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摘要:目的 探讨高尿酸血症与其他代谢异常的相关性, 指导临床对高尿酸血症患者的诊治。方法 对2008年本院2074名健康体检人群进行横断面调查, 描述高尿酸血症和其他代谢异常在健康体检人群的患病率, 通过双变量分析和Logistic多元回归分析, 探讨高尿酸血症和其他代谢异常的相关性。结果 本组人群总高尿酸血症患病率为14.27%, 男性为21.36%, 女性为11.48%;其他各代谢异常的患病率分别为肥胖12.07%, 高血压24.70%, 空腹高血糖19.46%, 高总胆固醇血症36.38%, 高甘油三酯血症28.68%, 低高密度脂蛋白-胆固醇血症33.80%, 高低密度脂蛋白-胆固醇血症35.25%, 高非高密度脂蛋白-胆固醇血症22.59%, 脂肪肝40.28%;高尿酸血症组其他代谢异常的患病率均较非高尿酸血症组高, 调整年龄、性别后两组比较差异仍有统计学意义; 双变量相关分析显示血清尿酸值与年龄、性别、体重指数、收缩压、舒张压、高密度脂蛋白-胆固醇、低密度脂蛋白-胆固醇、总胆固醇、甘油三酯、非高密度脂蛋白-胆固醇、空腹血糖、肌酐、脂肪肝均具有显著相关性。多元Logistic回归分析发现血清尿酸水平与肥胖、高血压、低高密度脂蛋白-胆固醇、高甘油三酯、脂肪肝独立相关。结论 高尿酸血症与肥胖、高血压、血脂紊乱、脂肪肝等代谢异常独立相关, 其可能增加上述代谢异常的发生风险。Abstract:Objective To explore the association between hyperuricemia and other metabolism dysfunctions.Methods A cross-sectional study in 2074 health examination subjects in our hospital in 2008. We calculated the prevalences of hyperuricemia and other metabolism dysfunctions and explored the association between hyperuricemia and other metabolism dysfunctions using bivariate correlation analysis and Logistic multiple analysis.Results The prevalence were as follows:hyperuricemia is 14.27%, obesity 12.07%, hypertension 24.70%, fasting hyperglycaemia 19.46%, hypercholesteremia 36.38%, hypertriglyceridemia 28.68%, fatty liver 40.28%. The prevalences of metabolism dysfunctions were significantly higher in hyperuricemia group than in non-hyperuricemia group, and such significant differences still existed after having been adjusted with age. Bivariate correlation analysis showed that hyperuricemia was significantly correlated with age, gender, body mass index, systolic blood pressure, diastolic blood pressure, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, triglyceride, non-high-density lipoprotein cholesterol, glucose, creatinine, and fatty liver. Logistic multiple regression analysis showed that the level of serum uric acid was independently associated with obesity, hypertension, low-density lipoprotein cholesterol, hypertriglyceridemia, and fatty liver.Conclusions Hyperuricemia is independently associated with obesity, hypertension, hypertriglyceridemia, and fatty liver. It can increase the risk of these metabolic disorders.
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Keywords:
- hyperuricemia /
- obesity /
- hypertension /
- hyperglycaemia /
- hyperlipoidemia /
- fatty liver
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北京协和医院血管外科刘昌伟教授对2002年4月至2008年4月收治的10例贝赫切特病(白塞病)合并主动脉假性动脉瘤患者的预后情况进行研究, 认为腔内治疗是一种可行、有效的方法, 而术后坚持长期有效的免疫抑制治疗是减少复发、降低死亡率的关键。该研究结果已发表在JVasc Surg杂志上, SCI影响因子达3.77。
Behcet(贝赫切特)病, 是一种多系统的慢性损害性综合征。临床症状主要有:复发性口腔溃疡、生殖器溃疡及复发性葡萄膜炎等。贝赫切特病伴有主动脉受累的患者, 临床上并不多见, 文献报道约为1.5% ~ 2.7%, 但死亡率高、预后极差, 未经手术治疗的患者多死于主动脉假性动脉瘤破裂。1998年Vasseur等首次报道通过分叉型支架植入成功治疗1例贝赫切特病合并主—髂动脉假性动脉瘤的患者, 证实了对此类患者腔内治疗的可行性。
北京协和医院血管外科自2002年4月始, 尝试对贝赫切特病主动脉假性动脉瘤进行腔内治疗, 截至2008年4月共积累了10例病例, 腔内治疗均获成功, 并在国内首先开展利用主动脉支架自行开窗植入治疗累及肾动脉的主动脉假性动脉瘤2例, 获得成功。10例患者中2例在术后出现支架近端假性动脉瘤复发, 这2例复发的患者均未坚持进行激素治疗。
通过对国内外多篇文献的总结, 并结合实际临床经验, 刘昌伟教授认为, 腔内治疗对于贝赫切特病合并主动脉假性动脉瘤是一种可行、有效的方法。而术后坚持长期有效的免疫抑制治疗亦十分必要, 能有效地减少复发、降低死亡率。
(北京协和医院血管外科 叶炜 刘暴，宣传处 陈明雁)
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