肝酶对钢铁工人代谢健康型肥胖与高尿酸血症关联影响

doi:10.16265/j.cnki.issn1003-3033.2024.02.1184

摘要/Abstract

摘要：

为探讨代谢健康型肥胖(MHO)和高尿酸血症(HUA)之间的关系,以及肝酶相关异常对此关系的影响,采用横断面研究,以参加河北钢铁公司职业体检的6 868名钢铁工人为研究对象,采用logistic回归模型和交互效应模型进行数据分析。结果表明:在校正混杂因素后,代谢健康全身肥胖的钢铁工人患HUA的风险增加2.13倍(比值比OR=2.13,95%置信区间CI:1.08~4.21);代谢健康腹型肥胖的钢铁工人患HUA的风险增加2.25倍(OR=2.25,95%CI:1.14~4.45)。在分层分析中,肝酶升高组MHO的钢铁工人HUA患病率显著高于肝酶正常组,不同肥胖表型和肝酶水平之间存在交互作用(P<0.05)。MHO与HUA的高患病率相关。肝酶升高可能改变MHO和HUA之间的关系。

关键词: 肝酶, 钢铁工人, 代谢健康型肥胖(MHO), 高尿酸血(HUA), 全身肥胖(GO), 腹型肥胖(AO)

Abstract:

The association between MHO and HUA and whether liver enzyme abnormalities could modify this association were studied. The cross-sectional study was conducted using 6,868 steelworkers in Hebei Iron and Steel Company who participated in occupational medical examinations as the study population. The data were analyzed using logistic regression models and interaction effect model. The results show that, in a multiple adjusted logistic model, the risk of HUA is increased 2.13-fold (odds ratio (OR)=2.13, 95% confidence interval (CI): 1.08-4.21) for metabolically healthy generalized obesity (MHGO). The risk of HUA is increased 2.25-fold (OR=2.25,95%CI: 1.14-4.45) for metabolically healthy abdominal obesity (MHAO). In stratified analysis, in the group with elevated liver enzymes, the prevalence of HUA in steelworkers with MHO(MHGO and MHAO) is significantly higher than that in the group with normal liver enzymes, and the interaction between obesity phenotypes and liver enzyme levels has a statistically significant effect on HUA (P<0.05). MHO is associated with a high prevalence of HUA. Liver enzyme levels may alter the relationship between MHO and HUA.

Key words: liver enzymes, steelworkers, metabolically healthy obesity (MHO), hyperuricemia (HUA), generalized obesity(GO), abdominal obesity(AO)

中图分类号:

X910安全人体学

于淼, 张生奎, 王利华, 袁聚祥. 肝酶对钢铁工人代谢健康型肥胖与高尿酸血症关联影响[J]. 中国安全科学学报, 2024, 34(2): 231-238.

YU Miao, ZHANG Shengkui, WANG Lihua, YUAN Juxiang. Effect of liver enzymes on association between metabolically healthy obesity and hyperuricemia in steelworkers[J]. China Safety Science Journal, 2024, 34(2): 231-238.

