血清尿酸与高密度脂蛋白胆固醇比值与女性不孕的关系

doi:10.3969/j.issn.1006-7795.2025.02.022

首都医科大学学报 ›› 2025, Vol. 46 ›› Issue (2): 348-355.doi: 10.3969/j.issn.1006-7795.2025.02.022

血清尿酸与高密度脂蛋白胆固醇比值与女性不孕的关系

简焕玲^1,2，戴梓¹，岑肖丽³，陈慧玲⁴，刘志文⁵，赵颖^6*

1.广州中医药大学第一临床医学院一妇科，广州 510405；2.广州中医药大学第三附属医院教育科研部，广州 510378；3.广州中医药大学第三附属医院一妇科，广州 510378；4.深圳市宝安区中医院生殖健康科，广东深圳 518133；5.广州中医药大学第三临床医学院创伤骨科，广州 510378；6.广州中医药大学第一附属医院妇儿中心，广州 510405

收稿日期:2024-09-30 出版日期:2025-04-21 发布日期:2025-04-14
通讯作者: 赵颖 E-mail:drzhaoying@126.com
基金资助:
广东省基础与应用基础研究基金自然科学基金项目（2024A1515012161），广东省基础与应用基础研究基金省企联合基金项目（2023A1515220247），广东省中医药局基金项目（20231170）。

The relationship between the serum uric acid to high density lipoprotein-cholesterol ratio and female infertility

Jian Huanling^1，2 , Dai Zi¹，Cen Xiaoli³，Chen Huiling⁴，Liu Zhiwen⁵，Zhao Ying^6*

1.First Department of Gynecology,The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, China；2. Department of Education and Scientific Research, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510378, China；3. First Department of Gynecology, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510378, China；4. Department of Reproductive Health，Shenzhen Bao’an Chinese Medicine Hospital，Shenzhen 518133, Guangdong Province, China; 5. Trauma Orthopedics,The Third Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou 510378, China; 6. Women and Children's Center，The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China

Received:2024-09-30 Online:2025-04-21 Published:2025-04-14
Supported by:
This study was supported by Guangdong Basic and Applied Basic Research Foundation Natural Science Foundation Project (2024A1515012161), Guangdong Basic and Applied Basic Research Foundation Provincial-Enterprise Joint Fund (2023A1515220247), Guangdong Provincial Administration of Traditional Chinese Medicine Fund Project (20231170).

摘要/Abstract

摘要： 目的横断面研究血清尿酸（serum uric acid,sUA）与高密度脂蛋白胆固醇（high density lipoprotein-cholesterol, HDL-C）比值（sUA to HDL-C ratio, UHR）与女性不孕之间的关系。方法分析来自美国国家健康与营养调查（National Health and Nutrition Examination Survey，NHANES）数据库中2013~2018年2 963例年龄在18~45岁之间的女性参与者。使用多变量逻辑回归模型评估UHR与不孕症之间的关联性，调整多种混杂因素，通过亚组分析和限制性立方样条（restricted cubic spline, RCS）模型探讨其相互作用和剂量反应关系，利用受试者工作特征（receiver operating characteristics, ROC）曲线分析评估UHR对不孕症的预测价值。结果不孕症女性的基线UHR（9.68±4.23）显著高于未患不孕症的女性（8.7±3.81，P<0.001）。多变量逻辑回归分析显示，UHR处于最高四分位数（Q4）的女性与最低四分位数（Q1）相比，患不孕症的概率显著增加。不同模型中调整后的OR范围为1.61（95% CI: 1.14~2.28）到1.98（95% CI: 1.42~2.78）（趋势P<0.001）。亚组分析显示，这些关联在不同年龄组、体质量指数（body mass index, BMI）和种族群体中具有一致性。RCS模型显示，UHR与不孕症风险之间存在显著的线性剂量-反应关系（非线性P=0.03，总体关联P<0.001）。ROC分析表明，UHR在预测女性不孕状态方面具有中等能力，其曲线下面积（area under the curve, AUC）为0.570。结论较高的UHR与女性不孕风险增加显著相关，UHR具有作为女性不孕症风险预测生物标志物的潜力。

