韦庆臣+谭茹尹+杨海燕+李励+梁杏欢+秦映芬+罗佐杰

【摘要】目的探討中老年腹型肥胖患者血尿酸水平与代谢综合征（MS）的相关性。方法以参加REACTION 研究（广西部分）回访的腹型肥胖患者为研究对象。所有患者都有完整的问卷调查、体检和血清学检查资料。比较不同尿酸水平代谢综合征患病率的差异，并用Logistic回归模型分析尿酸水平与MS患病风险之间的关系。结果对入选的379 例腹型肥胖患者进行分析，男141 例，女238 例，年龄43.1～86.1岁，平均（62.3±9.7）岁。超重/肥胖（BMI≥25 kg/m2）患者272名，占总人数的71.77%（272/379）。高尿酸血症总体患病率为28.23%（107/379），其中男性患病率为47.52%（67/141），女性患病率为16.81%（40/238），男性患病率高于女性（χ2=41.216，P<0.001）。MS总体患病率为59.10%（224/379），其中男性患病率为66.67%（94/141），女性患病率为54.62%（130/238），男性患病率高于女性（χ2=5.314，P=0.021）。男性患者按尿酸水平四分位分组，MS患病率分别为60%、71.42%、62.85%、72.22%，各组患病率差异无统计学意义（P>0.05）；女性患者按尿酸水平四分位分组，MS患病率分别为36%、58.33%、56.66%、66.67%，第1四分位与第2、3、4四分位患病率差异有统计学意义（P值分别为0.013、0.021、0.001）。Logistic回归分析提示，经校正年龄后，男性患者尿酸水平与MS患病率无统计学关联（P=0.609）；女性患者尿酸水平和MS呈正相关（OR值1.045，P=0.005）。女性患者尿酸处于第2四分位（291.2～332.0 μmol/L）、第3四分位（332.0～395.3 μmol/L）和第4四分位（>395.3 μmol/L）MS患病率是第1四分位（<291.2 μmol/L）的2.3、2.2、3.2倍（P值分别为0.034、0.046、0.003）。结论尿酸水平与MS在腹型肥胖患者中存在性别差异，女性患者尿酸水平与MS患病率密切相关。

【关键词】腹型肥胖；高尿酸血症；代谢综合征

中图分类号：R589 文献标识码：ADOI：10.3969/j.issn.1003-1383.2017.04.002

【Abstract】ObjectiveTo investigate relationship between serum uric acid levels and metabolic syndrome（MS）in abdominal obesity patients.MethodsObesity patients who were paid return visit in the REACTION study（part of Guangxi）were selected as study objects.All patients had complete questionnaires，physical examinations and serological tests data.Then，the prevalence of metabolic syndrome was compared among different uric acid levels，and the relationship between uric acid levels and the risk of MS was analyzed by Logistic regression model.Results379 abdominal obesity patients were analyzed，141 of them were males and 238 were females，ages ranged from 43.1 to 86.1 years，mean（62.3±9.7）years.There were 272 overweight/obese（BMI≥25 kg/m2）patients，accounting for 71.77% of the total number（272/379）.The overall prevalence of hyperuricemia was 28.23%（107/379），among which the prevalence of males was 47.52%（67/141），and that of females was 16.81%（40/238），that of males was higher than that of females（χ2=41.216，P<0.001）.The overall prevalence of MS was 59.10%（224/379），among which the prevalence of males was 66.67%（94/141），and the prevalence of females was 54.62%（130/238），that of males was higher than that of females（χ2=5.314，P=0.021）.Male patients were divided into quartile groups according to uric acid levels，the prevalence of MS was 60%，71.42%，62.85% and 72.22%，respectively，difference was not statistically significant among each group（P>0.05）.Female patients were also divided into quartile groups based on uric acid levels，the prevalence of MS was 36%，58.33%，56.66% and 66.67% respectively，there was statistically significant difference between the prevalence at the first quartile，the second quartile，the third quartile and the fourth quartile（P was 0.013，0.021 and 0.001）.Logistic regression analysis showed that the levels of uric acid in male patients were not statistically related to the prevalence of MS after correcting for age（P=0.609）.The uric acid levels in female patients were positively correlated with MS（OR was 1.045，P=0.005）.The prevalence of uric acid in female patients at the second quartile（291.2～332.0 μmol/L），the third quartile（332.0～39.5.3 μmol/L） and the fourth quartile（>395.3 μmol/L） was 2.3，2.2 and 3.2 times of that（<291.2 μmol/L） at the first quartile（P=0.034，0.046 and 0.003，respectively）.ConclusionThere are gender-related differences in the correlation between uric acid level and MS in patients with abdominal obesity，and the uric acid levels in female patients are closely related to the prevalence of MS.endprint

【Key words】abdominal obesity；hyperuricemia；metabolic syndrome

随着社会经济的发展，我国膳食习惯和生活方式发生巨大变化，肥胖症的发病率也随之提高。据2011年一项全国性的调查结果显示，中国成年人腹型肥胖整体患病率为44%，其中成年男性患病率为35.3%，女性患病率达51.7%，腹型肥胖成为危害我国公民健康的重要因素[1]。腹型肥胖是代谢综合征（metabolic syndrome，MS）重要的组成部分，也是MS其他组分如高血压、高血脂和高血糖重要的危险因素。尿酸是人体嘌呤代谢的终末产物，尿酸与MS发病密切相关，高尿酸血症人群MS患病率是尿酸正常人群的3～7倍，血尿酸是MS独立的预测指标[2～4]。肥胖……