Clinical Study On The Relationship Between SUA,Cys-C And Atherosclerosis In Middle-aged And Elderly Patients With Hypertension

ObjectiveThe purpose of the study is to analyze the relationship between serum uric acid(SUA),cystatin C(Cys-C)and peripheral arterial,carotid and coronary atherosclerosis in middle-aged and elderly patients with essential hypertension,and to explore the diagnostic value of SUA and Cys-C for atherosclerosis,which can provide credence to the theory for middle-aged and elderly patients with essential hypertension to delay the occurrence and development of atherosclerosis.MethodsThis is a s ingle-center,retrospective study.The middle-aged and elderly patients who were hospitalized in the vasculocardiology department,the First Affiliated Hospital of Clinical Medic ine of Guangdong Pharmaceutical Univers ity with essential hypertens ion from October 2016 to March 2019 were randomly selected as the study objects.According to the inclusion and exclusion criteria,338 patients were selected finally.(the average age was 64.41±9.53 years,57.4% for males).All patients were required to collect their age,height,weight,systolic blood pressure,diastolic blood pressure,pulse pressure,smoking and alcohol history,comorbidity and other general baseline data,and their fasting venous blood was used to detect blood lipids,SUA,Cys-C,and other biochemical indicators.All patients underwent Carotid color Doppler ultrasound detection,Noninvasive arteriosclerosis detector and Coronary arteriography(CAG)to measure brachial-ankle pulse wave velocity(baPWV),carotid intima-media thickness(c IMT),Crouse scores of carotid and Gensini scores of coronary artery disease(CAD),which were used as the standard of the degree of atherosclerosis.The patients were assigned to the high-level Cys-C group and low-level Cys-C group according to the median(0.99mg/l)of the Cys-C level and assigned to the high-level SUA group and low-level SUA group according to the median(376umol/l)of SUA level.T-test,Spearman correlation analysis,univariate and multivariate Logistic regression analysis and other statistical methods were used to analyze the relationship between different levels of SUA,Cys-C and atherosclerosis.Results1.Compared with the low-level Cys-C group,the high-level Cys-C group had higher proportions of patients with grade 2 and 3 hypertension and patients with CAD(especially multivessel disease).BaPWV,c IMT,Crouse scores and Gensini scores were also higher in high-grade Cys-C group(p<0.05).2.Compared with the low-level SUA group,the proportion of patients with CAD(especially multivessel disease)was higher in the high-level SUA group.BaPWV,c IMT,Crouse scores and Gensini scores were also higher in the high-level SUA group(P<0.05),but there was no statistically s ignificant difference between 2 groups in various levels of hypertension(p>0.05).3.In the study of the correlation between Cys-C,SUA and blood pressure levels,the Spearman correlation analys is showed that Cys-C was positively correlated with SBP(r=0.241),pulse pressure(r=0.304)(P<0.05),but not DBP(P>0.05).SUA was not significantly related to SBP,DBP,and PP(P>0.05).4.In the study of the correlation between Cys-C,SUA and peripheral arteriosclerosis,the Spearman correlation analysis showed that both Cys-C(r=0.480)and SUA(r=0.410)was positively correlated with baPWV(P<0.05).In univariate Logistic regression analys is with baPWV(exceed the upper limit of normal or not)as the dependent variable,there was significant difference in age,SBP,PP,FBS,hypertens ion(10-20 years),hypertens ion(≥20 years),high-level SUA and high-level Cys-C between the research group and the control group(P<0.05).After the multivariate Logistic regression model excluded confounders,the final results showed statistically significant differences in age(OR 1.052),SBP(OR 1.024),hypertension(≥20 years)(OR 1.997)and high-level Cys-C(OR 2.037)(P<0.05).Through ROC curve analysis,the critical value of Cys-C to predict peripheral atherosclerosis is 0.78 mg/l.5.In the study of the correlation between Cys-C,SUA and carotid atherosclerosis,the Spearman correlation analysis showed that Cys-C was positively correlated with c IMT(r=0.357)and Crouse scores(r=0.427),while SUA was also positively correlated with c IMT(r=0.304)and Crouse scores(r=0.408)(P<0.05).In univariate Logistic regression analys is with c IMT(thicken or not)as the dependent variable,there was significant difference in age,gender,smoking,SBP,PP,FBS,hypertens ion(10-20 years),hypertens ion(≥20 years),high-level SUA and high-level Cys-C between the research group and the control group(P<0.05).After the multivariate Logistic regression model excluded confounders,the final results showed statistically significant differences in age(OR 1.078),hypertens ion(≥20 years)(OR 2.079)and high-level Cys-C(OR 2.234)(P<0.05).Through the ROC curve analys is,the critical value of Cys-C predicting carotid atherosclerosis is 0.81mg/l.6.In the study of the correlation between Cys-C,SUA and coronary atherosclerosis,the Spearman correlation analys is showed that both Cys-C(r=0.403)and SUA(r=0.289)was positively correlated with Gensini scores(P<0.05).In univariate Logistic regression analysis with CAD(Yes or no)as the dependent variable,there was significant difference in age,gender,smoking,SBP,PP,HDL-C,TG,FBS,hypertens ion(10-20 years),hypertens ion(≥20 years),high-level SUA and high-level Cys-C between the research group and the control group(P<0.05).After the multivariate Logistic regression model excluded confounders,the final results showed statistically significant differences in age(OR 1.053),PP(OR 1.022),HDL-C(OR 0.286)hypertens ion(10-20 years)(OR 1.593),hypertension(≥20 years)(OR 2.018)and high-level Cys-C(OR 1.844)(P<0.05).Through ROC curve analys is,the cut-off value of Cys-C to predict coronary heart disease is 0.76mg/l.ConclusionElevated Cys-C and SUA were related to the occurrence of peripheral artery,carotid,and coronary atherosclerosis in middle-aged and elderly patients with essential hypertens ion.With the increase of Cys-C and SUA level,the risk and severity of atherosclerosis were higher,but Cys-C,the independent risk factor,had higher diagnostic value than the SUA which was a non-independent factor.It can be speculated that the critical value interval of Cys-C predicting atherosclerosis is 0.75-0.80 mg/l.