肥胖与高尿酸血症、高脂血症的相关性

Relation of Obesity and Hyperuricemia, Hyperlipidemia

摘要: 目的：肥胖已逐渐成为严重的流行病，并且与心血管疾病、代谢性疾病有着密切的关系。肥胖与高脂血症、高尿酸血症之间的关系已经逐渐引起大众的关注。高尿酸血症与高血糖亦有许多共同之处，如年龄、肥胖、胰岛素抵抗等共为两者的危险因素。本研究旨在通过对肥胖人群的减重干预后，观察其人体测量指标、尿酸及血脂代谢指标等相关指标的变化，并探索其相关性，从而为临床肥胖患者的诊疗提供参考依据及新思路。方法：本研究通过对2018年3月~2019年3月南京医科大学第一附属医院营养科门诊就诊的超重/肥胖患者进行了一项前后对照的临床观察性研究，对48例10~29岁患者根据我国超重/肥胖的诊断标准(超重：体质指数BMI：24~27.9 kg/m²，肥胖BMI ≥ 28 kg/m²)筛选出目标人群，予以为期2个月的饮食干预及抗阻力运动指导，观察干预前后人体测量指标，如体重、脂肪量、骨骼肌量、腰围及臀围、BMI等、以及尿酸、血脂指标(总胆固醇TC、甘油三酯TG、低密度脂蛋白胆固醇LDL、高密度脂蛋白胆固醇HDL-C)、糖化血红蛋白(HbAIC)的变化并分析体测指标与尿酸、血脂代谢指标之间的相关性。结果：本研究筛选48例门诊患者中，皆符合超重/肥胖的诊断标准，并愿配合进行肥胖相关指标的检查，并符合其诊断。其中男:女 = 25:23，平均年龄17.58 ± 4.82岁，最终完成研究的共30人，(因故中途脱组/退出18人)，配合完成本研究检测项目的共9人。干预56 ± 7天后，体重、腰围及臀围等人体测量指标有明显的下降；尿酸亦有明显下降；血脂指标(总胆固醇、甘油三酯、低密度脂蛋白胆固醇)均有明显改善、糖化血红蛋白降低。相关性分析：体重与尿酸(P = 0.031, r = −0.510)、骨骼肌与尿酸(P = 0.046, r = 0.477)、腰围与尿酸(P = 0.045, r = −0.478)存在相关;高脂血症与高尿酸血症之间存在着一定的联系。结论：肥胖患者通过营养干预及运动指导后，人体测量指标、尿酸、血脂代谢指标均有一定的变化；体测指标与尿酸之间具有一定的相关性，因此进一步探索尿酸、血脂代谢等在肥胖发生发展中的影响及作用机制，对早期干预及治疗超重及肥胖人群有一定的启发指导意义。

Abstract: Objective: Obesity has gradually become a serious epidemic disease and it is closely related to cardiovascular diseases and metabolic diseases. The relationship between obesity and Hyperlipidemia, Hyperuricemia has gradually attracted public attention. Hyperuricemia and Hyperglycemia have many common factors, such as age, obesity, insulin resistance and others which are the risk factors of both. The purpose of this study is to observe the changes of anthropometric indexes, uric acid and lipid metabolism indexes of obesity after weight reduction intervention, and explore their correlation, so as to provide a reference basis and new ideas for clinical diagnosis and treatment of obesity. Methods: This study conducted a pre- and post-control clinical observational study on the overweight/obesity in the outpatient department of Nutrition Department of the First Affiliated Hospital of Nanjing Medical University from March 2018 to March 2019. According to the diagnostic criteria of overweight/obesity in China (Overweight: BMI: 24 - 27.9 kg/m², Obesity BMI >28 kg/m²), 48 patients (age: 10 - 29) were selected for diet intervention and resistance exercise in two months to observe the changes of anthropometric indexes such as body weight, fat mass, skeletal muscle mass, waist circumference and hip circumference, BMI, uric acid, blood lipid index (Total Cholesterol, Triglyceride, Low Density Lipoprotein, High density liptein cholesterol), HbAIC, and the correlation between the indexes of anthropometric measurement and uric acid, blood lipid metabolism index was analyzed. Results: In this study, 48 patients were selected; all of them met the diagnostic criteria of overweight/obesity, and were willing to cooperate with the examination of obesity-related indicators and accord with their diagnosis. Among them, male:female is 25:23, with an average age of 17.58 ± 4.82. A total of 30 people completed the study (18 out of group/out of group) and 9 people cooperated with the completion of the test project. After 56 ± 7 days of intervention, body weight, waist circumference, hip circumference and other anthropometric indicators decreased significantly; uric acid also decreased significantly; blood lipid indicators (TC, TG, LDL) were significantly improved, and HbAIC decreased. Relevance analysis: Body weight was correlated with uric acid (P = 0.031, r = −0.510), skeletal muscle with uric acid (P = 0.046, r = 0.477), and waist circumference with uric acid (P = 0.045, r = −0.478). There is a relationship between Hyperlipidemia and Hyperuricemia. Conclusion: After nutritional intervention and exercise guidance, the indexes of anthropometry, uric acid and blood lipid metabolism of obesity have changed; there is a certain correlation between the indexes of body measurement and uric acid, so further exploring the influence and mechanism of uric acid and blood lipid metabolism on the occurrence and development of obesity can provide some inspiration and guidance for early intervention and treatment of overweight and obesity.