不同年龄和性别中老年2型糖尿病合并高尿酸血症的特点

Clinical characteristics of hyperuricemia in the Chinese type 2 diabetes patients with different age and gender

目的了解不同年龄不同性别中老年2型糖尿病合并高尿酸血症的特点。方法对2003年9月至2011年12月于我科就诊的3768例年龄≥40岁的2型糖尿病患者临床资料进行分析，根据尿酸水平将患者分为高尿酸组（A组，男性尿酸〉420μmol／L，女性尿酸〉357μmol／L）和尿酸正常组（B组），排序后再进行五分位分组；年龄按40～70岁每5岁分组共分为7组，比较各组高尿酸血症患病率、BMI、腰臀比（WHR）、血压和生化指标。尿酸与血糖、HbAle、胰岛素抵抗指数（HOMA-IR）的相关性采用Pearson相关分析，采用logistic回归方法分析尿酸的影响因素。结果男性尿酸水平明显高于女性（t=-11．091，P〈0．05），随年龄变化为先下降后上升；女性尿酸随着年龄增长而上升。男性A组较女性A组平均年龄小、高密度脂蛋白胆固醇（HDL-C）低（t=2．526、2．764，均P〈0．05）。女性A组空腹、餐后血糖和男性A组HbAlC均低于B组（t=2．147、3．284、2．982，均P〈0．05），男女A组空腹、餐后胰岛素、HOMA-IR和甘油三酯（TG）、尿素氮（BUN）、肌酐（Ser）均明显高于B组（均P〈0．05），而HDL-C、肾小球滤过率（e-GFR）明显低于B组（均P〈0．05）。男性A组白蛋白／肌酐（Alb／Cr）明显高于B组（t=-3．922；P〈0．05），女性两组无差异。logistic回归分析示男性尿酸与BMI、TG、A1b／Cr呈正相关（OR=1．128、1．231、1．004，均P〈0．05），与HbAlC和e-GFR呈负相关（OR=0．811、0．973，均P〈0．05）；女性尿酸与BMI、TG、HDL-C呈正相关（OR=1．171、1．179、0．264，均P〈0．05），与e-GFR呈负相关（OR：0．978；P〈0．05）。结论糖尿病合并高尿酸血症的患者有更严重的胰岛素抵抗、血脂异常以及e—GFR下降。男女糖尿病患者的尿酸水平及其年龄、体重、血压等对尿酸水平的影响有所不同。

Objective To investigate the characteristics of hyperuricemia in the type 2 diabetes patients aged over 40 years old. Methods A total of 3768 type 2 diabetes patient over 40 years old who visit the clinics of the 306 th Hospital during the period from September, 2003 to December, 2011 were enrolled in the study. The subjects were divided into 2 groups based on the blood uric acid （BUA） , which were group A with hyperuricemia （ 〉 420 μmol/L in the male and 〉357 μmol/L in the female） and group B with normal BUA level. The quinquepartite method was used after sorting the BUA level. The subjects were stratified by age into 7 groups with every 5 yrs differences from 40 to 70 years old. The prevalence of hyperuricemia, BMI, WHR （waist-to-hip ratio）, BP （blood pressure） and biochemical parameters were compared among these groups. The spearman analysis was used to explore the correlation between BUA and blood glucose, HbAlc and insulin-resistance index. The logistic regression analysis was applied to investigate the related risk factors of hyperurieemia. Results BUA was significantly higher in the male than in the female（t = - 11. 091, P 〈0. 05）. In the males, the level of BUA was initially decreased with age followed by an increase when aged over 65 yrs, while the level of BUA kept increasing with age in the female. In group A, the male were younger and with lower level of HDL-C （ t = 2. 526, 2. 764, all P 〈 0. 05 ） than the female. Compared with group B, the female had lower fasting and post prandial glucose level （t =2. 147, 3. 284, all P 〈0. 05） ,and the male had lower HbAlc （t =2. 982, P 〈0. 05） in group A. in Higher fasting and post-prandial insulin level and higher insulin-resistance index were observed in group A than in group B （ all P 〈 O. 05）. In both the male and the female of group A, the levels of blood TG, BUN, and creatinine were higher, while the HDL-C and e-GFR were lower than those in group B （ all P 〈 0. 05 ）. The urine Alb/Cr ratio was significantly higher in group A than that in group B for the male（ t = -3. 922; P 〈0. 05）, but not for the female. Logistic regression analysis showed that BUA was positively correlated with BMI, TG, and Alb/Cr （OR： 1. 128, 1. 231, 1.004; all P 〈 0.05）, while negatively correlated with HbA1 c and e-GFR（ OR： O. 811, 0. 973; all P 〈 0.05 ） for the male. In the female, BUA was showed to be positively correlated with BMI, TG, HDL-C （OR： 1. 171, 1. 179, 0. 264; all P 〈0. 05）, while negatively correlated with e-GFR（ OR ：0. 978 ; P 〈 0. 05 ）. Conclusions The patients with diabetes and hyperuricenfia have more severe insulin resistance, lipids abnormalities and decrease of e-GFR. The level of BUA itself and the impact of age, BMI and blood pressure on the level of BUA differ in the male and in the female.