Chinese General Practice ›› 2022, Vol. 25 ›› Issue (23): 2836-2843.DOI: 10.12114/j.issn.1007-9572.2022.0279

• Article • Previous Articles     Next Articles

Serum Uric Acid and the Progression of Carotid Atherosclerosis: Association in a 10-year Chinese Cohort Study of a Health Check-up Population with Normal Uric Acid Levels

  

  1. 1Graduate School, Hebei Medical University, Shijiazhuang 050017, China
    2Department of Neurology, Hebei General Hospital Affiliated to Hebei Medical University, Shijiazhuang 050051, China
  • Received:2022-01-07 Revised:2022-04-20 Published:2022-08-15 Online:2022-05-26
  • Contact: Hebo WANG
  • About author:
    LI L, GU Y S, QIN L, et al. Serum uric acid and the progression of carotid atherosclerosis: association in a 10-year Chinese cohort study of a health check-up population with normal uric acid levels[J]. Chinese General Practice, 2022, 25 (23) : 2836-2843.

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

  

  1. 1050017 河北省石家庄市,河北医科大学研究生学院
    2050051 河北省石家庄市,河北医科大学附属河北省人民医院神经内科
  • 通讯作者: 王贺波
  • 作者简介:
    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. [www.chinagp.net] 作者贡献:李琳、王贺波提出研究命题与研究思路,进行研究方案的构思与设计;李琳、谷永胜、王贺波负责实施研究、结果的解读;李琳、谷永胜、秦璐、何伟亮、范红珍、张凯华、孙莹茹、赵万年负责数据收集;李琳、谷永胜、秦璐、范红珍、张凯华、赵万年负责数据整理;李琳、谷永胜负责统计学分析、数据处理、绘制图表;李琳、何伟亮、牛小莉、魏慈、李俐涛、王贺波负责论文的修订;王贺波负责文章的质量控制及审校,研究经费的支持与写作指导,并对文章整体负责,监督管理。
  • 基金资助:
    国家自然科学基金资助项目(81801312); 河北省科学自然基金重点项目(H2020307041); 2020年政府资助临床医学人才培养项目计划

Abstract:

Background

It is considered that serum uric acid (SUA), which may induce oxidative stress and vascular endothelial dysfunction, has a potential association with atherosclerosis, but it has not been fully clarified.

Objective

To investigate the association of high normal SUA level with the progression of carotid atherosclerosis.

Methods

A retrospective cohort design was used. Participants (n=7 074) were individuals who received two or more times of health examinations in Physical Examination Center, Hebei General Hospital from 2010 to 2019. All of them had no carotid atherosclerosis with normal SUA levels〔classified into quartiles of SUA: quartile 1 (n=1 794), quartile 2 (n=1 752), quartile 3 (n=1 785) and quartile 4 (n=1 743) 〕 at the enrolment. General information, physical examination, laboratory test indicators and carotid ultrasound indicators were collected. A follow-up was conducted with them until December 2019 with the prevalence of progression of carotid atherosclerosis〔defined as carotid intima-media thickness (cIMT) greater than 1 mm or carotid atherosclerosis prevalence detected by carotid ultrasound〕 as the endpoint. Cox regression analysis was used to explore the association of SUA with carotid atherosclerosis.

Results

Among the participants, 1 476 (20.86%) showed progression of carotid atherosclerosis. The prevalence of carotid atherosclerosis progression in quartiles 1-4 was 17.50% (314/1 794), 21.12% (370/1 752), 21.79% (389/1 785) and 23.12% (403/1 743), respectively, demonstrating a trend of growth with the increase in SUA level (χ2trend=3.58, P<0.001). After adjusting for confounding factors, Cox regression analysis showed that the risk of carotid atherosclerosis progression in quartile 4 group was higher than that in quartile 1 group〔HR=1.46, 95%CI (1.06, 2.01), P<0.05〕. Further analysis revealed that the risk of carotid atherosclerosis progression was higher in those aged less than 60 years〔HR=1.68, 95%CI (1.15, 2.45), P<0.05〕, men〔HR=1.52, 95%CI (1.04, 2.22), P<0.05〕, non-smokers〔HR=2.12, 95%CI (1.21, 3.71), P<0.05〕, non-drinkers〔HR=1.78, 95%CI (1.13, 2.79), P<0.05〕, those without metabolic syndrome〔HR=1.51, 95%CI (1.02, 2.23), P<0.05〕, and those with BMI≤24.0 kg/m2HR=1.75, 95%CI (1.09, 2.81), P<0.05〕 in quartile 4 group in comparison with the corresponding conventional counterparts in quartile 1 group.

