2型糖尿病患者血清尿酸浓度与心房颤动发生率的关系

Relation of serum uric acid levels and incidence of atrial fibrillation in patients with type 2 diabetes mellitus

目的 旨在探讨2型糖尿病患者中血清尿酸（SUA）浓度和心房颤动（房颤）发生率的相关性.方法 抽取佛山市中医院门诊就诊的400例2型糖尿病患者进行了为期6年的随访,这些患者在研究开始时（基线时）并无房颤.每年对患者进行标准12导联心电图检查,并由心内科医师对患者是否发生房颤进行诊断.结果 在超过6年的研究中,有42例患者发生房颤（累计发生率10.5％）.血清尿酸浓度升高与房颤发生明显相关（OR=2.43,95％CI：1.8～3.4,血清尿酸浓度每增加1-SD,P＜0.0001）.校正年龄、性别、体质量指数、原发性高血压、慢性肾脏疾病、心电图特征（左心室肥大和PR间期）、使用利尿药和别嘌呤醇等因素后,血清尿酸浓度和房颤发生率之间的相关性并未减弱（OR =2.44,95％CI,1.6～3.9,P＜0.0001）.进一步校正房颤风险评分的变量后,两者的相关性并未减弱.将血清尿酸浓度作为分类变量建立模型（用血清尿酸浓度中值或高尿酸血症）和将患有冠状动脉粥样硬化性心脏病（冠心病）或心力衰竭患者排除在分析外时,结果仍保持不变.结论 2型糖尿病患者中,血清尿酸浓度升高与房颤发生率的增加明显相关,即使在调整多个房颤的危险因素之后,这种联系仍然存在.

Objectives To examine the association between serum uric acid （SUA） levels and incidence of atrial fibrillation （AF） in patients with type 2 diabetes mellitus. Methods We followed up a random sample of 400 outpatients with type 2 diabetes mellitus for 6 years, who were free from AF at baseline. Standard 12-lead electrocardiography was undertaken annually and diagnosis of AF was confirmed in affected participants by a single cardiologist. Results For over 6 years＇ follow-up, there were 42 cases confirmed AF （cumulative incidence was 10.5% ）. Elevated SUA levels were associated with an increased incidence of AF [odds ratio （OR）= 2.43, 95% confidence interval （CI）： 1.8 to 3.4, P〈 0.0001 for each 1-SD increase in SUA level]. Adjusted for age, gender, body mass index, hypertension, chronic kidney disease, electrocardiographic features （left ventricular hypertrophy and PR interval）, after using diuretics and allopurinol, the association of elevated SUA levels and incidence of AF did not attenuate （adjusted OR=2.44, 95%CI： 1.6 to 3.9, P〈0.0001 ）. Further adjusted for variables that were included in the 10-year Framingham Heart Study, the association of them did not appreciably weaken. Results remained unchanged even when SUA was modeled as a categorical variable （stratifying by either SUA median or hyperurieemia）, and when patients with previous coronary heart disease or heart failure were excluded from analysis. Conclusions Elevated SUA levels are strongly associated with an increased incidence of AF in patients with type 2 diabetes mellitus, even after adjustment for multiple clinical risk factors for AF.