2型糖尿病患者下肢动脉粥样硬化与血尿酸的关系

Relationship between serum uric acid level and lower extremity atherosclerosis in patients with type 2 diabetes mellitus

目的探讨2型糖尿病患者血尿酸水平与下肢动脉粥样硬化间的相关性,为降低2型糖尿病并发下肢动脉粥样硬化的发病率提供临床依据。方法选择2017年5月至2018年5月在首都医科大学附属北京安贞医院全科医疗科住院的76例2型糖尿病患者作为研究对象,收集患者的一般资料,测定研究对象的血糖、血压、血脂、血尿酸和血肌酐等生化指标,根据踝肱指数是否异常将研究对象分为下肢动脉疾病(LEDA)组(25例)和无LEDA组(51例)。通过两组各指标的比较,分析下肢动脉粥样硬化与生化指标间的相关性。用SPSS 21.0统计软件进行数据的分析,计量资料的组间比较用t检验,计数资料的组间比较用χ^2检验,用多因素logistic回归分析2型糖尿病患者下肢动脉粥样硬化的影响因素。结果 2型糖尿病患者高尿酸血症患病率为26.32%,2型糖尿病患者发生下肢动脉粥样硬化出现高尿酸血症的风险是无下肢动脉粥样硬化的6.809倍。LEDA组血尿酸水平[(425.43±47.26)μmol/L]明显高于无LEDA组[(330.58±41.32)μmol/L],差异有统计学意义(P<0.01);LEDA组糖尿病病程、糖化血红蛋白、收缩压和尿素氮水平明显高于无LEDA组,差异均有统计学意义(P<0.05),LEDA组周围神经病变、糖尿病肾病和服用影响尿酸排泄的药物患者比例均明显高于无LEDA组,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,血尿酸、糖化血红蛋白和糖尿病肾病与2型糖尿病下肢动脉粥样硬化相关(OR值分别为8.036、3.212和4.406,P<0.05)。结论血尿酸水平升高,高尿酸血症是2型糖尿病下肢动脉硬化的危险因素。

Objective To explore the relationship between serum uric acid level and lower extremity atheroselerosis in T2DM patients,and to provide the clinical basis for reducing the morbidity of lower extremity atherosclerosis in T2DM patients.Methods From May of 2017 to May of 2018,76 T2DM inpatients in the general practice department of affiliated Anzhen hospital of Capital medical university were selected as the subjects.The data of general demographic information for all subjects were collected,the biochemical indexes (blood glucose,blood pressure,blood lipid,blood uric acid and blood creatinine)of all subjects were measured.The subjects were divided into LEDA group (25 cases)and non-LEDA group (51 cases)according to whether the ankle index was abnormal or not;the correlation between atherosclerosis of lower extremities and biochemical indexes was analyzed as compared the all indexes between two groups.The t test,χ^2 test and multivariate logistic regression analysis were used to analyze the data and influencing factors.The used software was SPSS 21.0.Results The morbidity of hyperuricemia in T2DM patients was 26.32%,the hyperuricemia risk in T2DM patients with lower extremity atherosclerosis was 6.809 folds in T2DM patients without lower extremity atherosclerosis.The level (425.43±47.26μmol/L)of blood uric acid in the LEDA group was significantly higher than the level (330.58±41.32μmol/L)of blood uric acid in the non-LEDA group (P<0.05).Course of T2DM, glycosylated hemoglobin,systolic pressure and urea nitrogen levels in LEDA group were significantly higher than those in non-LEDA group (P<0.05);the proportions of patients with peripheral neuropathy,diabetic nephropathy and patients taking medications affecting uric acid excretion in LEDA group were significantly higher than those in non-LEDA group (P<0.05). Multivariate logistic regression analysis showed that the uric acid,glycosylated hemoglobin,diabetic nephropathy were associated with lower extremity atherosclerosis in T2DM (P<0.05).Conclusion High blood uric acid level and hyperuricemia were risk factors for lower extremity arteriosclerosis in T2DM patients.