2型糖尿病患者血尿酸水平与尿白蛋白/肌酐的关系

Correlation of uric acid and urinary albumin-creatinine ratio in patients with Type 2 diabetes mellitus

目的研究2型糖尿病患者血尿酸水平与尿白蛋白/肌酐的关系。方法该院住院540例(男265例,女275例)2型糖尿病者,年龄(60.6±11.5)岁,没有用过利尿剂、降尿酸药物或饮酒史,检测血尿酸及尿白蛋白与肌酐比。根据尿白蛋白与肌酐比值分为正常(<30.0mg/g)、微量白蛋白(30.0～299.9mg/g)、大量蛋白尿组(>300.0mg/g)。采用单因素分析血尿酸与尿白蛋白排泄率的相关性;多元回归分析该组2型糖尿病患者血尿酸水平与收缩压、舒张压、尿白蛋白与肌酐比、糖化血红蛋白A1c、血脂的关系。结果在糖尿病正常蛋白尿组、微量蛋白尿组及大量蛋白尿组对应的血尿酸水平分别为(242±60)μmol/L,(345±84)μmol/L,和(416±108)μmol/L,有统计学差异(P<0.05);在男性组,异常蛋白尿发生率在低尿酸水平组(<295μmol/L)及高尿酸水平组(>295μmol/L)分别为35.9%,63.1%(P<0.01)在女性组分别为33.5%,66.4%(P<0.01)。在男性组,血尿酸水平与TG、In(ACR)相关,与HDL-C负相关;而在女性组及总体人群血尿酸水平除上述相关关系外,还与CCr呈负相关(P<0.05)。在调整了CCr及年龄、BMI、高血压病史、吸烟、SBP、DBP、HbA1c、TG、TC、HDL-C和LDL-C等混杂因素后In(ACR)的标化系数为0.214(P<0.05),血尿酸水平每增加1mg/dl则异常蛋白尿的相对危险度为1.256(P<0.05)。结论该研究提示血尿酸水平与2型糖尿病患者尿白蛋白/肌酐相关。

[Objective] This study evaluated the association between serum uric acid and urinary albumin-tocreatinine ratio （ACR） among patients with Type 2 diabetes mellitus. [Methods] A total of 540 patients （265 men and 275 women） aged （60.6±11.5） were recruited who did not use uric acid-lowering agents, diuretics, or alcohol. Serum uric acid and urinary ACR were determined. Normoalbuminuria, microalbuminuria, and macroalbuminuria were defined as ACR 〈30.0, 30.0 to 299.9, and /〉 300.0 mg/g, respectively. One-way analysis of variance （ANOVA） followed by multiple comparison test with the least significant difference was used to compare the differences of uric acid levels among the three subgroups of ACR. Pearson correlation coefficients among uric acid, continuous covariates and In （ACR） were calculated for different genders. [Results] The respective uric acid levels for normoalbuminuria （n=231）, microalbuminuria （n=204）, and macroal-buminuria （n=105） were （242±60） μmol/L, （345±84） μmol/L, and （416±108）μmol/L （P 〈0.05）. In male growp ,prevalence of abnormal albuminuria （microalbuminuria plus macroalbuminuria） for the respective values of uric acid for lower （〈295 μmol/L） to higher （〉 295μmol/L） were 35.9%, 63.1% （P 〈0.01）. In female group, prevalence of abnormal albuminuria （microalbuminuria plus macroalbuminuria） for the respective values of uric acid for lower （〈295 μmol/L） to higher （〉295 μmol/L） were 33.5%, 66.4% （P 〈0.01）. In male group, uric acid correlated positively with triglycerides, LDL-ch and natural logarithmic [In （ACR）] （r=0.261, P 〈0.05）. In female group, uric acid correlated positively with triglycerides, In （ACR） （=0.280, P 〈0.01）, but negatively with calculated creatinine clearance. The standardized regression coefficient for In （ACR） and the odds ratio for abnormal albuminuria for every 1 mg/dL increment of uric acid after adjusting for calculated creatinine clearance and other confounders were 0.214 （P 〈0.05） and 1.256 （P〈0.05）, respectively. [Conclusion] Serum uric acid correlated positively with natural logarithmic of urinary ACR [In （ACR）] in patients with Type 2 diabetes melhtus.