血清尿酸与正常体重人群全因死亡率之间呈 U 型关联。
A U-shaped association between serum uric acid with all-cause mortality in normal-weight population.
机构信息
The Second School of Clinical Medicine, Southern Medical University , Guangzhou, China.
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Academy of Medical Sciences , Guangzhou, China.
出版信息
Postgrad Med. 2020 May;132(4):391-397. doi: 10.1080/00325481.2020.1730610. Epub 2020 Feb 26.
BACKGROUND
It is uncertain how serum uric acid (SUA) associated with all-cause mortality among people with normal weight, hence was explored in this study.
METHODS
We enrolled participants from 1999 to 2006 National Health and Nutrition Examination Survey (NHANES) that had mortality status through 31 December 2015. We estimated adjusted hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality using Cox proportional hazard models, and propensity score analyses were performed. We also performed restricted cubic splines to demonstrate the nonlinear relationship, and used subgroup analysis to examine the effect modification.
RESULTS
We enrolled 6169 participants (2905 men and 3264 women, mean age 42.3 ± 21.4 years) and 1060 (17.2%) cases of all-cause mortality occurred during the mean follow-up of 11.9 years. When using the lowest quartile of SUA as referent, the multivariable HRs for all-cause mortality increased in not parallel with the quartiles of SUA (HRs were 0.92 (95%CI: 0.68, 1.23), 1.10 (95%CI: 0.82, 1.47), and 1.08 (95%CI: 0.80, 1.45) from the second to the fourth quartiles, respectively. When treating SUA as continuous variable, the HRs for all-cause mortality were 1.07 (95%CI: 1.00, 1.15; P = 0.046), 1.03 (95%CI: 0.94, 1.12; P = 0.518) and 1.15 (95%CI: 1.01, 1.31; P = 0.032) in all population, male and female subjects, respectively. Elevated SUA was associated with all-cause mortality and the propensity scores analysis showed the similar results. Subgroup analysis showed SUA was an independent risk of all-cause mortality in female (HR1.17, 95%CI: 1.05, 1.31, P = 0.005), people aged <60 years (HR1.18, 95%CI: 1.03, 1.35, P = 0.018), non-diabetic population (HR1.10, 95%CI: 1.02, 1.18, P = 0.017) and people with eGFR<90 (HR1.10, 95%CI: 1.02, 1.19, P = 0.016). Smoothing spline plots suggested the optimal SUA for the lowest risk of all-cause mortality was approximately 4.7 mg/dl.
CONCLUSION
In normal-weight population, SUA was seemed to be a U-shaped relationship with all-cause mortality.
背景
血清尿酸（SUA）与正常体重人群的全因死亡率之间的关系尚不确定，因此本研究对此进行了探讨。
方法
我们纳入了 1999 年至 2006 年全国健康与营养调查（NHANES）中的参与者，这些参与者的死亡状态截止到 2015 年 12 月 31 日。我们使用 Cox 比例风险模型估计了全因死亡率的调整后风险比（HR）和 95%置信区间（CI），并进行了倾向评分分析。我们还使用限制性三次样条来展示非线性关系，并进行亚组分析以检验效应修饰。
结果
我们纳入了 6169 名参与者（2905 名男性和 3264 名女性，平均年龄 42.3±21.4 岁），在平均 11.9 年的随访期间发生了 1060 例（17.2%）全因死亡。当使用 SUA 的最低四分位数作为参考时，全因死亡率的多变量 HR 并未随着 SUA 四分位数的增加而呈平行变化（HR 分别为 0.92（95%CI：0.68，1.23）、1.10（95%CI：0.82，1.47）和 1.08（95%CI：0.80，1.45））。当将 SUA 视为连续变量时，全因死亡率的 HR 分别为 1.07（95%CI：1.00，1.15；P=0.046）、1.03（95%CI：0.94，1.12；P=0.518）和 1.15（95%CI：1.01，1.31；P=0.032），分别在所有人群、男性和女性中。SUA 升高与全因死亡率相关，倾向评分分析显示了相似的结果。亚组分析表明，SUA 是女性（HR1.17，95%CI：1.05，1.31，P=0.005）、年龄<60 岁（HR1.18，95%CI：1.03，1.35，P=0.018）、非糖尿病人群（HR1.10，95%CI：1.02，1.18，P=0.017）和 eGFR<90 的人群（HR1.10，95%CI：1.02，1.19，P=0.016）全因死亡的独立危险因素。平滑样条图提示 SUA 的最佳值约为 4.7mg/dl，此时全因死亡率的风险最低。
结论
在正常体重人群中，SUA 与全因死亡率似乎呈 U 型关系。
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