血尿酸肌酐比值累积暴露与颈动脉斑块发生风险的前瞻性队列研究

Cumulative exposure of serum uric acid to serum creatinine ratio and the risk of carotid plaque： a prospective cohort study

摘要

目的  探究血清尿酸肌酐比值（serum uric acid to serum creatinine ratio，SUA/Scr）累积暴露指标与颈动脉斑块发生的关联。方法  选取北京健康管理队列的体检者作为研究对象，纳入符合纳排标准者共计9 228例。以2010年至2011年（体检1）、2012年至2013年（体检2）、2014-2015年（体检3）3次体检的SUA/Scr值计算累积暴露量、累积暴露负担和高暴露时间。随访中通过颈动脉超声诊断颈动脉斑块，随访至2021年12月31日。应用Logistic回归模型分析SUA/Scr累积暴露指标与颈动脉斑块发生的关联，而后排除服用降压药或降糖药或降脂药的人群进行敏感性分析。结果  本研究人群平均年龄（48.89±10.22）岁，其中男性5 846（63.35%）例，将其按SUA/Scr累积暴露四分位数分组，分别为Q1~Q4组。矫正协变量后，与Q1相比，Q2、Q3、Q4组发生颈动脉斑块的比值比分别为1.221 （95%CI：1.066~1.400）、1.255（95%CI：1.095~1.439）、1.478 （95%CI：1.287~1.697）。累积暴露负担大于0（OR=1.223，95%CI：1.109~1.349）和高暴露时间为6年（OR=1.332，95%CI：1.171~1.515）均与颈动脉斑块发生风险的增加相关。排除服用降压药或降糖药或降脂药的人群进行敏感性分析后，上述结论仍然成立。结论  SUA/Scr累积暴露、累积暴露负担和高暴露时间均与颈动脉斑块的发生风险增加存在关联。颈动脉斑块的一级预防不仅要关注单一时点的SUA/Scr值，而且要对SUA/Scr值展开长期监测。

Abstract

Objective  To explore the association between cumulative exposure indicators of serum uric acid to serum creatinine ratio (SUA/Scr) and incident carotid plaque. Methods  This study included 9 228 individuals who met the inclusion and exclusion criteria from the Beijing Health Management Cohort. The cumulative exposure, cumulative exposure burden and high exposure time of SUA/Scr were calculated based on the values of SUA/Scr in three physical examinations in 2010 to 2011 (visit 1), 2012 to 2013 (visit 2), and 2014 to 2015 (visit 3). Carotid plaque was diagnosed by carotid ultrasound, and the follow-up was until December 31, 2021. Logistic regression model was used to analyze the association between SUA/Scr cumulative exposure indicators and carotid plaque occurrence, and sensitivity analysis was performed by excluding the participants with the usage of antihypertensive drugs, or glucose-lowering drugs, or lipid-lowering drugs. Results  The mean age of the study population was (48.89±10.22) years, and 5 846(63.35%) participants were males. The participants were divided into four groups according to the quartiles of SUA/Scr cumulative exposure, namely Q1-Q4 groups. After adjusting for covariates in models, compared with Q1 group, the ORs (95%CIs) of incident carotid plaque in Q2, Q3 and Q4 groups were 1.221 (95%CI：1.066-1.400), 1.255(95%CI： 1.095-1.439) and 1.478 (95%CI：1.287-1.697). Cumulative exposure burden greater than 0 (OR=1.223，95%CI：1.109-1.349) and high exposure time of 6 years (OR=1.332，95%CI：1.171-1.515) were both associated with increased risk of carotid plaque occurrence. Sensitivity analysis excluded participants with the usage of any antihypertensive drugs, glucose-lowering drugs, or lipid-lowering drugs. The results were similar to those in main analysis. Conclusion Cumulative exposure, cumulative exposure burden and high exposure time of SUA/Scr were associated with increased risk of incident carotid plaque. In the primary prevention of carotid plaque, we should focus not only on SUA/Scr value at a single point time, but also on long-term monitoring of SUA/Scr values.

关键词

血尿酸肌酐比值 / 累积暴露 / 颈动脉斑块 / 队列研究

Key words

serum uric acid to serum creatinine ratio / cumulative exposure / carotid plaque / cohort study