唐山市超重和肥胖儿童尿酸水平与心血管危险因素关系分析

李丹; 孙国华; 陈新春; 寇永妹

doi:10.16766/j.cnki.issn.1674-4152.002301

唐山市超重和肥胖儿童尿酸水平与心血管危险因素关系分析

doi: 10.16766/j.cnki.issn.1674-4152.002301

唐山市人民医院儿科，河北唐山 063001

基金项目:

河北省医学科学研究课题 20191599

详细信息

通讯作者:
李丹，E-mail: wancxc.123@163.com

中图分类号: R54 R446
计量
- 文章访问数: 403
- HTML全文浏览量: 109
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2021-01-24
- 网络出版日期: 2022-03-03

Relationship between uric acid level and cardiovascular risk factors in overweight and obese children in Tangshan City

Department of pediatrics, Tangshan Municipal People's Hospital, Tangshan, Hebei 063001, China

摘要

摘要: 目的了解唐山市超重、肥胖儿童尿酸水平与心血管危险因素间的关系，为预防高尿酸血症、降低心血管疾病罹患风险提供理论依据。方法以2018—2019年唐山市学龄儿童体检筛查出的560例超重、肥胖儿童为研究对象，测量身高、体重、腰围、血压(BP)，计算体重指数；检测尿酸(UA)、空腹血糖(FPG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)。以性别分层，采用偏相关分析、logistic回归分析UA与心血管危险因素间的关系。结果 (1) 男、女生高尿酸血症检出率分别为36.50%、26.26%(P < 0.05)；(2)随UA水平增高，男生SBP、DBP升高、HDL-C下降，女生SBP、FPG、TC、TG、LDL-C升高、HDL-C下降，组间差异有统计学意义(均P < 0.05)；(3)男生UA水平与HDL-C负相关(r=-0.154，P < 0.05)、与TG、SBP正相关(r=0.141、0.238，均P < 0.05)，女生UA水平与HDL-C负相关(r=-0.700，P < 0.05)、与LDL-C、TG正相关(r=0.615、0.341，均P < 0.05)；(4)男生高尿酸血症的影响因素为年龄、低HDL-C血症、空腹血糖异常、超重/肥胖；女生高尿酸血症的影响因素为年龄、高TC血症、低HDL-C血症、高TG血症、超重/肥胖、高血压。结论唐山地区超重、肥胖儿童UA水平与心血管危险因素相关；应定期监测超重、肥胖儿童尿酸水平变化。
- 超重 /
- 肥胖 /
- 尿酸 /
- 心血管疾病
Abstract: Objective To understand the relationship between uric acid level and cardiovascular risk factors in overweight and obesity children in Tangshan, and to provide theoretical basis for preventing hyperuricemia and reducing the risk of cardiovascular disease. Methods Total 560 overweight and obesity children screened by physical examination of school-age children in Tangshan City from 2018 to 2019 were taken as the research objects. Height, weight, waist circumference (WC), blood pressure (BP) were measured, body mass index (BMI) was calculated. Uric acid (UA), fasting blood glucose (FPG), total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) were detected. The relationship between uric acid and cardiovascular risk factors was analyzed by sex stratification. Results (1) The detection rates of boys and girls hyperuricemia were 36.50% and 26.26% respectively (P < 0.05). (2) With the increase of UA level, SBP and DBP increased and HDL-C decreased in boys, SBP, FPG, TC, TG, LDL-C increased and HDL-C decreased in girls, the difference between groups was statistically significant (all P < 0.05). (3) UA level in boys was negatively correlated with HDL-C (r=-0.154, P < 0.05), positively correlated with TG and SBP (r=0.141, 0.238, all P < 0.05), meanwhile UA level in girls was negatively correlated with HDL-C (r=-0.700, P < 0.05), and positively correlated with LDL-C and TG (r=0.615, 0.341, all P < 0.05). (4) The influencing factors of hyperuricemia in boys were age, low HDL-C, abnormal fasting blood glucose, overweight/obesity, meanwhile the influencing factors of hyperuricemia in girls were age, high TC, low HDL-C, high TG, overweight/obesity and hypertension. Conclusion UA level of overweight and obesity children in Tangshan City is related to cardiovascular risk factors. Uric acid levels of overweight and obesity children should be monitored regularly.
- Overweight /
- Obesity /
- Uric acid /
- Cardiovascular disease