Conclusion

The increase of SUA level within the normal range may be associated with increased risk of carotid atherosclerosis, and the risk may be higher in those aged <60 years, men, smoking history, no drinking history, no metabolic syndrome, or having BMI≤24.0 kg/m2.

Key words: Carotid artery diseases, Carotid atherosclerosis, Uric acid, Carotid intima-media thickness, Carotid stenosis, Cohort studies, Physical examination

摘要:

背景

血尿酸(SUA)具有激活氧化应激、诱导血管内皮功能障碍等特性,被认为可能与动脉粥样硬化存在联系,但两者关系尚未完全明确。

目的

探究SUA水平在参考范围内升高是否会对颈动脉粥样硬化进展产生影响。

方法

采用回顾性队列研究,选取2010—2019年于河北省人民医院体检中心进行健康查体的人群,纳入基线无颈动脉粥样硬化且SUA水平在参考范围,并进行至少2次体检的7 074例受试者。收集受试者一般资料、体格检查指标、实验室检查指标、颈动脉超声等信息。受试者在随访中经颈动脉超声诊断为颈动脉内中膜厚度(cIMT)>1 mm或有颈动脉斑块形成则被认为出现颈动脉粥样硬化进展并结束随访。受试者若未出现颈动脉粥样硬化进展,则直至2019年12月随访结束。根据基线SUA水平的四分位数将受试者分为Q1组(n=1 794)、Q2组(n=1 752)、Q3组(n=1 785)、Q4组(n=1 743)。采用多因素Cox比例风险回归分析探究SUA对颈动脉粥样硬化进展的影响。

结果

7 074例受试者中,1 476例(20.86%)受试者出现颈动脉粥样硬化进展,其中Q1组、Q2组、Q3组、Q4组颈动脉粥样硬化进展发生率分别为17.50%(314/1 794)、21.12%(370/1 752)、21.79%(389/1 785)、23.12%(403/1 743),随着SUA水平在参考范围内升高,颈动脉粥样硬化进展发生率逐渐升高(χ2趋势=3.58,P<0.001)。在调整混杂因素后,多因素Cox比例风险回归分析结果显示,Q4组颈动脉粥样硬化进展发生风险高于Q1组〔HR=1.46,95%CI(1.06,2.01),P<0.05〕;亚组分析结果显示,在年龄<60岁、男性、有吸烟史、无饮酒史、无代谢综合征、体质指数(BMI)≤24.0 kg/m2的受试者中,Q4组颈动脉粥样硬化进展发生风险高于Q1组〔HR=1.68,95%CI(1.15,2.45),P<0.05;HR=1.52,95%CI(1.04,2.22),P<0.05;HR=2.12,95%CI(1.21,3.71),P<0.05;HR=1.78,95%CI(1.13,2.79),P<0.05;HR=1.51,95%CI(1.02,2.23),P<0.05;HR=1.75,95%CI(1.09,2.81),P<0.05〕。

结论

SUA水平在参考范围内升高可增加颈动脉粥样硬化进展的风险,在年龄<60岁、男性、有吸烟史、无饮酒史、无代谢综合征、BMI≤24.0 kg/m2的人群中此作用效应更强。

关键词: 颈动脉疾病, 颈动脉粥样硬化, 尿酸, 颈动脉内膜中膜厚度, 颈动脉狭窄, 队列研究, 体格检查