血清尿酸与高密度脂蛋白胆固醇比值与女性不孕的关系  

The relationship between the serum uric acid to high density lipoproteincholesterol ratio and female infertility

作　　者：简焕玲 戴梓 岑肖丽 陈慧玲 刘志文 赵颖[6] Jian Huanling;Dai Zi;Cen Xiaoli;Chen Huiling;Liu Zhiwen;Zhao Ying(First Department of Gynecology,The First Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou 510405,China;Department of Education and Scientific Research,The Third Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510378,China;First Department of Gynecology,The Third Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510378,China;Department of Reproductive Health,Shenzhen Bao’an Chinese Medicine Hospital,Shenzhen 518133,Guangdong Province,China;Trauma Orthopedics,The Third Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou 510378,China;Women and Childrens Center,The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China)

机构地区：[1]广州中医药大学第一临床医学院一妇科,广州510405 [2]广州中医药大学第三附属医院教育科研部,广州510378 [3]广州中医药大学第三附属医院一妇科,广州510378 [4]深圳市宝安区中医院生殖健康科,广东深圳518133 [5]广州中医药大学第三临床医学院创伤骨科,广州510378 [6]广州中医药大学第一附属医院妇儿中心,广州510405

出　　处：《首都医科大学学报》2025年第2期348-355,共8页Journal of Capital Medical University

基　　金：广东省基础与应用基础研究基金自然科学基金项目(2024A1515012161);广东省基础与应用基础研究基金省企联合基金项目(2023A1515220247);广东省中医药局基金项目(20231170)。

摘　　要：目的横断面研究血清尿酸(serum uric acid,sUA)与高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)比值(sUA to HDL-C ratio,UHR)与女性不孕之间的关系。方法分析来自美国国家健康与营养调查(National Health and Nutrition Examination Survey,NHANES)数据库中2013~2018年2963例年龄在18~45岁之间的女性参与者。使用多变量逻辑回归模型评估UHR与不孕症之间的关联性,调整多种混杂因素,通过亚组分析和限制性立方样条(restricted cubic spline,RCS)模型探讨其相互作用和剂量反应关系,利用受试者工作特征(receiver operating characteristics,ROC)曲线分析评估UHR对不孕症的预测价值。结果不孕症女性的基线UHR(9.68±4.23)显著高于未患不孕症的女性(8.7±3.81,P<0.001)。多变量逻辑回归分析显示,UHR处于最高四分位数(Q4)的女性与最低四分位数(Q1)相比,患不孕症的概率显著增加。不同模型中调整后的OR范围为1.61(95%CI:1.14~2.28)到1.98(95%CI:1.42~2.78)(趋势P<0.001)。亚组分析显示,这些关联在不同年龄组、体质量指数(body mass index,BMI)和种族群体中具有一致性。RCS模型显示,UHR与不孕症风险之间存在显著的线性剂量-反应关系(非线性P=0.03,总体关联P<0.001)。ROC分析表明,UHR在预测女性不孕状态方面具有中等能力,其曲线下面积(area under the curve,AUC)为0.570。结论较高的UHR与女性不孕风险增加显著相关,UHR具有作为女性不孕症风险预测生物标志物的潜力。Objective To conduct a cross-sectional study on the relationship between the serum uric acid(sUA)to high density lipoprotein-cholesterol(HDL-C)ratio(UHR)and female infertility.Methods We analyzed data from the National Health and Nutrition Examination Survey(NHANES)2013—2018 cycle,examining 2,963 women aged 18 to 45 years.A multivariable Logistic regression model was used to assess the association between UHR and infertility,adjusting for various confounding factors.The study also explored interactions and dose-response relationships through subgroup analyses and restricted cubic spline(RCS)models,and evaluated the predictive value of UHR for infertility by using receiver operating characteristic(ROC)curve analysis.Results The results showed that the prevalence of infertility was significantly higher among women with elevated UHR.Baseline characteristics revealed that the mean UHR in women with infertility(9.68±4.23)was significantly higher than in those without infertility(8.7±3.81,P<0.001).Multivariable Logistic regression analysis indicated that women in the highest quartile(Q4)of UHR had a significantly increased likelihood of infertility compared to those in the lowest quartile(Q1),with adjusted odds ratios(ORs)ranging from 1.61(95%CI:1.14-2.28)to 1.98(95%CI:1.42-2.78)across different models(P for trend<0.001).Subgroup analyses demonstrated that these associations were consistent across different age groups,body mass index(BMI)categories,and racial groups.The RCS model showed a significant linear dose-response relationship between UHR and infertility risk(nonlinear P=0.03,overall association P<0.001).Additionally,ROC analysis indicated that UHR had a moderate ability to discriminate infertility status,with an area under the curve(AUC)of 0.570.Conclusion A higher UHR is significantly associated with an increased risk of female infertility,and UHR has the potential to serve as a predictive biomarker for the risk of female infertility.

关 键 词：血清尿酸 高密度脂蛋白胆固醇 血清尿酸与高密度脂蛋白胆固醇比 不孕 NHANES 预测 生物标志物 

分 类 号：R715[医药卫生—妇产科学]