醫療從業人員高尿酸血症的盛行率及其相關危險因子探討

The Prevalence of Hyperuricemia and its Associated Risk Factors among Hospital Workers

林新凱(Hsin-Kai Lin) ； 陳亮憲(Liang-Sien Chen) ； 陳昭源(Jau-Yuan Chen)

《中華職業醫學雜誌》 26卷4期 (2019/10) Pp. 235-246

摘要

目的：尿酸近年來被視作是心血管健康與否的重要標記；過去統計結果發現大部分尿酸異常都是無症狀的高尿酸血症，而且通常都是等到例行性的健康檢查才會發現尿酸值偏高，此階段一般不需要藥物治療；但Stack等學者研究卻發現高尿酸血症和許多慢性新陳代謝和心血管疾病及其死亡率有關。自民國100年成人預防保健服務刪除尿酸檢驗後，影響近年來國人對於高尿酸血症的認識相對不足。本研究旨在探討台北某醫院員工高尿酸血症的盛行率及其相關危險因子的關聯性。方法：本研究為觀察性及橫斷性研究，收錄北部某醫院員工年度健檢報告的資料，依抽血尿酸數值分成「高尿酸血症（Uric Acid ≥ 7 mg/dL）」及「尿酸正常（Uric Acid ＜ 7 mg/dL）」兩組，利用獨立樣本t檢定、卡方檢定來分析兩組間類別及連續變項的差異。並以皮爾森相關係數分析尿酸與代謝性和心血管疾病危險因子的關係，最後再利用單變項和多變項邏輯斯回歸分析（univariate and multivariate logistic regression analysis）建立代謝性及心血管疾病危險因子對高尿酸血症影響的關聯性。結果：在1261位醫療從業人員中，平均年齡42.5歲，男性占37.9%。結果發現在尿酸正常與高尿酸血症兩組之間，其身體質量指數、血壓、腰圍、總膽固醇、三酸甘油酯、空腹血糖、高密度膽固醇在兩組間都有統計上顯著的差異（p＜0.05）。三酸甘油酯／高密度膽固醇的比值與尿酸數值呈正相關性。進一步以多變項邏輯斯回歸分析發現影響尿酸濃度的因素：包含三酸甘油酯／高密度膽固醇的比值（OR=1.16, 95%CI= 1.07-1.26, p＜0.001）、身體質量指數（OR=1.12, 95%CI= 1.07-1.17, p＜0.001）、抽菸史（OR=4.49, 95%CI= 1.91-10.56, p=0.001）、高血壓（OR=1.87, 95%CI= 1.21-2.90, p=0.01）、糖尿病（OR=0.78, 95%CI= 0.36-1.70, p=0.54）、高血脂（OR=1.84, 95%CI= 1.20-2.82, p=0.01）。結論：本研究顯示男性醫療從業人員比一般男性民眾，有較高比率的高尿酸血症。而高尿酸血症和許多代謝症候群和心血管疾病的危險因子相關。建議努力改善飲食及生活型態以減少身體質量指數及腰圍尺寸，控制血壓、血糖、膽固醇（尤其是三酸甘油酯／高密度膽固醇的比值），並增加高密度膽固醇，以降低代謝症候群及心血管疾病的發生。

關鍵字

醫療從業人員 ； 高尿酸血症 ； 代謝症候群 ； 心血管疾病 ； 三酸甘油酯／高密度膽固醇的比值

並列摘要

Background and Objective: Uric acid has been thought for important health markers of cardiovascular condition. In the past, the statistical results had revealed most of the abnormal levels of uric acid are asymptomatic hyperuricemia, and mostly was been highly noted during routine health checkup and without any treatment benefit during this level. Whatever, Stack et al found hyperuricemia is associated with many chronic metabolic and cardiovascular disease and its related mortality. The item of uric acid was excluded from the routine health checkup since 2011, the public knowledge was relatively insufficient so far. Therefore, the purpose of this study is to explore the prevalence of hyperuricemia and the relationship between uric acid and its health risks among northern Taiwan hospital workers. Methods: This is an observational cross-sectional study. We collected annual health checkup data in a hospital of northern Taiwan, and divided its workers into two groups, according to the level of uric acid, hyperuricemia group (uric acid ≥ 7 mg/dL) and the non-hyperuricemia group (uric acid ＜ 7 mg/dL). We used independent T test and chi-square analysis to compare the demographic and clinical characteristics between the two groups. Pearson's correlation was performed to analyze the relationship between uric acid and cardiometabolic risk factors. Finally, univariate and multivariate logistic regression analysis were used to establish the relationship between cardiometabolic risk factors and hyperuricemia. Results: A total of 1261 hospital workers were included, 37.9% were male, and their average age was 42.52 years old. Body composition and biochemical lab data revealed that body mass index (BMI), waist circumference (WC), systolic and diastolic blood pressure (SBP, DBP), total cholesterol (TC), triglyceride (TG), fasting plasma glucose (FPG), high-density lipoprotein- cholesterol (HDL-C) were significantly different between the two groups (p＜0.05). The ratio of triglyceride (TG) to high-density lipoprotein-cholesterol (HDL-C) is positive relationship to the level of uric acid. The multiple logistic regression analysis revealed that the ratio of TG to HDL-C (OR=1.16, 95% CI=1.07-1.26, p＜0.001), BMI (OR=1.12, 95% CI=1.07-1.17, p＜0.001), smoking history (OR=4.49, 95% CI=1.91-10.56, p＜0.001), hypertension (OR=1.87, 95% CI=1.21-2.90, p=0.01), type 2 diabetes mellitus (OR=0.78, 95% CI=0.36-1.70, p=0.54), and hyperlipidemia (OR=1.84, 95% CI=1.20-2.82, p=0.01) were strongly associated with hyperuricemia. Conclusion: In this study, the results showed that uric acid is associated with health condition and other metabolic and cardiovascular disease. Therefore, we suggest that healthy but high risk workers should be aware of the diet and their life style, including of BMI, waist circumference, blood pressure, fasting plasma glucose, lipid (especially the ratio of TG to HDL-C) to avoid metabolic and cardiovascular disease.

並列關鍵字

hospital workers ； hyperuricemia ； metabolic syndrome ； cardiovascular disease ； the ratio of triglyceride to high-density lipoprotein-cholesterol