关键词: 血清尿酸, 高密度脂蛋白胆固醇, 血清尿酸与高密度脂蛋白胆固醇比, 不孕, NHANES, 预测, 生物标志物

Abstract: Objective To conduct a cross-sectional study on the relationship between the serum uric acid (sUA) to high density lipoprotein-cholesterol (HDL-C) ratio (UHR) and female infertility. Methods We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2013—2018 cycle, examining 2,963 women aged 18 to 45 years.A multivariable Logistic regression model was used to assess the association between UHR and infertility, adjusting for various confounding factors. The study also explored interactions and dose-response relationships through subgroup analyses and restricted cubic spline (RCS) models, and evaluated the predictive value of UHR for infertility by using receiver operating characteristic (ROC) curve analysis. Results The results showed that the prevalence of infertility was significantly higher among women with elevated UHR. Baseline characteristics revealed that the mean UHR in women with infertility (9.68±4.23) was significantly higher than in those without infertility (8.7±3.81, P<0.001). Multivariable Logistic regression analysis indicated that women in the highest quartile (Q4) of UHR had a significantly increased likelihood of infertility compared to those in the lowest quartile (Q1), with adjusted odds ratios (ORs) ranging from 1.61 (95% CI: 1.14－2.28) to 1.98 (95% CI: 1.42－2.78) across different models (P for trend<0.001). Subgroup analyses demonstrated that these associations were consistent across different age groups, body mass index (BMI) categories, and racial groups. The RCS model showed a significant linear dose-response relationship between UHR and infertility risk (nonlinear P=0.03, overall association P<0.001). Additionally, ROC analysis indicated that UHR had a moderate ability to discriminate infertility status, with an area under the curve (AUC) of 0.570. Conclusion A higher UHR is significantly associated with an increased risk of female infertility，and UHR has the potential to serve as a predictive biomarker for the risk of female infertility.

Key words: serum uric acid, high density lipoprotein-cholesterol, uric acid to high density lipoprotein-cholesterol ratio, infertility, NHANES, forecast, biomarker

中图分类号:

R715

简焕玲, 戴梓, 岑肖丽, 陈慧玲, 刘志文, 赵颖. 血清尿酸与高密度脂蛋白胆固醇比值与女性不孕的关系[J]. 首都医科大学学报, 2025, 46(2): 348-355.

Jian Huanling , Dai Zi, Cen Xiaoli, Chen Huiling, Liu Zhiwen, Zhao Ying. The relationship between the serum uric acid to high density lipoprotein-cholesterol ratio and female infertility[J]. Journal of Capital Medical University, 2025, 46(2): 348-355.

参考文献

［1］杨一华，黄国宁，孙海翔，等. 不明原因不孕症诊断与治疗中国专家共识［J］. 生殖医学杂志，2019, 28(9): 984-992.
［2］Carson S A，Kallen A N. Diagnosis and management of infertility：a review ［J］. JAMA, 2021, 326(1): 65-76.
［3］Sun H，Gong T T，Jiang Y J，et al. Global，regional，and national prevalence and disability-adjusted life-years for infertility in 195 countries and territories，1990—2017：results from a global burden of disease study，2017 ［J］. Aging(Albany NY), 2019, 1(23) : 10952-10991.
［4］Chandra A, Copen C E, Stephen E H. Infertility and impaired fecundity in the United States，1982—2010：data from the National Survey of Family Growth［J］. Natl Health Stat Report, 2013, 14(67): 1-18, 1 p following 19.
［5］宋美杉，连方. 中医特色疗法在女性不孕症中的应用研究［J］. 中国中医基础医学杂志，2022，28(4): 654-657.
［6］Xu J，Du X，Zhang S L，et al. Diagnostic value of uric acid to high density lipoprotein-cholesterol ratio in abdominal aortic aneurysms［J］. Ann Med, 2024, 56(1): 2357224.
［7］Bazmandegan G，Dehghani M H，Karimifard M，et al. Uric acid to HDL ratio：a marker for predicting incidence of metabolic syndrome in patients with type Ⅱ diabetes［J］. Nutr Metab Cardiovasc Dis, 2024, 34(4): 1014-1020.
［8］卢周裕，吴瑞鹏，章梦君，等. 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［J］. 现代预防医学, 2024, 51(14): 2507-2512，2547.
［9］Deng F X，Jia F，Sun Y，et al. Predictive value of the serum uric acid to high density lipoprotein-cholesterol ratio for culprit plaques in patients with acute coronary syndrome［J］. BMC Cardiovasc Disord, 2024, 24(1): 155.
［10］Zhou X H，Xu J. Association between serum uric acid-to-high density lipoprotein-cholesterol ratio and insulin resistance in patients with type 2 diabetes mellitus［J］. J Diabetes Investig, 2024, 15(1): 113-120.
［11］Yang Y，Zhang J，Jia L，et al. Uric acid to high density lipoprotein-cholesterol ratio predicts adverse cardiovascular events in patients with coronary chronic total occlusion［J］.Nutr Metab Cardiovasc Dis, 2023, 33(12): 2471-2478.
［12］Nazir S，Jankowski V，Bender G，et al. Interaction between high-density lipoproteins and inflammation：function matters more than concentration! ［J］. Adv Drug Deliv Rev, 2020, 159: 94-119.
［13］Shenta A，Saud K，Al-Shawi A. Assessment the correlations of hormones，lipid profiles，oxidative stress，and zinc concentration in Iraqi women with polycystic ovary syndrome［J］. Rep Biochem Mol Biol, 2020, 9(3): 270-277.
［14］McGuire S. Frayar，D.C，Ervin，R.B. Caloric intake from fast food among adults：United States，2007—2010. NCHS Data Brief，No. 114，February 2013. Hyattsville，MD：National Center for Health Statistics, 2013［J］. Adv Nutr, 2013, 4(5): 578.
［15］Yang T L，Zhao J，Liu F，et al. Lipid metabolism and endometrial receptivity［J］. Hum Reprod Update, 2022, 28(6): 858-889.
［16］Szczuko M, Kikut J, Szczuko U, et al. Nutrition strategy and life style in polycystic ovary syndrome—narrative review［J］. Nutrients, 2021, 13(7): 2452.
［17］Barter P. The role of HDL-cholesterol in preventing atherosclerotic disease［J］. Eur Heart J Suppl, 2005, 7(Suppl F): F4-F8.
［18］Kaltsas A. Oxidative stress and male infertility：the protective role of antioxidants［J］. Medicina(Kaunas), 2023, 59(10): 1769.
［19］Coussa A，Hasan H A，Barber T M. Impact of contraception and IVF hormones on metabolic，endocrine, and inflammatory status［J］. J Assist Reprod Genet, 2020, 37(6): 1267-1272.
［20］Mu L S, Pan J X, Yang L L, et al. Association between the prevalence of hyperuricemia and reproductive hormones in polycystic ovary syndrome［J］. Reprod Biol Endocrinol, 2018, 16(1): 104.
［21］Wang G Q，Yang H Y，Jiang X T，et al. Association of serum uric acid with women's ovarian reserve：observational study and Mendelian randomization analyses［J］.Fertil Steril, 2024, 122(1): 162-173.
［22］Livingston J R，Payne B，Brown M，et al. Uric acid as a predictor of adverse maternal and perinatal outcomes in women hospitalized with preeclampsia［J］. J Obstet Gynaecol Can, 2014, 36(10): 870-877.
［23］Moolhuijsen L M E，JVisser J A. Anti-müllerian hormone and ovarian reserve: update on assessing ovarian function［J］. J Clin Endocrinol Metab, 2020, 105(11): 3361-3373.
［24］Tsiapakidou S，Mahmood T，Savona-Ventura C. The potential impact of tobacco use on female fertility and pregnancy outcomes：an invited scientific review by EBCOG［J］. Eur J Obstet Gynecol Reprod Biol, 2023, 290: 85-87.
［25］Łakoma K，Kukharuk O， S′li D. The influence of metabolic factors and diet on fertility［J］. Nutrients, 2023, 15(5): 1180.
［26］Teede H J，Bailey C，Moran L J，et al. Association of antenatal diet and physical activity-based interventions with gestational weight gain and pregnancy outcomes: a systematic review and meta-analysis［J］. JAMA Intern Med, 2022, 182(2): 106-114.
［27］Norman R J，Davies M J，Lord J，et al. The role of lifestyle modification in polycystic ovary syndrome［J］. Trends Endocrinol Metab, 2002, 13(6): 251-257.
［28］Chiang S C，Abroms L C，Cleary S D，et al. E-cigarettes and smoking cessation：a prospective study of a national sample of pregnant smokers［J］. BMC Public Health, 2019, 19(1): 964.
［29］Popova S，Dozet D，Pandya E，et al. Effectiveness of brief alcohol interventions for pregnant women：a systematic literature review and meta-analysis［J］. BMC Pregnancy Childbirth，2023，23（1）：61.

