高尿酸血症在2型糖尿病早期肾脏损害中的作用

The effects of hyperuricemia on early diabetic nephropathy in patients with type 2 diabetes meilitus

目的探讨高尿酸血症在2型糖尿病早期肾脏损害中的作用，并观察通过生活方式干预控制血尿酸水平正常后尿白蛋白与肌酐比值（ACR）的改善情况。方法选取2011年1—12月于我院内分泌科住院治疗的2型糖尿病患者160例为研究对象，根据血尿酸水平分为高尿酸（HUA）组60例，正常尿酸（NUA）组100例，比较两组患者空腹血糖（FBG）、空腹胰岛素（FINS）、糖化血红蛋白（HbAlc）、血脂、ACR、体质量指数（BMI）、胰岛素抵抗指数（HOMA—Ia）的差异。HUA组进行生活方式干预至少6个月，重新测定相关指标。结果HUA组患者FINS、HOMA—IR、ACR和甘油三酯较NUA组升高[（110．334-38．73）、（72．64±21．94）pmol／L，t=2．876；7．04-2．3、4．64-1．3，t=2．364；13．6（5．1，53．2）mg／mmol与6．4（2．9，16．8）mg／mmol，H=3．390；（2．534-1．45）、（1．714-1，32）mmol／L，t=2．626；P均〈0．05]。Spearman相关分析显示，血尿酸与FINS、HOMA-IR、ACR、BMI呈正相关（r值分别为0．304、0．225、0．248、0．271，P均〈0．05）。采用偏相关分析校正年龄、病程、肥胖、血糖、胰岛素抵抗的影响，血尿酸与ACR仍呈正相关（r：0．312，P〈0．01）。生活方式干预后HUA组患者血尿酸、FINS、HOMA-IR和ACR较干预前降低[（463．7±18．6）、（380．34-9．5）umol／L，t=3．065；（110．33±38．73）、（83．30±28．21）pmol／L，t=2．532；7．04-2．3、5．04-0．9，t=2．165；13．6（5．1，53．2）mg／mmo]与8．1（4．9，20．4）mg／mmo]，H=2．912；P均〈0．05]。结论2型糖尿病合并高尿酸血症患者更容易出现ACR超标。改善生活方式、控制血尿酸水平可能对控制早期糖尿病肾病的发生发展有益。

Objective To investigate the effect of hyperuricemia on early renal damage in patients with type 2 diabetic, and to explore the improvement of albumin-to-creatinine ratio （ACR） after lifestyle intervention to control the level of serum uric acid. Methods One hundred and sixty patients with type 2 diabetic mellitus from our hospital from January 2012 to December 2012 were recruited and divided into the high uric acid group （ HUA,60 cases）, and the normal uric acid group （ NUA, 100 cases）. Fasting blood glucose （FBG） , insulin （FINS）, glycosylated hemoglobin （HbAlc）, serum lipid levels, morning urine albumin-to-creatinine ratio （ACR） were detected in each group, and body mass index （BMI）, insulin resistance index （HOMA-IR） were calculated. The HUA group was intervened by lifestyle for at least 6 months, and related indexes were measured again. Results The FINS, HOMA-IR, ACR and triglyceride （TG） of the patients in the HUA group were higher than that in the NUA group （ （ 110. 33 ± 38.73 ） pmol/L vs. （72. 64 ± 21.94） pmo]/L, t = 2. 876 ; （7.0 ± 2. 3 ） vs. （4. 6 ± 1.3 ）, t = 2. 364 ; 13.6 （5.1,53.2） mg/mmol vs. 6.4 （2. 9,16. 8 ） mg/mmol, H = 3. 390 ; （2. 53 ± 1.45） mmolfL vs. （1.71 ± 1.32） mmol/L,t =2. 626;P 〈0. 05）. By the Spearman correlation analysis,the level of serum uric acid was positively correlated with FINS, HOMA-IR, ACR, and BMI （ r = 0. 304,0. 225, 0. 248,0. 271 respectively; P 〈 O. 05 ）. After adjusting the factor of age, duration, obesity, blood glucose and insulin resistance, the level of serum uric acid was still positively correlated with ACR （ r = 0. 312, P 〈 0.01 ）. The FINS, UA, HOMA-IR and ACR in group HUA were lower than those before lifestyle intervention （ （463.7 ~ 18.6） ixmol/L vs. （ 380. 3±9.5 ） Ixmol/L, t = 3. 065 ; （ 110. 33 ± 38.73 ） pmol/L vs. （ 83.30 ± 28.21 ） pmol/L,t =2. 532; （7.0 ±2.3） vs. （5.0 ±0.9） ,t =2. 165;13.6（5.1,53.2） mg/mmol vs. 8. 1（4.9,20.4） mg/mmol,H = 2. 912 ; P 〈 0.05 ）. Conclusion The patients with type 2 diabetes complicating hyperuricemia were likely to having abnormal ACR. Controlling the level of serum uric acid by lifestyle intervention may be benefit for delaying the development of early diabetic nephropathy in patients with type 2 diabetes.