Université Paris Diderot, UFR médicale, Paris, France.
Hôpital Lariboisière, Service de Rhumatologie, Paris, Cedex, France.
Ann Rheum Dis. 2018 Mar;77(3):328-335. doi: 10.1136/annrheumdis-2016-210767. Epub 2017 Jul 28.
In patients with gout, maintaining too low serum uric acid (SUA) level with urate-lowering therapy is a concern because uric acid is thought to be neuroprotective. However, the relation between SUA and dementia remains debated. This study aimed to investigate the impact of SUA level on the incidence of dementia.
We assessed the longitudinal association between SUA level and incident dementia (Diagnostic and Statistical Manual of Mental Disorders Version IV (DSM-IV) criteria) in a large cohort of healthy older people from the community (Three-City Dijon cohort). Additionally, we investigated the relation between SUA level and MRI markers of brain ageing (white matter hyperintensity volume (WMHV), lacunes and hippocampal volume).
The study sample comprised 1598 people (mean (SD) age 72.4(4.1) years, 38.3% male). During the 13,357 person-years of follow-up (median duration: 10.1 years), dementia developed in 110 participants (crude incidence rate: 8.2/1000 person-years). After multiple adjustments, the multivariate HR with the highest (≥75th percentile) versus lowest SUA level was 1.79 (95% CI 1.17 to 2.73; p=0.007). The association was stronger with vascular or mixed dementia (HR=3.66 (95% CI 1.29 to 10.41), p=0.015) than Alzheimer's disease (HR=1.55 (95% CI 0.92 to 2.61), p=0.10). There was a non-significant trend towards an association between high SUA level and extensive WMHV (p=0.10), a biomarker of small vessel disease, but not hippocampal volume (p=0.94) or lacunes (p=0.86). The association between SUA level and vascular or mixed dementia might be affected by interim strokes.
Risk of dementia, especially vascular or mixed dementia, may be increased with high SUA levels in elderly people.
在痛风患者中，降尿酸治疗将血清尿酸（SUA）水平维持得过低是一个令人担忧的问题，因为尿酸被认为具有神经保护作用。然而，SUA 与痴呆之间的关系仍存在争议。本研究旨在探讨 SUA 水平对痴呆发病的影响。
我们评估了来自社区的大型老年健康人群队列（三城市第戎队列）中 SUA 水平与新发痴呆（精神障碍诊断与统计手册第四版（DSM-IV）标准）之间的纵向关联。此外，我们还研究了 SUA 水平与脑老化的 MRI 标志物（白质高信号体积（WMHV）、腔隙和海马体积）之间的关系。
研究样本包括 1598 人（平均（SD）年龄 72.4（4.1）岁，38.3%为男性）。在 13357 人年的随访期间（中位随访时间：10.1 年），110 名参与者发生了痴呆（粗发病率：8.2/1000 人年）。经过多次调整后，SUA 水平最高（≥75 百分位数）与最低水平相比，多变量 HR 为 1.79（95%CI 1.17 至 2.73；p=0.007）。SUA 水平与血管性或混合性痴呆（HR=3.66（95%CI 1.29 至 10.41），p=0.015）的相关性强于阿尔茨海默病（HR=1.55（95%CI 0.92 至 2.61），p=0.10）。SUA 水平与广泛的 WMHV（p=0.10）呈正相关，WMHV 是小血管疾病的生物标志物，但与海马体积（p=0.94）或腔隙（p=0.86）无显著相关性。SUA 水平与血管性或混合性痴呆之间的关联可能受到中间性卒中的影响。
在老年人中，SUA 水平升高可能会增加痴呆的风险，尤其是血管性或混合性痴呆的风险。
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