肾脏尿酸排泄在不同糖耐量状态下的变化

The Changes of renal excretion of uric acid in the subjects with different glucose tolerance conditions

目的研究T2DM自然病程的不同阶段肾脏尿酸排泄的变化,识别影响尿酸排泄的相关因素,为T2DM合并高尿酸血症个体化用药提供依据。方法收集168名无糖尿病病史的志愿者,行75g OGTT,测定UA1b、Cr、Scr、UA与SUA,计算尿中尿酸/肌酐比值(UUA/CRE)和尿酸排泄分数(FUE)。结果 FUE在NGT(n=61)、糖尿病前期(IFG和/或IGR,n=55)和T2DM(n=52)组间差异无统计学意义;男性(P=0.007)、向心性肥胖(P=0.001)及高尿酸血症者(P<0.0001)有相对低的FUE;WC是尿酸排泄独立的相关因素(P<0.0001);在糖尿病和糖尿病前期合并高尿酸血症患者(n=16)中,仅有12.5%患者UUA/CRE低于正常人1%分位(根据16例男性和29例女性无高血压、无高血糖、无高尿酸计算)。结论尿酸排泄降低是高尿酸血症发生的重要机制;尿酸排泄在糖尿病发生不同阶段无明显变化,大部分糖尿病和糖尿病前期合并高尿酸血症患者可能存在尿酸生成和排泄双重障碍,在治疗前和治疗期间测定UUA/CRE是必要的。

Objectives To investigate the changes of renal uric acid excretion in different stages of type 2 diabetes,and identify its relating facts,providing the evidence for individualized treatment for hyperuricemia in patients with type 2 diabetes.Methods 168 participants without history of diabetes were included in this study.OGTTs were conducted,the concentrations of uric acid,creatinine and albumin in spot morning fasting urine,concurrently the concentrations of uric acid and creatinine of fasting serum samples were determined.The fraction of uric acid excretion（FUE） and ratio of uric acid/creatinine（UUA/CRE） were calculated.Results No significant difference among three groups with normal OGTT（n=61）,pre-diabetes（impaired fasting glucose and /or impaired glucose tolerance,n=55） and diabetes（n=52） was observed;The subjects with male gender（P=0.007）,central obesity（P=0.001） and hyperuricemia（P0.0001） have relatively low FUE and UUA/CRE compared with female gender,no central obesity and normal serum uric acid levels;Waist circumference was an independent fact associated with UUA/CRE（P0.0001）.16 subjects with diabetes or pre-diabetes have hyperuricemia,of whom 12.5% subjects have lower than 1% percentile of UUA/CRE obtained from 16 men and 29 women without hyperglycemia,hypertension and hyperuricemia.Conclusion Reduced renal excretion of uric acid play an important role in pathogenesis of hyperuricemia,and most patients with hyperglycemia and hyperuricemia might have combined excess product and low excretion of uric acid.Therefore,it＇s necessary to determine UUA/CRE before and after initiation of treatment for hyperuricemia in the patients with type 2 diabetes.