1 144例尿酸测值动态变化与痛风发病的关联性分析

doi:10.6040/j.issn.1671-7554.0.2021.0204

摘要/Abstract

摘要： 目的采用联合模型探讨男性和女性人群尿酸值的纵向动态变化与痛风发病的关联,为痛风疾病的早期防控提供理论依据。方法分析陕西省西安市某医院2007年至2014年1 144例健康人群体检数据,通过R 3.6.2软件,利用联合模型(结构包括线性混合效应模型与Cox比例风险模型),基于共享参数α,探讨尿酸与痛风发病之间的关联性。在此基础上,参照尿酸正常值,按观测次数进行等级划分,采用Cox比例风险模型,分析纵向数据下尿酸值的动态变化对痛风发病的作用大小。结果研究纳入1 144例受试者,随访期间有102例发生结局事件(痛风),其中,男性发病76例,女性发病26例,发病密度分别为34.21/万人年和16.15/万人年。联合模型结果显示,男性尿酸水平的纵向变化与痛风发病之间存在关联(HR=1.014 9,95%CI:1.010 6~1.019 2, P<0.001),女性尿酸值的纵向变化与痛风发病之间无关联(P>0.05)。Cox比例风险模型结果显示,相对于尿酸值处于正常范围的男性,尿酸转正常后发病风险增加4.458 0倍(HR=4.458 0,95%CI:2.528 0~7.862 0),尿酸波动后发病风险会增加4.679 0倍(HR=4.679 0,95%CI:2.716 6~8.058 0)。结论健康男性尿酸值的纵向波动会增加痛风发病的风险,应关注男性个体尿酸值的动态变化,降低痛风的发病风险。

关键词: 联合模型, 尿酸, 痛风, 纵向数据, 生存分析

Abstract: Objective To analyze the correlation between longitudinal dynamic changes of uric acid and gout in male and female populations so as to provide theoretical basis for the early prevention and control of gout. Methods The physical examination data of healthy people from a hospital in Xian, Shannxi Province during 2007 and 2014 were collected. The joint model including linear mixed effects model and Cox proportional risk model was adopted to explore the relationship between uric acid level and gout based on the correlation parameter α, which was run by R 3.6.2 software. Then, based on the normal range of uric acid, grades were classified according to the number of observations. Cox proportional risk model was used to analyze the effects of dynamic changes of uric acid on the incidence of gout. Results A total of 1,144 subjects were enrolled in our study. During the follow-up, 102 individuals developed gout, with 76 males(34.21/10,000/year), and 26 females(16.15/10,000/year). The joint model showed that longitudinal changes in uric acid level were associated with gout incidence in male population(HR=1.014 9, 95%CI: 1.010 6-1.019 2, P<0.001), but there was no correlation between longitudinal changes in uric acid and gout in female population(P>0.05). The Cox model showed that compared with males with normal uric acid level, those with uric acid level returned to normal had the risk of gout increased by 4.458 0-fold(HR=4.458 0, 95%CI: 2.528 0-7.862 0), and by 4.679 0-fold(HR=4.679 0, 95%CI:2.716 6-8.058 0)after uric acid fluctuations. Conclusion The longitudinal fluctuations of uric acid level in healthy male adults could increase the risk of gout. Due attention should be paid to the dynamic changes of uric acid level to reduce the risk of gout.

Key words: Joint model, Uric acid, Gout, Longitudinal data, Survival analysis

中图分类号:

R195.1

毛倩,王喆,管佩霞,刘玉洁,肖宇飞,杨毅,丛慧文,王廉源,石福艳,王素珍. 1 144例尿酸测值动态变化与痛风发病的关联性分析[J]. 山东大学学报 (医学版), 2021, 59(8): 107-112.

MAO Qian, WANG Zhe, GUAN Peixia, LIU Yujie, XIAO Yufei, YANG Yi, CONG Huiwen,WANG Lianyuan, SHI Fuyan, WANG Suzhen. Correlation analysis of dynamic changes of uric acid and incidence of gout in 1,144 cases[J]. Journal of Shandong University (Health Sciences), 2021, 59(8): 107-112.

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