内脏脂肪指数在甲状腺功能正常人群血尿酸/血肌酐比值与代谢综合征发生风险间的中介效应研究  

Mediating Effect Analysis of Visceral Adiposity Index on Serum Uric Acid to Creatinine Ratio and Metabolic Syndrome in People with Normal Thyroid Function

作　　者：刘焕欣 孟翠巧[1] 聂倩[1] 于春红 邢煜铃 王忠丽[1] 刘承浩 马慧娟[3,4] LIU Huanxin;MENG Cuiqiao;NIE Qian;YU Chunhong;XING Yuling;WANG Zhongli;LIU Chenghao;MA Huijuan(Health Examination Center,Hebei General Hospital,Shijiazhuang 050051,China;Graduate School,Hebei Medical University,Shijiazhuang 050017,China;Hebei Key Laboratory of Metabolic Diseases,Hebei General Hospital,Shijiazhuang 050051,China;Department of Endocrinology,Hebei General Hospital,Shijiazhuang 050051,China)

机构地区：[1]河北省人民医院体检中心,河北省石家庄市050051 [2]河北医科大学研究生学院,河北省石家庄市050017 [3]河北省人民医院代谢病重点实验室,河北省石家庄市050051 [4]河北省人民医院内分泌科,河北省石家庄市050051

出　　处：《中国全科医学》2022年第15期1850-1856,共7页Chinese General Practice

基　　金：河北省医学科学研究重点课题计划(20211202)。

摘　　要：背景 我国代谢综合征(MS)患病率逐年升高,血尿酸(SUA)水平与MS的发生密切相关,由于SUA受肾功能影响,采用标化SUA〔SUA/血肌酐比值(SUA/Scr)〕可更好地预测MS。内脏脂肪指数(VAI)是衡量内脏脂肪蓄积程度的重要指标,可更直接地预测MS的发生风险。但目前在甲状腺功能正常人群中,关于VAI是否介导SUA/ Scr与MS关联的研究较少。目的 探讨VAI在甲状腺功能正常人群中SUA/Scr与MS发生风险间的中介效应。方法 选取2020年1月至2021年6月于河北省人民医院体检中心进行年度体检的10 042例体检人群。收集研究对象的基本信息,并进行体格检查和生化检测,计算SUA/Scr和VAI。采用中华医学会糖尿病学分会制定的标准诊断MS。将研究对象分别按照SUA/Scr水平四分位数和VAI四分位数,各分为4组:Q1~Q4组和V1~V4组。采用Pearson相关分析探究SUA/Scr与VAI的相关性;多因素Logistic回归分析探讨SUA/Scr和VAI对MS发生的影响;采用bootstrap方法分析VAI是否介导SUA/Scr与MS之间的关联。结果 10 042例研究对象中,MS患者1 833例(18.25%),非MS患者8 209例(81.75%)。Pearson相关分析结果显示,SUA/Scr与VAI呈正相关(P<0.05)。多因素Logistic回归分析结果显示,与Q1组相比,Q2组〔OR=1.310,95%CI(1.039,1.651)〕、Q3组〔OR=1.372,95%CI(1.089,1.729)〕、Q4组〔OR=1.744,95%CI(1.381,2.203)〕人群发生MS的风险增加(P<0.05);与V1组相比,V3组〔OR=6.721,95%CI(4.600,9.819)〕、V4组〔OR=33.327,95%CI(21.509,51.640)〕人群MS的发病风险增加(P<0.01)。中介效应分析表明,SUA/Scr对MS发病率具有直接影响〔β=0.154,95%CI(0.104,0.205)〕,并且VAI部分介导了SUA/Scr对MS发病率的影响〔β=0.183,95%CI(0.156,0.213)〕,中介效应占总效应的54.25%。结论 甲状腺功能正常人群SUA/Scr和VAI是MS发生风险的预测指标,VAI部分介导了SUA/Scr对MS发病率的影响。Background The yearly prevalence of metabolic syndrome(MS) is increasing in China.Although the level of serum uric acid(SUA) is closely related to MS,due to the influence of renal function on SUA,standardized SUA 〔SUA/serum creatinine ratio(SUA/Scr)〕may be a better predictor for MS.Visceral adiposity index(VAI),as an important indicator for estimating visceral fat accumulation,could be used to predict MS more directly.However,few studies have explored whether VAI mediates the association between SUA/Scr ratio and MS in euthyroid population.Objective To explore the mediating effect of VAI on SUA/Scr ratio and MS in people with normal thyroid function.Methods A total of 10 042 annual health examinees were selected from the Health Examination Center,Hebei General Hospital from January 2020 to June 2021.The basic demographic information,physical examination and biochemical parameters,as well as calculated SUA/Scr ratio and VAI were collected.MS was diagnosed according to the criteria recommended by Chinese Diabetes Society.The risk of MS was analyzed by quartiles of SUA/Scr ratio(Q1-Q4 quartiles),and VAI(V1-V4 quartiles),respectively.Pearson correlation analysis was used to explore the association between SUA/Scr ratio and VAI.Multivariate Logistic regression analysis was used to explore the association of SUA/Scr ratio and VAI with MS.Bootstrap was used to explore whether VAI mediated the association between SUA/Scr ratio and MS.Results Of the 10 042 participants,1 833(18.25%) had MS and 8 209(81.75%) did not.Pearson correlation analysis showed that SUA/Scr ratio was positively associated with VAI(P<0.05).Multivariate Logistic regression analysis indicated that compared with Q1 group,the risk of MS significantly increased in Q2 group〔OR=1.310,95%CI(1.039,1.651)〕,Q3 group〔OR=1.372,95%CI(1.089,1.729)〕,and Q4 group〔OR=1.744,95%CI(1.381,2.203)〕(P<0.05).Compared with V1 group,the risk of MS notably increased in V3 group〔OR=6.721,95%CI(4.600,9.819)〕and V4 group〔OR=33.327,95%CI(21.509,51.640)〕(P<0.0

关 键 词：代谢综合征 内脏脂肪指数 血尿酸 血肌酐 甲状腺功能 中介效应 

分 类 号：R589[医药卫生—内分泌]