尿酸和腰围对老年男性阻塞性睡眠呼吸暂停患者主要不良心血管事件发生风险的影响

Impact of uric acid and waist circumference on risk of major adverse cardiovascular events in elderly male patients with obstructive sleep apnea

【摘要】目的探讨尿酸(UA)和腰围(WC)对老年男性阻塞性睡眠呼吸暂停(OSA)患者主要不良心血管事件(MACE)发生风险的影响。方法选取2015年1月至2017年10月在中国人民解放军总医院及北京大学国际医院等6家三甲医院门诊或睡眠中心首诊为OSA的男性患者671例。收集患者人口学信息、睡眠呼吸参数、生化指标以及临床病史等资料。根据UA和WC水平将患者分为4组,对照组(n＝290)、单纯高尿酸血症组(n＝54)、单纯腹型肥胖组(n＝276)和高尿酸血症-腰围组(HUAW,n＝51)。每3个月对患者进行一次随访,随访终点事件为MACE。采用SPSS 26.0统计软件进行数据分析。根据数据类型,组间比较分别采用方差分析、非参数检验或χ²检验。采用Kaplan-Meire曲线分析4组患者MACE累积发生率。采用Cox比例风险回归模型评估UA和WC对老年男性OSA患者MACE发生风险的影响。结果4组患者年龄、吸烟、体质量指数、WC、高密度脂蛋白胆固醇、UA、呼吸暂停低通气指数、氧减指数、平均血氧饱和度、最低血氧饱和度和高血压比较,差异均有统计学意义(均P＜0.05)。Kaplan-Meier生存分析显示,HUAW组MACE累积生存率低于其他3组(PLog-rank＝0.001)。单因素Cox回归分析显示,与对照组相比,单纯腹型肥胖组(HR=1.968,95%CI 1.106~3.503；P=0.021)及HUAW组(HR=3.811,95%CI 1.811~8.019；P＜0.001)MACE发生风险显著升高。调整混杂因素后,结论一致。调整后单纯腹型肥胖组和HUAW组的风险比分别为2.737(95%CI 1.343~5.581；P＝0.006)和4.228(95%CI 1.783~10.026；P=0.001)。此外,年龄(HR＝1.048,95%CI 1.013~1.084; P=0.006)和高血压(HR＝2.547,95%CI 1.312~4.945; P=0.006)是老年男性OSA患者MACE发生的危险因素。亚组分析中,单纯腹型肥胖组和HUAW组中≥70岁[(HR＝3.039,95%CI 1.008~9.165)和(HR＝4.703,95%CI 1.158~19.090)]以及合并高血压[(HR＝2.606,95%CI 1.183~5.740)和(HR＝4.747,95%CI 1.898~11.870)]患者MACE的发生风险显著增加(均P＜0.05)。此外,HUAW组＜70岁患者MACE风险也升高(HR＝4.530,95%CI 1.379~14.878；P＜0.05)。结论HUAW和单纯腹型肥胖老年男性OSA患者MACE发生风险较高。OSA患者应控制体质量并关注全身体脂分布,早期筛查UA水平。

基金项目:军队保健专项科研课题(22BJZ52,23BJZ27)；军队装备建设应用研究项目(LB20211A010013)；军队实验动物专项研究项目(SYDW_KY[2021]04)

【Abstract】Objective To investigate the impact of uric acid (UA) and waist circumference (WC) on the risk of major adverse cardiovascular events (MACE) in elderly male patients with obstructive sleep apnea (OSA). Methods From January 2015 to October 2017, a total of 671 male patients were enrolled, who were diagnosed with OSA for first time at outpatient clinics or sleep centers of six tertiary hospitals, including the Chinese PLA General Hospital and Peking University International Hospital. Demographic data, sleep respiration parameters, biochemical indicators, and clinical histories were collected. Patients were divided into four groups based on UA and WC levels:control group (n=290), hyperuricemia group (n=54), abdominal obesity group (n=276), and hyperuricemia-waist (HUAW) group (n=51). Follow-ups were conducted every three months, with MACE as the primary endpoint. Data analysis was performed using SPSS 26.0. Intergroup comparisons were conducted using ANOVA, nonparametric tests, or the Chi-square test based on data types. Kaplan-Meier curves were used to analyze the cumulative MACE incidence in the four groups. The Cox proportional hazards regression model was used to assess the impact of UA and WC on the risk of MACE in elderly male OSA patients. Results Statistically significant differences were observed among the four groups of patients in age, smoking, body mass index, WC, high-density lipoprotein cholesterol, UA, apnea-hypopnea index, oxygen desaturation index, average blood oxygen saturation, minimum blood oxygen saturation, and hypertension (P<0.05 for all). Kaplan-Meier survival analysis indicated that the cumulative survival rate for MACE in the HUAW group was lower than that in the other three groups (PLog-rank=0.001). Univariate Cox regression analysis revealed that, compared to the control group, the risk of MACE was significantly higher in the abdominal obesity group (HR=1.968,95%CI 1.106-3.503; P=0.021) and HUAW group (HR=3.811,95%CI 1.811-8.019; P<0.001). After adjusting for confounders, the conclusion remained consistent. The hazard ratio for the abdominal obesity group was 2.737 (95%CI 1.343-5.581; P=0.006) and 4.228 (95%CI 1.783-10.026; P=0.001) for the HUAW group after adjustment. Additionally, age (HR=1.048,95%CI 1.013-1.084; P=0.006) and hypertension (HR=2.547,95%CI 1.312-4.945; P=0.006) were identified as risk factors for MACE in elderly male OSA patients. Subgroup analysis showed significantly increased risk of MACE in patients aged ≥70 years [(HR=3.039,95%CI 1.008-9.165) and (HR=4.703,95%CI 1.158-19.090)] as well as in those with comorbid hypertension [(HR=2.606,95%CI 1.183-5.740) and (HR=4.747,95%CI 1.898-11.870)] in the abdominal obesity and HUAW groups (P<0.05 for all). Moreover, the risk of MACE also increased in patients under 70 years of age in the HUAW group (HR=4.530,95%CI 1.379-14.878; P<0.05). Conclusion Elderly male OSA patients with HUAW and abdominal obesity have higher risk for MACE. OSA patients should focus on body mass index control, overall body fat distribution, and early UA screening.

This work was supported by Special Scientific Research Project for Military Health Care ( 22BJZ52, 23BJZ27), Research Project ofMilitary Equipment Construction Application ( LB20211A010013 ) and Special Research Project of Military Experimental Animals(SYDW_KY[2021]04).