HTML全文

表 1 超重、肥胖儿童基础资料比较

组别	例数	超重/肥胖(例)	年龄(x±s，岁)	UA(x±s，μmol/L)	TC(x±s，mmol/L)	TG[M(P₂₅, P₇₅), mmol/L]^c
男童	263	96/167	9.69±1.97	361.84±110.96	4.09±1.08	0.82(0.59~1.14)
女童	297	99/198	9.41±2.15	318.89±93.43	3.91±0.71	0.89(0.60~1.35)
统计量		0.617^a	1.586^b	4.920^b	2.259^b	-1.734^b
P值		0.432	0.113	< 0.001	0.024	0.083

组别	例数	HDL-C(x±s，mmol/L)	LDL-C(x±s，mmol/L)	FPG(x±s，mmol/L)	SBP(x±s，mm Hg)	DBP(x±s，mm Hg)
男童	263	1.36±0.34	2.82±0.77	5.34±0.88	109.32±9.62	69.92±8.52
女童	297	1.28±0.24	2.67±0.49	5.09±0.56	106.60±8.98	67.98±8.70
统计量		3.220^b	2.783^b	3.998^b	3.459^b	2.663^b
P值		0.001	0.006	< 0.001	0.001	0.008

组别	例数	心血管危险因素检出率[例(%)]
组别	例数	高血压	FPG异常	高TC血症	高TG血症	低HDL-C血症	高LDL-C血症
男童	263	78(29.66)	68(25.85)	27(10.27)	58(22.05)	30(11.41)	48(18.25)
女童	297	75(25.25)	42(14.14)	18(6.06)	84(28.28)	32(10.77)	39(13.13)
统计量		1.363^a	12.126^a	3.338^a	2.860^a	0.057^a	2.786^a
P值		0.243	< 0.001	0.068	0.091	0.812	0.095
注：^a为χ²值，^b为t值，^c为经对数转换后进行t检验。

下载: 导出CSV

表 2 不同尿酸水平心血管危险因素比较

组别	例数	男生
组别	例数	UA(μmol/L)	年龄(x±s，岁)	SBP(x±s，mm Hg)	DBP(x±s，mm Hg)	FPG(x±s，mmol/L)	TC(x±s，mmol/L)	TG[(M(P₂₅, P₇₅)，mmol/L]^b	HDL-C(x±s，mmol/L)	LDL-C(x±s，mmol/L)
第1分位	66	< 277	8.86±1.64^a	105.83±7.17^a	67.70±6.53^a	5.30±1.01	3.93±0.65	0.74(0.56~0.96)^c	1.42±0.27^a	2.72±0.48
第2分位	66	277~348	9.35±1.83^a	108.09±8.63^a	69.42±8.00	5.29±0.73	4.05±0.71	0.79(0.65~0.96)^c	1.44±0.52	2.83±0.50
第3分位	68	348~457	9.44±1.78^a	109.07±9.37^a	69.74±8.09	5.33±0.62	4.15±1.68	1.02(0.68~1.26)	1.33±0.24	2.84±1.21
第4分位	63	> 457	11.19±1.86	114.54±11.06	72.95±10.47	5.48±1.11	4.23±0.91	0.88(0.50~1.24)	1.27±0.21	2.91±0.63
F值		20.901	10.458	4.405	0.638	0.969	3.655	3.656	0.640
P值		< 0.001	< 0.001	0.005	0.591	0.408	0.013	0.013	0.590

