基于电子病历系统的老年患者血尿酸与骨代谢指标的相关性探讨  

Study of correlation between serum uric acid and bone metabolism in elderly patients based on electronic medical record system

作　　者：郭玫 毛旭东 周志文 徐娟 王洪复[3] Guo Mei;Mao Xudong;Zhou Zhiwen;Xu Juan;Wang Hongfu(Zhongshan-Xuhui Hospital Affiliated to Fudan University,Shanghai,200031,P.R.China;Sijing Hospital of Songjiang Dis-trict,Shanghai,201601,P.R.China;Institute of Radiation Medicine,Shanghai Medical University,Shanghai,200032,P.R.China)

机构地区：[1]复旦大学附属中山医院徐汇医院,上海200031 [2]上海市松江区泗泾医院,上海201601 [3]上海医科大学放射医学研究所,上海200032

出　　处：《老年医学与保健》2022年第6期1298-1304,1319,共8页Geriatrics & Health Care

基　　金：上海市卫健委临床研究专项(201740163);上海市医学重点专科(ZK2019A18)。

摘　　要：目的分析及探讨血尿酸与骨代谢指标之间的相关性。方法通过医院电子病历信息系统里2016年4月—2020年4月内科及老年科10643例患者的完整临床数据,分析血尿酸水平与骨代谢生物标志物如N-MID,β-CTX,PTH和25(OH)VitD3之间的相关性及性别差异。结果高尿酸血症(血尿酸≥420μmol/L)检出率为14.3%(1522例),其中男性17.0%(842例),女性11.9%(680例)。80%的患者25(OH)VitD3缺乏(<20 ng/mL)。高尿酸血症组PTH水平显著高于血尿酸正常组(P<0.001);血尿酸水平正常及略高于正常范围时,与β-CTX负相关,与25(OH)VitD3为正相关关系。在UA<240μmol/L及UA≥540μmol/L组,25(OH)VitD3在不同性别老年患者中有下降趋势,而β-CTX显著上升。Logistic回归分析提示β-CTX,PTH及25(OH)VitD3是独立影响高尿酸血症的因素。结论过高或过低的血尿酸水平均增加了老年患者骨质流失的风险。高尿酸血症可一定程度反映ATP能量代谢及骨骼代偿功能的失衡,值得进一步研究。Objective To explore the correlation between serum uric acid(UA)and bone metabolism indexes.Methods The complete clinical data of 10643 patients in Department of Internal Medicine and Department of Geriatrics from April 2016 to April 2020 were collected through the electronic medical record(EMR)system of the hospital.The correlation between serum UA level and bone metabolic biomarkers such as N-MID,β-CTX,PTH and 25(OH)VitD3 and gender difference were analyzed.Results The detection rate of hyperuricemia(serum UA≥420μmol/L)was 14.3%(1522 cases),including 17.0%(842 cases)in males and 11.9%(680 cases)in females.80%of patients were deficient in 25(OH)VitD3(<20 ng/mL).The level of PTH in the hyperuricemia group was significantly higher than that in the normal serum UA group(P<0.001).Serum UA was negatively correlated withβ-CTX and positively correlated with 25(OH)VitD3 when serum UA level was normal or slightly above the normal range.In the UA<240μmol/L group and UA≥540μmol/L group,25(OH)VitD3 showed a downward trend in elderly patients of different genders,whileβ-CTX increased significantly.Logistic regression analysis indicated thatβ-CTX,PTH and 25(OH)VitD3 were independent factors affecting hyperuricemia.Conclusion Extremely high or low UA level increased the risk of bone loss in elderly patients.Hyperuricemia can reflect the imbalance of ATP energy metabolism and skeletal compensatory function to a certain extent,which is worthy of further study.

关 键 词：老年 血尿酸 电子病历系统 骨代谢标志物 

分 类 号：R589.7[医药卫生—内分泌]