糖尿病患者血尿酸水平的变化及其意义

Changes of Serum Uric Acid Level and Their Clinical Significance in Patients with Diabetes Mellitus

目的探讨糖尿病患者血尿酸(UA)水平的变化及其意义。方法对275例糖尿病住院病人,分为糖尿病肾病组(n=72)和糖尿病肾功能正常组(n=203),检测血清UA、三酰甘油(TG)和胆固醇(TC),分析UA水平变化与肾功能及血糖(GLU)和血脂的关系,同时以80例正常人作对照。结果糖尿病肾功能正常组血UA水平(234.6±69.4)μmol/L明显低于正常对照组(294.4±60.3)μmol/L,(t=6.739,P<0.001);糖尿病肾病组UA水平(367.1±121.4)μmol/L则明显高于正常对照组,(t=4.714,P<0.001)。203例糖尿病肾功能正常组中UA降低者44例(21.7%),UA升高者1例(0.5%);72例糖尿病肾病组UA降低者1例(1.4%),UA升高者16例(22.2%),两组间UA异常率均有显著性差异(P<0.01)。102例糖尿病伴有TG升高者UA水平为(299.7±96.4)μmol/L,173例糖尿病TG正常者UA水平为(251.6±104.2)μmol/L,两组相比,差异有显著性意义(t=3.754,P<0.001)。相关分析显示,糖尿病患者UA与GLU呈明显负相关(r=-0.3111,P<0.01),与TG呈明显正相关(r=0.2691,P<0.01),与TC无明显相关性(r=0.1067,P>0.05)。结论糖尿病患者有低UA血症和高UA血症两种表现型,糖尿病早期肾功能正常时,血UA水平降低,当糖尿病并发肾病时,血UA水平明显升高。检测血清UA对帮助判断糖尿病病情有一定的价值。

Objective To explore the changes of serum uric acid （UA） and their clinical significance in the patients with diabetes mellitus. Methods A total of 275 in-patients with diabetes mellitus were divided into diabetic nephropathy group （ n = 72） and normal renal function group （ n = 203 ） , and their serum levels of UA, tfiacylglycerol （TG） and total cholesterol （TC） were detected. Besides, the relationship of UA level with serum, renal function, blood glucose （GLU） and blood lipids was analyzed, and meanwhile, 80 health adult were enrolled as normal controls. Results The level of serum UA in （ diabetes mellitus with） the norreal renal fimction group （ 234.6 ± 69.4 μmol/L） was significantly lower than that in the normal controls （ 294.4 ± 60.3μmol/L）, and there was a significant difference between them （ t = 6. 739, P 〈 0. 001 ）. The serum uric acid level was significantly higher in the diabetic nephropathy group （367.1 ± 121.4μmol/L） than in the normal controls, which also showed a significant difference （ t = 4.714,P 〈 0.001 ）. In the （ diabetes mellitus with） normal renal function group, 21.7 % （ 44/203 ） of the patients had a significantly lower level of serum UA, and 0.5 % （ 1/203 ） had a increased level. Meanwhile, 1.4% （ 1/72 ） of the patients with diabetic nephrepathy had a lower level of serum UA, 22.2% （16/72） had a increased level. There was a significant difference in the rate of serum UA abnormahty between the two groups （P 〈0.01 ）. The level of UA was 299.7 ±96.4 （μmol/L） in the 102 diabetes mellitus patients accompanied by TG increase, and in the 173 diabetes mellitus patients with normal TG the level of serum UA was 251.6 ± 104.2 （μmol/L） , which suggested a significant difference （ t = 3. 754, P 〈 0. 001 ）. Correlation analysis suggested that there was a significantly negative correlation between UA and GLU （r = -0.311 1, P 〈 0.01 ） and a significantly positive correlation between UA and TG （r = 0. 269 1 ,P 〈 0.01 ） in the patients with diabetes mellitus. The correlation between UA and TC was not found （ r = 0.106 7, P 〉 0.05 ）. Conclusion There are two phenotypes in the patients with diabetes mellitus, i. e. hypouricemia and hyperuricemia. When the patients with early diabetes mellitus have a normal renal function, the level of serum UA decreases, and it will increase significantly when diabetes mellitus was complicated with nephropathy. Detection of serum UA has an im portant value for judging the condition of the patients with diabetes mellitus.