组别	例数	女生
组别	例数	UA(μmol/L)	年龄(x±s，岁)	SBP(x±s，mm Hg)	DBP(x±s，mm Hg)	FPG(x±s，mmol/L)	TC(x±s，mmol/L)	TG[(M(P₂₅, P₇₅)，mmol/L]^b	HDL-C(x±s，mmol/L)	LDL-C(x±s，mmol/L)
第1分位	75	< 252	9.03±2.14	104.24±10.38^a	67.79±10.04	4.97±0.59^a	3.73±0.55^a	0.73(0.57~1.11)^a	1.41±0.26^a	2.58±0.39^a
第2分位	78	252~290	9.35±2.28	106.13±7.50	67.53±8.40	5.04±0.37	3.80±0.67^a	0.79(0.59~1.31)^a	1.27±0.21^a	2.63±0.50^a
第3分位	72	290~370	9.51±2.01	106.35±6.91	67.74±8.57	5.15±0.66	3.81±0.69^a	0.84(0.60~1.24)^a	1.26±0.21	2.62±0.48^a
第4分位	72	> 370	9.79±2.12	109.83±9.92	68.90±7.69	5.21±0.58	4.32±0.77	1.23(0.92~1.83)	1.19±0.21	2.84±0.54
F值			1.640	5.135	0.370	2.785	11.791	18.714	12.458	4.352
P值			0.180	0.002	0.775	0.041	< 0.001	< 0.001	< 0.001	0.005
注：与第四分位比较，^aP < 0.05；与第三分位比较，^cP < 0.05；^b为经对数转换后进行方差分析。

下载: 导出CSV

表 3 尿酸与心血管危险因素偏相关分析

组别	统计量	TC	HDL-C	LDL-C	TG	FPG	SBP	DBP
男生	r值	0.101	-0.154	-0.091	0.141	0.080	0.238	0.044
	P值	0.105	0.013	0.146	0.024	0.201	< 0.001	0.482
女生	r值	0.022	-0.700	0.615	0.341	0.085	0.083	0.083
	P值	0.709	< 0.001	< 0.001	< 0.001	0.147	0.155	0.159

下载: 导出CSV

表 4 以HUA为因变量的logistic回归分析

性别	变量	B	SE	Wald χ²	P值	OR值	95% CI
男生	年龄	0.341	0.082	17.384	< 0.001	1.406	1.198~1.651
	高TC	0.848	0.680	1.554	0.213	2.334	0.616~8.848
	低HLDC	1.772	0.479	13.657	< 0.001	5.880	2.298~15.045
	高LDLC	0.134	0.536	0.062	0.803	1.143	0.399~3.270
	高TG	0.068	0.381	0.032	0.858	1.071	0.507~2.260
	FPG异常	1.024	0.328	9.767	0.002	2.784	1.465~5.291
	超重/肥胖	0.707	0.326	4.696	0.030	2.027	1.070~3.842
	高血压	0.578	0.330	3.065	0.080	1.783	0.933~3.406
	常量	-5.176	0.905	32.702	< 0.001	0.006
女生	年龄	0.172	0.084	4.180	0.041	1.187	1.007~1.399
	高TC	3.139	0.854	13.527	< 0.001	23.083	4.333~122.970
	低HLDC	1.579	0.489	10.441	0.001	4.848	1.861~12.632
	高LDLC	-0.754	0.613	1.513	0.219	0.471	0.142~1.564
	高TG	1.432	0.363	15.577	< 0.001	4.186	2.056~8.522
	FPG异常	0.277	0.480	0.332	0.564	1.319	0.514~3.382
	超重/肥胖	2.434	0.505	23.269	< 0.001	11.408	4.243~30.672
	高血压	0.922	0.378	5.956	0.015	2.514	1.199~5.270
	常量	-5.644	1.032	29.884	< 0.001	0.004

下载: 导出CSV

参考文献(20)

