血清尿酸水平与新发糖尿病关系的前瞻性研究

Serum uric acid and risk of new onset diabetes

目的探讨高血压与非高血压对象不同血尿酸水平对新发糖尿病的影响。方法采用前瞻性队列研究方法，以参加2006—2007年度开滦集团职工健康体检职工101510人中空腹血糖〈7．0mmol／L且无糖尿病病史、未使用降糖药物的职工作为观察队列，排除未参加2008—2009、2010—2011年度体检以及空腹血糖资料缺失者，最终纳入统计分析73279例。将高血压与非高血压对象按不同性别和尿酸五分位数分组，比较不同性别高血压与非高血压亚组间糖尿病的发病率。用多因素Cox回归分析尿酸水平对糖尿病发病风险的影响。结果按性别分层后，女性非高血压与高血压亚组糖尿病的发病率（／1000人年）分别为3．9、4．6、7．4、6．2、7．9和4．3、3．2、5．3、4．7、11．8；男性分别为8．0、8．2、7．8、8．2、9．0和10．7、9．8、8．8、9．2、12．5。影响糖尿病发病的多因素Cox回归分析显示，校正年龄、总胆固醇、空腹血糖后，女性非高血压组，与尿酸第1分位比较，第2到第5分位发生糖尿病的HR（95％CI）分别为1．10（0．74～1．65）、1．63（1．12～2．37）、1．50（1．03～2．20）、1．48（1．02～2．15）；女性高血压组，与尿酸第1分位比较，第2到第5分位发生糖尿病的HR（95％CI）分别为0．75（0．48～1．16）、1．23（0．84～1．81）、0．87（0．59～1．29）、1．42（1．01～2．00）；男性非高血压组，与发病率最低组（第3分位）比较，第1、2、4、5分位发生糖尿病的HR（95％CI）分别为1．04（0．90～1．21）、1．03（0．88～1．19）、1．02（0．88～1．18）、1．10（0．95～1．28）；男性高血压组，相应的HR（95％CI）分别为1．15（1．00～1．32）、1．16（1．01～1．34）、1．01（0．87～1．16）、1．13（0．99～1．28）。结论不论非高血压组还是高血压组，高尿酸均可使女性糖尿病的发病风险增加，低尿酸（〈233μmol／L）时可能增加男性高血压患者糖尿病的发病风险。

Objective To investigate the relationship between uric acid（UA） and new onset diabetes（NOD） in hy- pertensives and normotensives. Methods In 101 510 subjects who took part in the regular health examination from 2006 to 2007 for the employees of Kailuan Group, subjects with fasting plasma glucose（ FPG）〈7.0 mmol/L, with- out history of diabetes and usage of hypoglycemic agents were enrolled, those with incomplete data of FPG and loss of follow up were excluded. There were 73 279 subjects remained in final analysis. The quintiles of uric acid were determined, and the incidence of diabetes between hypertension and normotension group in different gender were compared. The relationship between serum uric acid and NOD was estimated by multiple Cox proportional hazard models. Results Along with quintiles of UA increasing, the incidence of NOD（/1000 person-year） in normoten- sion and hypertension group was 3.9, 4.6, 7.4, 6.2, 7.9 and 4.3, 3.2, 5.3, 4.7, 11.8 respectively in women, and 8.0, 8.2, 7.8, 8.2, 9.0 and 10.7, 9.8, 8.8, 9.2, 12.5 respectively in men. The result of multiple Cox pro- portional hazard models showed that, in female, the HR value（ 95 % CI）of the second, third, forth and fifth group was 1.10 （0.74-1.65）, 1.63（1.12-2.37） ,1.50（1.03-2.20）, 1.48（1.02-2.15） and 0. 75（0. 48-1.16） , 1.23 （0.84-1.81）, 0. 87（0. 59-1. 29） , 1.42（1.01-2.00）, respectively, in normotension and hypertension group after adjusting for age, total cholesterol（TC） and FPG, when compared with the first group. In male, compared with the third group, in which the incidence of NOD is the lowest, the HR value （95 % CI） of the first, second, forth and fifth group was 1.04（0.90-1.21）, 1.03（0. 88-1.19）, 1.02（0. 88-1.18）, 1.10（0.95-1.28） and 1.15（1.00-1.32）, 1.16（1.01-1.34）, 1.01（0.87-1.16） ,1.13（0.99-1.28）, respectively, in normotension and hypertension group after adjusting for age, TC and FPG. Conclusion High level of uric acid increased the risk of new onset dia- betes in femal, while low level of uric acid （〈233 μmol/L） may be the risk factor for new onset diabetes in male hypertensives.