尿酸与冠心病及血脂指标的关系研究

摘要

目的：分析尿酸（UA）与冠心病及血脂指标的关系。方法选取2012年12月—2014年12月因“胸闷、胸痛、晕厥症状”于江苏大学附属武进医院心内科就诊的冠心病患者841例作为冠心病组；另选取同期因“胸闷、胸痛、晕厥症状”于江苏大学附属武进医院心内科就诊的健康人129例作为健康对照组。收集并比较两组受试者临床资料，分析冠心病危险因素，比较两组不同性别受试者 UA 水平及不同 UA 水平冠心病患者的血脂指标。结果两组受试者总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（ LDL-C）水平比较，差异无统计学意义（ P >0.05）；冠心病组患者年龄、男性比例、吸烟史阳性率、高血压发生率、糖尿病发生率、UA 水平高于健康对照组，高密度脂蛋白胆固醇（HDL-C）水平低于健康对照组（P <0.05）。多因素 logistic 回归分析结果显示，年龄〔OR =1.076，95% CI （1.054，1.098）〕、吸烟史〔 OR =2.168，95% CI （1.283，3.662）〕、高血压〔 OR =2.007，95% CI （1.313，3.068）〕、糖尿病〔 OR =3.091，95% CI（1.715，5.571）〕是冠心病的危险因素，HDL-C〔 OR =0.222，95% CI （0.116，0.426）〕是冠心病的保护因素（P <0.05）。两组男性受试者 UA 水平比较，差异无统计学意义（P >0.05）；冠心病组女性患者 UA 水平高于健康对照组女性（P <0.05）。冠心病患者 UA 水平>419μmol/ L 者 TC、TG、LDL-C 水平高于 UA 水平<288μmol/ L 者，HDL-C 水平低于 UA 水平<288μmol/ L 者（P <0.05）；UA 水平>419μmol/ L 者TC、TG 水平高于 UA 水平为288~346μmol/ L 者，HDL-C 水平低于 UA 水平为288~346μmol/ L 者（P <0.05）；UA水平为347~419μmol/ L 者 TC、LDL-C 水平高于 UA 水平<288μmol/ L 者（P <0.05）；UA 水平为347~419μmol/ L 者LDL-C 水平高于 UA 水平为288~346μmol/ L 者（P <0.05）。结论冠心病患者 UA 水平较高，且与冠心病的发生、发展及血脂异常有关，但 UA 不是冠心病的危险因素，而其对冠心病的影响存在性别差异。%Objective To analyze the relationship between uric acid and coronary heart disease,blood lipids index. Methods From December 2012 to December 2014,a total of 841 coronary heart disease patients performed as chest distress, chest pain and syncope were selected as case group in the Department of Cardiology,Wujin Hospital Affiliated to Jiangsu University,and a total of 129 healthy people performed as chest distress,chest pain and syncope were selected as control group at the same time. Clinical data of the two groups were collected and compared,and risk factors of coronary heart disease were analyzed;uric acid levels were compared in male and in female between the two groups,and blood lipids index were compared in coronary heart disease patients with different uric acid levels. Results No statistically significant differences of TC,TG or LDL-C was found between the two groups(P > 0. 05);age,the proportion of male,positive rate of smoking history,incidence of hypertension and diabetes,and uric acid level of case group were statistically significantly higher than those of control group, while HDL-C of case group was statistically significantly lower than that of control group( P < 0. 05). Multivariate logistic regression analysis showed that,age〔 OR = 1. 076,95% CI(1. 054,1. 098)〕,smoking history〔 OR = 2. 168,95% CI (1. 283,3. 662)〕,hypertension〔OR = 2. 007,95% CI(1. 313,3. 068)〕 and diabetes〔OR = 3. 091,95% CI(1. 715, 5. 571)〕were risk factors of coronary heart disease,while HDL-C〔 OR = 0. 222,95% CI( 0. 116,0. 426 )〕 was the protective factor(P < 0. 05). No statistically significant differences of uric acid level was found in male between the two groups (P > 0. 05),while uric acid level of case group was statistically significantly higher than that of control group in female(P <0. 05). TC,TG and LDL-C of coronary heart disease patients with uric acid level over 419 μmol/ L were statistically significantly higher than patients with uric acid level less than 288 μmol/ L,while HDL-C was statistically significantly lower than patients with uric acid level less than 288 μmol/ L(P < 0. 05);TC and TG of patients with uric acid level over 419 μmol/ L were statistically significantly higher than patients with uric acid level between 288 and 346 μmol/ L,while HDL-C was statistically significantly lower than patients with uric acid level between 288 and 346 μmol/ L(P < 0. 05);TC and LDL-C of patients with uric acid level between 347 and 419 μmol/ L were statistically significantly higher than patients with uric acid level less than 288 μmol/ L(P <0. 05);LDL-C of patients with uric acid level between 347 and 419 μmol/ L was statistically significantly higher than patients with uric acid level between 288 and 346 μmol/ L( P < 0. 05). Conclusion Uric acid level of patients with coronary heart disease is relatively high,and it plays an important role in the occurrence and development of coronary heart disease and dyslipidemia,but it is not one of risk factors of coronary heart disease,while its impact on coronary heart disease exists some gender difference.