with type 2 diabetes mellitus［J］. Front Endocrinol (Lausanne), 2022, 13: 890305.
［6］ Sugiura T, Dohi Y, Takagi Y, et al. Increased impact of serum uric acid on arterial stiffness and atherosclerosis in females［J］. J Atheroscler Thromb, 2022, 29(11): 1672-1691.
［7］ Mastroiacovo D, Ettorre E, Mengozzi A, et al. Serum uric acid levels are associated with the echogenic features of carotid plaque vulnerability in elderly patients with atherosclerotic disease［J］. Metabolites, 2023, 13(6): 693.
［8］李琳, 谷永胜, 秦璐, 等. 正常血尿酸人群中血尿酸水平对颈动脉粥样硬化进展的影响：一项体检人群的10年队列研究［J］. 中国全科医学, 2022, 25(23): 2836-2843.
［9］高媛媛. 血尿酸与颈动脉内-中膜厚度的相关性研究［D］. 长春: 吉林大学, 2022.
［10］ Wang A X, Tian X, Wu S L, et al. Metabolic factors mediate the association between serum uric acid to serum creatinine ratio and cardiovascular disease［J］. J Am Heart Assoc, 2021, 10(23): e023054.
［11］ Piani F, Agnoletti D, Baracchi A, et al. Serum uric acid to creatinine ratio and risk of preeclampsia and adverse pregnancy outcomes［J］. J Hypertens, 2023, 41(8): 1333-1338.
［12］吴瑞鹏, 袁丙坤, 彭成, 等. 我国中老年人群血清尿酸/肌酐比值与代谢综合征的关联研究［J］. 中国慢性病预防与控制, 2023, 31(6): 438-443.
［13］宋永健, 杜鑫, 郑梦伊, 等. 低密度脂蛋白胆固醇累积暴露对新发急性心肌梗死影响的前瞻性队列研究［J］. 中国循环杂志, 2020, 35(3): 246-253.
［14］ Tian X, Wang A X, Zuo Y T, et al. Time course of serum uric acid accumulation and the risk of diabetes mellitus［J］. Nutr Diabetes, 2022, 12(1): 1.
［15］韩泽, 赵小雨, 许宗锴, 等. 空气污染物时间加权个体暴露与颈动脉内中膜厚度的关系［J］. 环境与职业医学, 2023, 40(3): 289-295, 303.
［16］ Wang P, Liao G H, Wu X, et al. Brachial-ankle pulse wave velocity as a risk factor for high body fat mediated by blood pressure［J］. Clin Exp Hypertens, 2023, 45(1): 2197568.
［17］ Wu Z Y, Zhou D, Liu Y, et al. Association of TyG index and TG/HDL-C ratio with arterial stiffness progression in a non-normotensive population［J］. Cardiovasc Diabetol, 2021, 20(1): 134.
［18］ Chobanian A V, Bakris G L, Black H R, et al. The seventh report of the joint National committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report［J］. JAMA, 2003, 289(19): 2560-2572.
［19］ Zhu J J, Zhang Y, Wu Y L, et al. Obesity and dyslipidemia in Chinese adults: a Cross-Sectional study in Shanghai, China［J］. Nutrients, 2022, 14(11): 2321.
［20］中国医师协会超声医师分会. 血管超声检查指南［J］. 中华超声影像学杂志, 2009, 8(10): 11-920.
［21］ Liu X M, Wang Y, Wu J W, et al. Association between cumulative exposure to increased Low-Density lipoprotein cholesterol and the new occurrence of peripheral artery disease［J］. Front Neurol, 2021, 12: 696695.
［22］ Guan X M, Shi H P, Xu S, et al. Cumulative non-high-density lipoprotein cholesterol burden and risk of atherosclerotic cardiovascular disease: a prospective community-based study［J］. Front Cardiovasc Med, 2023, 10: 1105342.
［23］ Wu Y T, Xu W Q, Guo L, et al. Association of the time course of Chinese visceral adiposity index accumulation with cardiovascular events in patients with hypertension［J］. Lipids Health Dis, 2023, 22(1): 90.
［24］ Wang X A, Feng B Y, Huang Z G, et al. Relationship of cumulative exposure to the triglyceride-glucose index with ischemic stroke: a 9-year prospective study in the Kailuan cohort［J］. Cardiovasc Diabetol, 2022, 21(1): 66.
［25］ Kimura Y, Tsukui D, Kono H. Uric acid in inflammation and the pathogenesis of atherosclerosis［J］. Int J Mol Sci, 2021, 22(22): 12394.
［26］ Yu M A, Sánchez-Lozada L G, Johnson R J, et al. Oxidative stress with an activation of the renin-angiotensin system in human vascular endothelial cells as a novel mechanism of uric acid-induced endothelial dysfunction［J］. J Hypertens, 2010, 28(6): 1234-1242.
［27］ Song P G, Fang Z, Wang H Y, et al. Global and regional prevalence, burden, and risk factors for carotid atherosclerosis: a systematic review, meta-analysis, and modelling study［J］. Lancet Glob Health, 2020, 8(5): e721-e729.

血尿酸肌酐比值累积暴露与颈动脉斑块发生风险的前瞻性队列研究

Cumulative exposure of serum uric acid to serum creatinine ratio and the risk of carotid plaque： a prospective cohort study

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