Uric acid and incident dementia over 12 years of follow-up: a population-based cohort study
Uric acid and incident dementia over 12 years of follow-up: a population-based cohort study
复制标题
DOI：
10.1136/annrheumdis-2016-210767
复制
发表时间：
2018-03-01
影响因子：
27.4
通讯作者：
Richette, Pascal
中科院分区：
文献类型：
--
作者：
Latourte, Augustin;Soumare, Aicha;Richette, Pascal
目的 对于痛风患者，通过降尿酸治疗维持过低的血清尿酸 (SUA) 水平是一个值得关注的问题，因为尿酸被认为具有神经保护作用。然而，SUA 和痴呆症之间的关系仍然存在争议。本研究旨在探讨 SUA 水平对痴呆发病率的影响。 方法 我们在来自社区的一大群健康老年人（第戎三城队列）中评估了 SUA 水平与痴呆事件之间的纵向关联（精神障碍诊断和统计手册第四版（DSM-IV）标准）。此外，我们还研究了 SUA 水平与大脑衰老 MRI 标志物（白质高信号体积 (WMHV)、腔隙和海马体积）之间的关系。 结果 研究样本包括 1598 人（平均 (SD) 年龄 72.4(4.1) 岁，38.3% 男性）。在 13,357 人年的随访期间（中位持续时间：10.1 年），110 名参与者罹患痴呆症（粗发病率：8.2/1000 人年）。经过多次调整后，最高（= 75%）SUA 水平与最低 SUA 水平的多变量 HR 为 1.79（95% CI 1.17 至 2.73；p= 0.007）。与血管性或混合性痴呆（HR= 3.66（95% CI 1.29至10.41），p= 0.015）的相关性比阿尔茨海默病（HR= 1.55（95% CI 0.92至2.61），p= 0.10）更强。高 SUA 水平与广泛的 WMHV（p= 0.10）（小血管疾病的生物标志物）之间的关联趋势不显着，但与海马体积（p= 0.94）或腔隙（p= 0.86）无关。 SUA水平与血管性或混合性痴呆之间的关系可能会受到中期中风的影响。结论老年人中SUA水平高可能会增加痴呆，特别是血管性或混合性痴呆的风险。
Objectives In patients with gout, maintaining too low serum uric acid (SUA) level with urate-lowering therapy is a concern because uric acid is thought to be neuroprotective. However, the relation between SUA and dementia remains debated. This study aimed to investigate the impact of SUA level on the incidence of dementia.Methods We assessed the longitudinal association between SUA level and incident dementia (Diagnostic and Statistical Manual of Mental Disorders Version IV (DSM-IV) criteria) in a large cohort of healthy older people from the community (Three-City Dijon cohort). Additionally, we investigated the relation between SUA level and MRI markers of brain ageing (white matter hyperintensity volume (WMHV), lacunes and hippocampal volume).Results T he study sample comprised 1598 people (mean (SD) age 72.4(4.1) years, 38.3% male). During the 13,357 person-years of follow-up (median duration: 10.1 years), dementia developed in 110 participants (crude incidence rate: 8.2/1000 person-years). After multiple adjustments, the multivariate HR with the highest (= 75th percentile) versus lowest SUA level was 1.79 (95% CI 1.17 to 2.73; p= 0.007). The association was stronger with vascular or mixed dementia (HR= 3.66 (95% CI 1.29 to 10.41), p= 0.015) than Alzheimer's disease (HR= 1.55 (95% CI 0.92 to 2.61), p= 0.10). There was a nonsignificant trend towards an association between high SUA level and extensive WMHV (p= 0.10), a biomarker of small vessel disease, but not hippocampal volume (p= 0.94) or lacunes (p= 0.86). The association between SUA level and vascular or mixed dementia might be affected by interim strokes.Conclusions R isk of dementia, especially vascular or mixed dementia, may be increased with high SUA levels in elderly people.