血清尿酸与类风湿关节炎患者全因和心血管死亡率的相关性：一项队列研究。

The association of serum uric acid with all-cause and cardiovascular mortality among adults with rheumatoid arthritis: a cohort study.

机构信息

Jiangxi Province Key Laboratory of Laboratory Medicine, Jiangxi Provincial Clinical Research Center for Laboratory Medicine, Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, China.

Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China.

出版信息

Clin Exp Rheumatol. 2024 Jan;42(1):122-129. doi: 10.55563/clinexprheumatol/ghfz0v. Epub 2023 Aug 28.

DOI:10.55563/clinexprheumatol/ghfz0v

PMID:37650291

Abstract

OBJECTIVES

Serum uric acid (SUA) is associated with poor outcomes in patients with numerous types of disease. However, the association between SUA and the outcomes of patients with rheumatoid arthritis (RA) remains to be fully elucidated. Thus, the present study aimed to determine the associations between SUA and all-cause or cardiovascular disease (CVD)-associated mortality in adults with RA.

METHODS

The data of patients with RA were collected from the National Health and Nutrition Examination Survey from 2001 to 2018. All-cause and CVD-associated mortality were identified using national death records through 31 December 2019. Weighted survival curves, Cox proportional hazards regression models, restricted cubic splines (RCS) and stratified analyses were used to assess the association between SUA levels and mortality.

RESULTS

Among 2,312 patients with RA, a total of 597 all-cause deaths and 198 CVD-associated deaths were recorded during 19,133 person-years of follow-up. The results of the Kaplan-Meier curves for long-term all-cause and CVD-associated mortality demonstrated that increased levels of SUA were associated with a higher incidence of mortality. In the fully adjusted models, the highest SUA quartile exhibited hazard ratios [(HRs); 95% confidence intervals (CIs)] of 1.53 (1.10, 2.14) for all-cause mortality and 1.93 (1.14, 3.27) for CVD-associated mortality, compared with the lowest SUA quartile. The results of the RCS analysis confirmed a strong linear association between SUA levels and the HR of all-cause mortality, while a U-shaped association was observed between SUA and CVD-associated mortality.

CONCLUSIONS

The results of the present study demonstrated that high SUA levels were significantly associated with increased risks of all-cause and CVD-associated mortality in patients with RA. Further studies are required to elucidate the potential impact of treatments on reducing SUA levels.

摘要

目的

血清尿酸（SUA）与多种疾病患者的不良预后相关。然而，SUA 与类风湿关节炎（RA）患者结局之间的关系仍有待充分阐明。因此，本研究旨在确定 SUA 与 RA 成人全因或心血管疾病（CVD）相关死亡率之间的关系。

方法

从 2001 年至 2018 年，从国家健康和营养检查调查中收集了 RA 患者的数据。通过截至 2019 年 12 月 31 日的国家死亡记录确定全因和 CVD 相关死亡率。使用加权生存曲线、Cox 比例风险回归模型、限制性立方样条（RCS）和分层分析来评估 SUA 水平与死亡率之间的关系。

结果

在 2312 例 RA 患者中，在 19133 人年的随访期间共记录了 597 例全因死亡和 198 例 CVD 相关死亡。长期全因和 CVD 相关死亡率的 Kaplan-Meier 曲线结果表明，SUA 水平升高与死亡率升高相关。在完全调整的模型中，SUA 最高四分位数的全因死亡率的危险比（HR）为 1.53（1.10，2.14），CVD 相关死亡率的 HR 为 1.93（1.14，3.27），与 SUA 最低四分位数相比。RCS 分析的结果证实了 SUA 水平与全因死亡率 HR 之间存在很强的线性关系，而 SUA 与 CVD 相关死亡率之间存在 U 型关系。