[1]	SONG Y, MA J, WANG H J, et al. Secular trends of obesity prevalence in Chinese children from 1985 to 2010: Urban-rural disparity[J]. Obesity (Silver Spring, Md. ), 2015, 23(2): 448-453. doi: 10.1002/oby.20938
[2]	王烁, 董彦会, 王政和, 等. 1985—2014年中国7~18岁学生超重与肥胖流行趋势[J]. 中华预防医学杂志, 2017, 51(4): 300-305. doi: 10.3760/cma.j.issn.0253-9624.2017.04.005
[3]	LIANG Y J, HOU D Q, ZHAO X Y, et al. Childhood obesity affects adult metabolic syndrome and diabetes[J]. Endocrine, 2015, 50(1): 87-92. doi: 10.1007/s12020-015-0560-7
[4]	PETKEVICIENE J, KLUMBIENE J, KRIAUCIONIENE V, et al. Anthropometric measurements in childhood and prediction of cardiovascular risk factors in adulthood: Kaunas cardiovascular risk cohort study[J]. BMC Public Health, 2015, 15(1): 218-226. doi: 10.1186/s12889-015-1528-5
[5]	闫银坤, 侯冬青, 段佳丽, 等. 肥胖儿童尿酸水平与心血管代谢异常及非酒精性脂肪肝的关系[J]. 中华实用儿科临床杂志, 2015, 30(13): 1000-1003. doi: 10.3760/cma.j.issn.2095-428X.2015.13.011
[6]	CAPUANO V, MARCHESE F, CAPUANO R, et al. Hyperuricemia as an independent risk factor for major cardiovascular events: A 10-year cohort study from Southern Italy[J]. J Cardiovasc Med, 2017, 18(3): 159-164. doi: 10.2459/JCM.0000000000000347
[7]	刘真成, 边云飞, 李嘉伟, 等. 血清尿酸与心血管疾病相关性的研究进展[J]. 中国医药导报, 2019, 16(29): 45-48. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201929011.htm
[8]	中国肥胖问题工作组, 季成叶. 中国学龄儿童青少年超重、肥胖筛查体重指数值分类标准[J]. 中华流行病学杂志, 2004, 25(2): 97-102. doi: 10.3760/j.issn:0254-6450.2004.02.003
[9]	中国医师协会心血管内科医师分会. 无症状高尿酸血症合并心血管疾病诊治建议中国专家共识[J]. 中国临床医生, 2011, 39(2): 73-77. doi: 10.3969/j.issn.1008-1089.2011.02.028
[10]	RHO Y H, ZHU Y, CHOI H K. The epidemiology of uric acid and fructose[J]. Semin Nephrol, 2011, 31(5) : 410-419. doi: 10.1016/j.semnephrol.2011.08.004
[11]	米杰, 王天有, 孟玲慧, 等. 中国儿童青少年血压参照标准的研究制定[J]. 中国循证儿科杂志, 2010, 5(1): 4-14. doi: 10.3969/j.issn.1673-5501.2010.01.002
[12]	ANON. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report[J]. Pediatrics, 2011, 128(S5): 213-256.
[13]	RICOTTI R, GENONI G L, GIGLIONE E, et al. High-normal estimated glomerular filtration rate and hyperuricemia positively correlate with metabolic impairment in pediatric obese patients[J]. PLoS One, 2018, 13(3): e0193755. doi: 10.1371/journal.pone.0193755
[14]	牛杨, 汤庆娅, 赵雪林, 等. 肥胖儿童尿酸水平与糖尿病及心血管疾病危险因子的相关性[J]. 中国学校卫生, 2016, 37(12): 1859-1862. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201612033.htm
[15]	庄婧誉, 徐滨华, 段滨红, 等. 青少年血尿酸水平与心血管内代谢危险因子的相关性分析[J]. 中国学校卫生, 2016, 37(3): 425-427, 431. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201603035.htm
[16]	CASTILLO-DURÁN C, SEPÙLVEDA A C, ESPINOZA G A, et al. Hyperuricaemia and metabolic syndrome in obese children and adolescents[J]. Revista Chilena De Pediatria, 2016, 87(1): 18-23. doi: 10.1016/j.rchipe.2015.07.022
[17]	刘英, 曾勇. 高尿酸血症与肥胖[J]. 中国心血管杂志, 2016, 21(1): 11-13. doi: 10.3969/j.issn.1007-5410.2016.01.004
[18]	ORLANDO A, CAZZANIGA E, GIUSSANI M, et al. Hypertension in children: Role of obesity, simple carbohydrates, and Uric Acid[J]. Front Public Health, 2018, 6: 129. doi: 10.3389/fpubh.2018.00129
[19]	刘新琼, 王晓朋, 关黎清, 等. 新疆伊犁哈萨克自治州不同民族中高尿酸血症与痛风患病率及相关危险因素分析[J]. 中华全科医学, 2016, 14(7): 1186-1188, 1192. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201607041.htm
[20]	雷伊玲, 源梓妃, 唐钊协, 等. 广州学龄儿童尿酸水平与心血管代谢指标的关联[J]. 中国学校卫生, 2020, 41(11): 1726-1729. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS202011036.htm