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尿微量元素、血清尿酸与10年动脉粥样硬化性心血管疾病风险关系：基于深圳社区老年人队列研究

Associations of urinary trace elements and serum uric acid with 10-year atherosclerotic cardiovascular disease risk: a study based on a community-dwelling older adult cohort in Shenzhen

    摘要
  • 摘要:
    目的  探讨尿微量元素与10年动脉粥样硬化性心血管疾病（ASCVD）风险之间的关系，并分析血清尿酸（SUA）在其中的中介作用。
    方法 基于深圳市老年相关疾病队列2021年调查数据，采用随机整群抽样方法纳入1 068名60岁及以上的社区老年人。收集人口学特征、生活方式及健康体检资料，采用电感耦合等离子体质谱（ICP-MS）检测尿液微量元素浓度。利用China-PAR模型评估10年ASCVD风险。采用限制性立方样条（RCS）模型分析尿微量元素与动脉粥样硬化指数（AIP）、SUA及ASCVD风险之间的剂量—反应关系，并通过多元回归模型筛选关键微量元素，进一步采用中介效应分析评估SUA在其中的作用。
    结果 共纳入研究对象1 068人，其中ASCVD高风险者184人（17.23%）。RCS模型显示，尿锌与AIP（χ2=10.460）及10年ASCVD（χ2=14.255）风险均呈显著剂量依赖性正相关（P<0.001）。广义线性模型（GLM）分析表明，尿锌与AIP（β=0.04，95%CI：0.02～0.06）及10年ASCVD风险（OR=1.64，95%CI：1.27～2.13）显著相关，尿锌与SUA水平呈正相关（β=9.28，95%CI：1.98～16.57）。中介效应分析显示，SUA在尿锌与AIP及ASCVD风险之间发挥部分中介作用，其中SUA对尿锌与AIP关系的中介比例为25.59%，对尿锌与ASCVD风险关系的中介比例为4.42%。
    结论 尿中微量元素仅有锌与ASCVD风险增加相关，研究发现尿锌水平升高与AIP及10年ASCVD风险增加显著相关，SUA在其中发挥部分中介作用，但在其他微量元素中未发现该联系。该结果提示SUA可能部分介导尿锌水平升高与AIP及ASCVD风险升高之间的关联，为微量元素在ASCVD风险评估中的作用提供新的流行病学证据。

     

    Abstract:
    Objective To investigate the associations between urinary trace elements and 10-year atherosclerotic cardiovascular disease (ASCVD) risk, and to assess the potential mediating role of serum uric acid (SUA).
    Methods This study selected 1 068 community-dwelling older adults (≥60 years) from the 2021 Shenzhen Elderly-Related Diseases Cohort, using a random cluster sampling method. Demographic characteristics, lifestyle factors, and health examination data were collected. Urinary trace element concentrations were measured through inductively coupled plasma mass spectrometry (ICP-MS). The 10-year ASCVD risk was estimated via the China-PAR model. Restricted cubic spline (RCS) models were adopted to examine dose-response relationships of urinary trace elements with the atherogenic index of plasma (AIP), SUA, and ASCVD risk. Multivariable regression analysis was performed to identify key trace elements, and mediation analysis to assess the role of SUA.
    Results Among the 1 068 participants, 184 (17.23%) were rated with high ASCVD risk. The RCS analysis indicated that urinary zinc was positively associated with both AIP (χ2=10.460, P<0.001) and 10-year ASCVD risk (χ2=14.255, P<0.001) in a dose-dependent manner. Generalized linear models (GLMs) showed that urinary zinc was significantly associated with AIP (β=0.04, 95%CI: 0.02–0.06) and ASCVD risk (OR=1.64, 95%CI: 1.27–2.13). Urinary zinc was also positively associated with the SUA level (β=9.28, 95%CI: 1.98–16.57). The mediation analysis revealed that SUA partially mediated the associations of urinary zinc with AIP and ASCVD risk, accounting for 25.59% and 4.42% of the total effects, respectively.
    Conclusions Among the trace elements measured in urine, only zinc was found to be associated with an increased risk of ASCVD. The study demonstrated that elevated urinary zinc levels were significantly correlated with increases in both AIP and 10-year ASCVD risk. SUA played a partial mediating role in these associations. However, no such relationship was observed for the other trace elements examined. These findings provide novel epidemiological evidence for the potential role of trace elements, particularly zinc, in ASCVD risk assessment.

     

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