图/表 6

表1

钢铁工人HUA患病分组的特征分布

变量		总计	非HUA	HUA	P
变量		n=6 868	n=4 595	n=2 273	P
年龄/岁,n/%	22~29	334 (4.9)	187 (4.1)	147 (6.5)	< 0.001
	30~39	1 582 (23.0)	910 (19.8)	672 (29.6)
	40~49	2 757 (40.1)	1 884 (41.0)	873 (38.4)
	50~60	2 195 (32.0)	1 614 (35.1)	581 (25.6)
教育程度,n/%	高中及以下	5 305 (77.2)	3 614 (79.2)	1 664 (73.2)	< 0.001
教育程度,n/%	大专及以上	1 563 (22.8)	954 (20.8)	609 (26.8)	< 0.001
吸烟,n/%	从不	2 842 (41.4)	1 975 (43.0)	867 (38.1)	< 0.001
	曾经	460 (6.7)	305 (6.6)	155 (6.8)
	现在	3 566 (51.9)	2 315 (50.4)	1 251 (55.1)
饮酒,n/%	从不	3 954 (57.5)	2 709 (59.0)	1 245 (54.8)	0.002
	曾经	245 (3.6)	167 (3.6)	78 (3.4)
	现在	2 669 (38.9)	1 719 (37.4)	950 (41.8)
体力活动,n/%	低	1 247 (18.2)	785 (17.1)	462 (20.3)	< 0.001
	中	3 447 (50.2)	2 371 (51.6)	1 076 (47.3)
	高	2 174 (31.6)	1 439 (31.3)	735 (32.3)
GO,n/%	否	3 138 (45.7)	2 395 (52.1)	743 (32.7)	< 0.001
GO,n/%	是	3 730 (54.3)	2 200 (47.9)	1 530 (67.3)	< 0.001
AO,n/%	否	2 302 (33.5)	1 746 (38.0)	556 (24.5)	< 0.001
AO,n/%	是	4 566 (66.5)	2 849 (62.0)	1 717 (75.5)	< 0.001
倒班作业,n/%	否	1 316 (19.2)	922 (20.1)	394 (17.3)	0.007
倒班作业,n/%	是	5 552 (80.8)	3 673 (79.9)	1 879 (82.7)	0.007
粉尘作业,n/%	否	2 595 (37.8)	1 783 (38.8)	812 (35.7)	0.013
粉尘作业,n/%	是	4 273 (62.2)	2 812 (61.2)	1 461 (64.3)	0.013
噪声作业,n/%	否	3 367 (49.0)	2 273 (49.5)	1 094 (48.1)	0.297
噪声作业,n/%	是	3 501 (51.0)	2 322 (50.5)	1 179 (51.9)	0.297
高温作业,n/%	否	3 481 (50.7)	2 412 (52.5)	1 069 (47.0)	< 0.001
高温作业,n/%	是	3 387 (49.3)	2 183 (47.5)	1 204 (53.0)	< 0.001
CO作业,n/%	否	3 952 (57.5)	2 660 (57.9)	1 292 (56.8)	0.408
CO作业,n/%	是	2 916 (42.5)	1 935 (42.1)	981 (43.2)	0.408
年龄/岁, ( $χ -$ ±S)		44.6±8.1	45.5±7.8	42.9±8.3	< 0.001
DASH评分,( $χ -$ ±S)		25.4±5.8	25.5±5.8	25.2±5.6	0.039
SBP/mmHg,( $χ -$ ±S)		129.0±15.9	128.0±16.0	130.8±15.6	< 0.001
DBP/mmHg,( $χ -$ ±S)		82.5±10.4	82.0±10.2	83.7±10.5	< 0.001
TC/(mmol·L^-1),( $χ -$ ±S)		5.1±1.0	5.1±0.9	5.2±1.0	< 0.001
TG/(mmol·L^-1),M (IQR)		1.3 (0.9-2.0)	1.2 (0.8-1.7)	1.6 (1.1-2.4)	< 0.001
HDL-C/(mmol·L^-1),( $χ -$ ±S)		1.3±0.3	1.3±0.3	1.2±0.3	< 0.001
LDL-C/(mmol·L^-1),( $χ -$ ±S)		3.2±0.9	3.2±0.8	3.3±0.9	< 0.001
FBG/(mmol·L^-1),( $χ -$ ±S)		6.1±1.3	6.1±1.5	6.0±1.0	< 0.001
ALT/(U·L^-1),M (IQR)		23 (17-31)	21 (16-28)	26 (20-37)	< 0.001
AST/(U·L^-1),M (IQR)		20 (17-23)	19 (17-22)	21 (18-25)	< 0.001
GGT/(U·L^-1),M (IQR)		26 (19-41)	24 (17-36)	32 (23-51)	< 0.001

