尿酸与动脉粥样硬化的横断面关联及低度炎症的作用：CODAM研究
The cross-sectional association between uric acid and atherosclerosis and the role of low-grade inflammation: the CODAM study.
作者信息
Wijnands José M A, Boonen Annelies, Dagnelie Pieter C, van Greevenbroek Marleen M J, van der Kallen Carla J H, Ferreira Isabel, Schalkwijk Casper G, Feskens Edith J M, Stehouwer Coen D A, van der Linden Sjef, Arts Ilja C W
机构信息
Division of Rheumatology, Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), Maastricht University, CARIM School for Cardiovascular Diseases, Maastricht University, Department of Epidemiology, Maastricht University, Department of Internal Medicine, Maastricht University Medical Centre, Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht and Department of Human Nutrition, Wageningen University, Wageningen, The Netherlands. Division of Rheumatology, Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), Maastricht University, CARIM School for Cardiovascular Diseases, Maastricht University, Department of Epidemiology, Maastricht University, Department of Internal Medicine, Maastricht University Medical Centre, Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht and Department of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
Division of Rheumatology, Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), Maastricht University, CARIM School for Cardiovascular Diseases, Maastricht University, Department of Epidemiology, Maastricht University, Department of Internal Medicine, Maastricht University Medical Centre, Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht and Department of Human Nutrition, Wageningen University, Wageningen, The Netherlands. Division of Rheumatology, Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), Maastricht University, CARIM School for Cardiovascular Diseases, Maastricht University, Department of Epidemiology, Maastricht University, Department of Internal Medicine, Maastricht University Medical Centre, Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht and Department of Human Nutrition, Wageningen University, Wageningen, The Netherlands. Division of Rheumatology, Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), Maastricht University, CARIM School for Cardiovascular Diseases, Maastricht University, Department of Epidemiology, Maastricht University, Department of Internal Medicine, Maastricht University Medical Centre, Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht and Department of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
出版信息
Rheumatology (Oxford). 2014 Nov;53(11):2053-62. doi: 10.1093/rheumatology/keu239. Epub 2014 Jun 10.
OBJECTIVES
The aims of this study were to investigate (i) associations between uric acid and prevalent cardiovascular disease (CVD), ankle-arm blood pressure index (AAIx) and carotid intima-media thickness (CIMT) in the total population and in predefined subgroups according to glucose metabolism status and (ii) the extent to which these associations are explained by low-grade inflammation.
METHODS
Cross-sectional analyses were conducted among 530 individuals [60.6% men, mean age 58.9 years (s.d. 6.9), 52.6% normal glucose metabolism (NGM)] at increased risk of CVD from the Cohort of Diabetes and Atherosclerosis Maastricht study. A low-grade inflammation score was computed by averaging the z-scores of eight inflammation markers [CRP, TNF-α, IL-6, IL-8, serum amyloid A, intercellular adhesion molecule 1 (ICAM-1), ceruloplasmin and haptoglobin].
RESULTS
After adjustment for traditional CVD risk factors, plasma uric acid (per s.d. of 81 μmol/l) was associated with CVD in individuals with NGM [odds ratio (OR) = 1.66, 95% CI 1.06, 2.58] but not with disturbed glucose metabolism (DGM) (OR = 0.81, 95% CI 0.55, 1.19, P interaction = 0.165). Uric acid was associated with CIMT in the total population (β = 0.024, 95% CI 0.007, 0.042) and slightly more strongly in individuals with NGM (β = 0.030, 95% CI 0.006, 0.054) than DGM (β = 0.018, 95% CI -0.009, 0.044, P interaction = 0.443). There was no association between uric acid and AAIx in any group (P interaction = 0.058). Uric acid was associated with low-grade inflammation in the total population (β = 0.074, 95% CI 0.013, 0.134, P interaction = 0.737). Adding low-grade inflammation to the models did not attenuate any of the associations.
CONCLUSION
The associations for uric acid with CIMT, and with CVD in NGM only, were not explained by low-grade inflammation. A difference in the strength of the associations between individuals with NGM and DGM was suggested.
目的
本研究旨在调查：（i）在总体人群以及根据糖代谢状态预先定义的亚组中，尿酸与心血管疾病（CVD）、踝臂血压指数（AAIx）和颈动脉内膜中层厚度（CIMT）之间的关联；（ii）低度炎症对这些关联的解释程度。
方法
对来自马斯特里赫特糖尿病与动脉粥样硬化队列研究中530名心血管疾病风险增加的个体[男性占60.6%，平均年龄58.9岁（标准差6.9），52.6%糖代谢正常（NGM）]进行横断面分析。通过对八种炎症标志物[CRP、TNF-α、IL-6、IL-8、血清淀粉样蛋白A、细胞间黏附分子1（ICAM-1）、铜蓝蛋白和触珠蛋白]的z分数求平均值来计算低度炎症评分。
结果
在调整传统心血管疾病危险因素后，血浆尿酸（标准差为81μmol/l）在糖代谢正常个体中与心血管疾病相关[比值比（OR）=1.66，95%置信区间1.06，2.58]，但在糖代谢异常（DGM）个体中不相关（OR = 0.81，95%置信区间0.55，1.19，P交互作用 = 0.165）。尿酸在总体人群中与CIMT相关（β = 0.024，95%置信区间0.007，0.042），在糖代谢正常个体中相关性略强（β = 0.030，95%置信区间0.006，0.054），高于糖代谢异常个体（β = 0.018，95%置信区间 -0.009，0.044，P交互作用 = 0.443）。在任何组中尿酸与AAIx均无关联（P交互作用 = 0.058）。尿酸在总体人群中与低度炎症相关（β = 0.074，95%置信区间0.013，0.134，P交互作用 = 0.737）。在模型中加入低度炎症并未减弱任何关联。
结论
尿酸与CIMT以及仅在糖代谢正常个体中与心血管疾病的关联不能用低度炎症来解释。提示糖代谢正常个体与糖代谢异常个体之间关联强度存在差异。
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