老年体检人群高尿酸血症流行现况及影响因素分析研究

背景　高尿酸血症（HUA）与多种慢性病密切相关,是继高血压、高血糖、高血脂之后的“第四高”。上海市浦东新区高东社区人口老龄化严重,但尚不清楚该社区老年人群HUA的流行状况。目的　调查上海市高东社区老年人群HUA的流行现状及可能危险因素,为HUA及相关慢性病的防治和社区管理提供依据。方法　基于高东社区卫生服务中心2018年3-5月开展的60岁以上老年人健康体检项目,调查内容主要包括健康档案信息收集、体格检查及实验室检查,分析HUA患病率以及人群分布,采用非条件Logistic回归模型筛选HUA的影响因素。结果　8 600名老年体检人群的HUA粗患病率和标化患病率分别为21.76%（男性24.15%,女性19.66%）和24.10%（男性24.21%,女性20.58%）;男性HUA粗患病率高于女性（χ2=25.312,P<0.001）;60~69岁年龄组,男性HUA粗患病率高于女性（χ2=51.121,P<0.001）;70~79岁及≥80岁年龄组,不同性别HUA患病率比较,差异无统计学意义（P>0.05）;总体及不同性别HUA粗患病率均随年龄的增长而增高（P<0.001）。HUA组和非HUA组社区老年体检人群性别、年龄、退休前职业、文化程度、吸烟情况、饮酒情况、运动情况、高血压、中心性肥胖、肥胖、CKD、冠心病、高脂血症、痛风患病率、白细胞计数、总蛋白、血清清蛋白、丙氨酸氨基转移酶水平比较,差异均有统计学意义（P<0.05）。多因素Logistic逐步回归分析结果显示,性别〔OR=1.27,95%CI（1.11,1.45）〕、年龄〔OR=1.01,95%CI（1.00,1.02）〕、饮酒情况〔经常饮酒对比从不饮酒OR=1.43,95%CI（1.19,1.70）〕、运动情况〔经常运动对比不运动OR=0.84,95%CI（0.73,0.98）〕、高血压〔OR=1.47,95%CI（1.30,1.66）〕、糖尿病〔是,血糖控制不佳对比否OR=0.76,95%CI（0.65,0.88）〕、中心性肥胖〔OR=1.29,95%CI（1.13,1.48）〕、肥胖〔OR=1.43,95%CI（1.23,1.66）〕、CKD〔OR=4.59,95%CI（3.91,5.38）〕、痛风〔OR=5.07,95%CI（3.54,7.28）〕、白细胞计数〔OR=1.08,95%CI（1.04,1.11）〕、总蛋白〔OR=1.04,95%CI（1.03,1.06）〕、血清清蛋白〔OR=1.03,95%CI（1.01,1.05）〕、丙氨酸氨基转移酶〔OR=1.01,95%CI（1.00,1.01）〕与社区老年体检人群HUA患病有回归关系（P<0.05）。结论　上海市高东社区老年体检人群HUA患病率较高,且与许多不良临床指标有关联,需加强社区居民HUA的防治。

Prevalence and Influencing Factors of Hyperuricemia in Aged Physical Examination Population

Background　Hyperuricemia（HUA） is closely associated with many chronic diseases,and it is recognized as the "fourth hyper" after hypertension,hyperglycemia and hyperlipidemia.The population aging in Shanghai Pudong New Area Gaodong Community is serious,but the prevalence of HUA in elderly group in this community is still unclear.Objective　To investigate the prevalence and possible risk factors of HUA among elderly people in Gaodong Community of Shanghai,so as to provide evidence for the prevention,control and community-based management of HUA and HUA-related chronic diseases.Methods　The survey was based on the physical examination program of the elderly over 60 years old carried out by Gaodong Community Health Center from March to May 2018,which mainly included health records information,and results of physical examination and laboratory tests.The prevalence and population distribution of HUA were analyzed,and the possible influencing factors of HUA were screened by unconditional Logistic regression model.Results　The crude and standardized prevalence rates of HUA in 8 600 physical examination subjects were 21.76%（male：24.15%,female：19.66%） and 24.10%（male：24.21%,female：20.58%）,respectively.The crude prevalence rate of HUA in males was higher than that in females（χ2=25.312,P<0.001）.In 60-69 age group,the crude prevalence rate of HUA in males was higher than that in females（χ2=51.121,P<0.001）,but there were no significant differences in sex-specific crude prevalence rate of HUA in both age groups of 70-79 and ≥80（P>0.05）.The overall crude prevalence rate of HUA increased with age（P<0.001）.The sex-specific crude prevalence rate of HUA also increased with age（P<0.001）.There were statistically significant differences in gender,age,occupation before retirement,education level,smoking,drinking,exercise,and the prevalence of hypertension,central obesity,obesity,chronic kidney disease（CKD）,coronary heart disease,hyperlipidemia and gout,white blood cell count,total protein,serum albumin and alanine aminotransferase between the HUA group and the non-HUA group（P<0.05）.Multivariate Logistic stepwise regression analysis showed that gender 〔OR=1.27,95%CI（1.11,1.45）〕,age 〔OR=1.01,95%CI（1.00,1.02）〕,drinking 〔regular drinking vs never drinking OR=1.43,95%CI（1.19,1.70）〕,exercise 〔regular exercise vs never exercise OR=0.84,95%CI（0.73,0.98）〕,hypertension 〔OR=1.47,95%CI（1.30,1.66）〕,diabetes 〔yes,and poor glycemic control vs no OR=0.76,95%CI（0.65,0.88）〕,central obesity 〔OR=1.29,95%CI（1.13,1.48）〕,obesity 〔OR=1.43,95%CI（1.23,1.66）〕,CKD 〔OR=4.59,95%CI（3.91,5.38）〕,gout 〔OR=5.07,95%CI（3.54,7.28）〕,white blood cell count 〔OR=1.08,95%CI（1.04,1.11）〕,total protein 〔OR=1.04,95%CI（1.03,1.06）〕,serum albumin 〔OR=1.03,95%CI（1.01,1.05）〕and alanine aminotransferase 〔OR=1.01,95%CI（1.00,1.01）〕 had regression relationship with the prevalence of HUA in aged physical examination population in the community（P<0.05）.Conclusion　The prevalence of HUA in aged physical examination population in Shanghai Gaodong community is high,and it is associated with many adverse clinical indicators.It is necessary to strengthen the prevention and treatment of hyperuricemia in community residents.