表1

表2

表3

图1

图2

表4

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变量		模型1	模型2	模型3	模型4
GO	否	1.00	1.00	1.00	1.00
GO	是	2.24(2.02~2.49)	2.14 (1.92~2.38)	2.34 (1.90~2.89)	2.15 (1.74 ~2.66)
AO	否	1.00	1.00	1.00	1.00
AO	是	1.89 (1.69 - 2.12)	1.88 (1.68~2.11)	2.35 (1.86~2.97)	2.15 (1.69~2.72)
代谢异常组分	BP	1.47(1.33~1.63)	1.58 (1.42~1.76)	1.57 (1.27~1.94)	1.49 (1.20~1.84)
	FBG	1.05 (0.95~1.17)	1.12 (1.00~1.25)	1.18 (0.94~1.48)	1.14 (0.91~1.43)
	TG	2.59 (2.33~2.88)	2.51 (2.26~2.80)	2.62 (2.13 ~3.22)	2.36 (1.91 ~2.92)
	HDL-C	1.66 (1.47~1.89)	1.69 (1.48~1.92)	1.36 (1.05~1.75)	1.31 (1.01~1.70)
代谢异常数量	0	1.00	1.00	1.00	1.00
	1	1.13 (0.94~1.37)	0.93 (0.71~1.20)	1.08 (0.73~1.59)	1.03 (0.70~1.52)
	2	1.62 (1.35~1.95)	1.25 (0.97~1.60)	1.64 (1.12~2.40)	1.50 (1.03~2.21)
	3	2.88 (2.37~3.50)	1.41 (1.08~1.85)	2.96 (1.98~4.43)	2.53 (1.68~3.81)
	4	3.14 (2.43~4.07)	1.68 (1.19~2.37)	3.11 (1.87~5.19)	2.70 (1.61~4.52)

肥胖表型		患病人数/%	OR (95% CI)值
肥胖表型		患病人数/%	模型1	模型2	模型3	模型4
BMI 分类	MHNGO	105 (18.1)	1.00	1.00	1.00	1.00
	MUNGO	638 (24.9)	1.50(1.20~1.90)	1.67 (1.32~2.11)	1.40 (0.87~2.27)	1.28 (0.79~2.08)
	MHGO	88 (35.3)	2.47 (1.77~3.46)	2.36 (1.68~3.32)	2.41 (1.23~4.73)	2.13 (1.08~4.21)
	MUGO	1442 (41.4)	3.20 (2.56~3.99)	3.37(2.69~4.24)	3.18 (1.99 ~5.06)	2.70 (1.69~4.32)
WC 分类	MHNAO	91/456 (20.0)	1.00	1.00	1.00	1.00
	MUNAO	465/1 846 (26.9)	1.35 (1.05~1.74)	1.45 (1.12~1.87)	1.50 (0.85~2.63)	1.38 (0.79~2.42)
	MHAO	102/373 (27.4)	1.51 (1.09~3.19)	1.44(1.03~2.00)	2.46 (1.25~4.85)	2.25 (1.14~4.45)
	MUAO	1 615/4 193 (38.5)	2.51 (1.98~3.19)	2.70(2.11~3.45)	3.38 (1.98~5.78)	2.87 (1.68~4.93)

肥胖表型		分组1^a		P	分组2^b		P
肥胖表型		肝酶正常	肝酶异常	P	肝酶正常	肝酶异常	P
BMI 分类	MHNGO	1.00	1.00	<0.001	1.00	1.00	<0.001
	MUNGO	1.04 (0.49~2.20)	1.30 (0.69~2.46)		0.96 (0.58~1.59)	1.06 (0.65~1.74)
	MHGO	1.80 (0.79~4.14)	3.52 (1.05~11.81)		1.91 (0.87~4.19)	2.19 (1.51~3.19)
	MUGO	2.41 (1.15~5.04)	2.50 (1.35~4.63)		2.10 (1.29~3.43)	2.92 (2.28~3.74)
WC 分类	MHNAO	1.00	1.00	<0.001	1.00	1.00	<0.001
	MUNAO	0.65 (0.28~1.51)	1.78 (0.81~3.92)		1.03 (0.57~1.85)	1.09 (0.54~2.17)
	MHAO	1.57 (0.51~4.85)	2.50 (1.02~6.17)		2.02 (0.96~4.27)	1.33 (0.56~3.17)
	MUAO	2.01 (0.95~4.27)	3.14 (1.47~6.72)		2.19 (1.26~3.82)	1.93 (1.13~3.37)