[1]	马郡, 阮祥燕, 许仲婷, 赵越, 王月姣, Alfred O.Mueck. 来曲唑联合资癸女贞胶囊对多囊卵巢综合征子宫内膜薄性不孕患者的疗效观察[J]. 首都医科大学学报, 2025, 46(4): 632-636.
[2]	郭宇, 陈伟观, 周三连, 汤莉巧, 孙王妍, 张冬梅, 卢红建. 急性缺血性脑卒中患者血清糖蛋白非转移性黑色素瘤蛋白B蛋白浓度与疾病严重度及预后的相关性分析[J]. 首都医科大学学报, 2025, 46(4): 702-709.
[3]	李茜, 朱红, 叶梦, 吴研哲, 吴利, 麻微微. 相位角与中老年2型糖尿病患者肌少症的相关性研究[J]. 首都医科大学学报, 2025, 46(2): 340-347.
[4]	翁克霞, 李冰. 活化的白细胞黏附分子在狼疮性肾炎中的研究进展[J]. 首都医科大学学报, 2025, 46(1): 150-153.
[5]	杨芳远, 彭诗洁, 刘婧, 杨金奎, 朱晓蓉. 应用蛋白质组学探索2型糖尿病增殖期视网膜病变潜在生物标志物[J]. 首都医科大学学报, 2024, 45(3): 385-391.
[6]	刘亘梁, 于震维, 冯涛. 早发型帕金森病患者红细胞α-突触核蛋白水平及临床意义研究[J]. 首都医科大学学报, 2023, 44(5): 782-787.
[7]	于建宇, 郑义, 李文斌. 海马钙素类1在原发性中枢神经系统淋巴瘤中表达和临床预后的生物信息学分析[J]. 首都医科大学学报, 2023, 44(5): 724-732.

血清尿酸与高密度脂蛋白胆固醇比值与女性不孕的关系

The relationship between the serum uric acid to high density lipoprotein-cholesterol ratio and female infertility

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 7

编辑推荐

Metrics

本文评价