极高海拔地区青年男性高尿酸血症及痛风发病情况与影响因素分析:一项前瞻性队列研究OA

Objective To investigate the change characteristics of serum uric acid in young males after ascending from the plains to the plateaus at varying altitude,focusing on the prevalence of hyperuricemia(HUA)and cumulative incidence of gout as well as their influencing factors after different durations of residence at extremely high altitude(>5500 m).Methods A prospective cohort study design was adopted.Young males scheduled to ascend from the plains to the plateau from April to December 2023 were enrolled.Prior to plateau entry,participant recruitment,informed consent acquisition,structured questionnaires(covering sociodemographic characteristics,lifestyle,and prior plateau exposure history),physical examinations,and fasting venous blood sampling were completed.A total of 651 participants were ultimately enrolled and divided into three groups by actual residential altitude:3000-4000 m group(n=200),4000-5500 m group(n=200),and>5500 m group(n=251).Serum uric acid and related biomarkers were re-examined for all participants 3 months after plateau migration;only the>5500 m group was followed up for an additional 3 months until the 6th month post-migration.Psychological status was assessed using the Zung Self-Rating Anxiety Scale(SAS)and Zung Self-Rating Depression Scale(SDS).Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for HUA and gout at extremely high altitudes.Results At the plain baseline,the overall HUA prevalence among all participants was 19.0%.Three months after plateau settlement,the HUA prevalence rates of 3000-4000 m,4000-5500 m,and>5500 m groups were 51.5%,59.0%,and 68.5%,respectively,with no significant overall difference(P=0.066),but a significant altitude-dependent increasing trend(P<0.001).The cumulative incidence of gout was 3.0%,4.0%,and 6.4%,respectively,with no significant difference among the groups(P=0.225).In the>5500 m group,the mean serum uric acid level rose from(475.31±113.50)μmol/L at 3 months to(485.25±109.62)μmol/L at 6 months(P=0.003),and the HUA prevalence rose from 68.5%to 70.1%(P=0.016),while the cumulative incidence of gout increased from 6.4%to 7.2%(P=0.632).Univariate analysis identified altitude,body mass index(BMI),waist circumference,previous plateau ascents,red meat intake,and exercise intensity as candidate variables for multivariate models.Multivariate logistic regression revealed that high altitude(OR=1.028,P<0.001),high BMI(OR=1.237,P<0.001),and high-intensity exercise(OR=5.217,P=0.008)were independent risk factors for HUA;elevated serum uric acid was an independent risk factor for gout(OR=1.014,P<0.001),whereas oxygen inhalation was an independent protective factor against gout(OR=0.284,P=0.004).Conclusions In young males ascending from plains to high-altitude regions,serum uric acid levels and the risk of HUA and gout increase with higher altitude and longer duration of stay.The risk is comprehensively influenced by multiple factors such as altitude,BMI,and exercise intensity;hyperuricemia is the core risk factor for gout,and oxygen inhalation is protective factor.These findings inform the prevention and management of HUA and gout at extremely high altitude.