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  • 张玄娥,顾蕾,张晓燕,等.上海杨浦中老年社区人群内脏脂肪指数和脂质蓄积指数与血尿酸的相关性[J].同济大学学报(医学版),2020,41(2):185-191.    [点击复制]
  • ZHANG Xuan-e,GU Lei,ZHANG Xiao-yan,et al.Associations of lipid accumulation product, visceral adiposity index with serum uric acid levels in middle-aged and elderly people[J].同济大学学报(医学版),2020,41(2):185-191.   [点击复制]
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上海杨浦中老年社区人群内脏脂肪指数和脂质蓄积指数与血尿酸的相关性
张玄娥,顾蕾,张晓燕,王博,张雪莲,郭凯,周尊海
0
(同济大学附属杨浦医院内分泌科,上海200090)
摘要:
目的探讨内脏脂肪指数(visceral adiposity index, VAI)、脂质蓄积指数(lipid accumulation product, LAP)与血尿酸(serum uric acid, SUA)水平的关系,评估其对高尿酸血症(hyperuricemia, HUA)预测的有效性。方法选取2016年4月—2016年7月在上海市杨浦区进行流行病学调查观察人群868人为研究对象。根据SUA水平四分位进行分组,比较组间BMI、腰围(WC)、臀围(HC)、腰臀比(WHR)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、餐后2h血糖(2hPG)、空腹胰岛素(FINS)、餐后2h胰岛素(2hINS)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血肌酐(Cr)、HOMA胰岛素抵抗指数(HOMA-IR)、HOMA胰岛素敏感性指数(HOMA-ISI)、LAP和VAI等指标的差异。采用多因素Logistic回归分析方法筛选与HUA关系密切的变量。以受试者工作曲线(ROC)分析体脂指标VAI、LAP对HUA风险预测有效性。结果随着SUA水平的升高,HOMA-IR逐渐增加(P<0.05),HOMA-ISI降低(P<0.001),LAP和VAI逐渐升高(P均<0.01)。SUA水平与体重、BMI、WC、HC、WHR、DBP、SBP、FINS、2hINS、HOMA-IR、TG、Cr、LAP、VAI呈显著正相关(P均<0.01),与TC、HDL-C、HOMA-ISI呈显著负相关(P均<0.05)。根据LAP和VAI的四分位将研究对象分组,在校正性别、年龄、吸烟、饮酒、血压、血糖、胰岛素水平、血脂、血Cr等因素后,LAP第3和第4分位组发生HUA的风险分别为3.164(95%CI:1.62~6.18)、4.131(95%CI:1.913~8.921)(P均<0.01);VAI第3和第4分位组发生HUA的风险分别为2.22(95%CI:1.197~4.115)、3.955(95%CI:2.159~7.245)(P均<0.05)。ROC分析显示,LAP和VAI评估HUA的曲线下面积(AUC)分别为0.673(95%CI:0.630~0.716,P<0.001)和0.645(95%CI:0.599~0.691,P<0.001),VAI、LAP及HOMA-IR三个指标联合可较好地在女性人群中识别HUA的风险。结论新型体脂指标LAP、VAI和SUA水平密切相关,LAP和VAI可作为HUA的独立预测因子。
关键词:  内脏脂肪指数  脂质蓄积指数  高尿酸血症
DOI:10.16118/j.1008-0392.2020.02.008
投稿时间:2019-10-23
基金项目:上海市自然科学基金面上项目(18ZR1435800); 中央高校基本科研业务费专项资金资助项目(22120180034)
Associations of lipid accumulation product, visceral adiposity index with serum uric acid levels in middle-aged and elderly people
ZHANG Xuan-e,GU Lei,ZHANG Xiao-yan,WANG Bo,ZHANG Xue-lia,GUO Kai,ZHOU Zun-hai
(Dept. of Endocrinology, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China)
Abstract:
ObjectiveTo investigate the association of serum uric acid(SUA)with lipid accu-mulation product(LAP)and visceral fat index(VAI),and to evaluate the effectiveness of LAP and VAI in predicting hyperuricemia(HUA). MethodsTotal 868 middle-aged and elderly residents from Shanghai Yangpu community were recruited in this cross-section study. The subjects were divided into quartile groups according to serum uric acid level. The difference of body mass index(BMI), waist circumference(WC), hip circumference(HC), waist to hip ratio(WHR), systolic blood pressure(SBP), diastolic blood pressure(DBP), fasting plasma glucose(FPG), 2-h postprandial glucose(2hPG), fasting insulin(FINS), 2-h postprandial insulin(2hINS), total cholesterol(TC), high-density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C), triglycerides(TG), serum creatinine(Cr), HOMA insulin resistance index(HOMA-IR), HOMA insulin sensitivity index(HOMA-ISI), LAP and VAI were compared in these 4 groups. Multivariate Logistic regression analysis was used to screen the variables closely related to hyperuricemia(HUA). The diagnostic value for HUA was evaluated by receiver operating character curve(ROC)analysis. ResultsWith the elevation of quartile levels of serum uric acid, the HOMA-IR increased(P<0.05), HOMA-ISI declined(P<0.001), LAP and VAI also increased gradually(all P<0.01). Serum uric acid level showed a significant positive correlation with body weight, BMI, WC, HC, WHR, DBP, SBP, FINS, 2hINS, HOMA-IR, TG, Cr, LAP and VAI, and a significant negative correlation with TC, HDL-C and HOMA-ISI(all P<0.05). After adjusting for gender, age, smoking, drinking, blood pressure, blood glucose, insulin, blood lipid, creatinine and other potential confounder,the risks of HUA in 3rd and 4th quantile of LAP group were increased relative to 1st quantile group(OR=3.164, 95%CI:1.62-6.18 and OR=4.131, 95%CI:1.913-8.921,respectively);and the risk of HUA in 3rd and 4th quantile of VAI group were increased relative to 1st quantile group(OR=2.22, 95%CI:1.197-4.115 and OR=3.955, 95%CI:2.159-7.245,respectively). The area under the ROC curve(AUC)of LAP and VAI in prediction of hyperuricemia were 0.673(95%CI:0.630-0.716, P<0.001)and 0.645(95%CI:0.599-0.691, P<0.001)respectively. The combination of VAI, LAP with HOMA-IR can better identify the risk of hyperuricemia in female population. ConclusionLAP and VAI are closely related to serum uric acid level. They are independent risk factors of HUA and may predict the occurrence of HUA.
Key words:  lipid accumulation product  visceral adiposity index  hyperuricemia

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