尿酸与早期2型糖尿病肾病关系的临床研究

Study of the relationship between serum uric acid and the early stage of diabetic nephropathy in patients with type 2 diabetes

目的探讨尿酸与早期糖尿病肾病之间的关系。方法以住院的2型糖尿病患者为研究对象。测定患者的体重指数(body mass index,BMI)、血压、肝肾功能、空腹血糖、血脂、血尿酸、糖化血红蛋白(glycated hemoglobin A1c,Hb A1c)、尿微量白蛋白(urinary albumin excretion rate,UAER)等相关临床指标。根据UAER水平的不同分为两组:早期糖尿病肾病组(DN组),20μg/min<UAER<200μg/min,共172例;糖尿病正常尿白蛋白组(DM组),UAER<20μg/min,共156例。比较两组临床检测指标,运用统计学方法分析糖尿病肾病与尿酸及其他指标之间的关系。结果 DN组的糖尿病病程、Hb A1c、空腹血糖、甘油三酯(triglyceride,TG)、血清总胆固醇(serum total cholesterol,TC)、低密度脂蛋白(low density lipoprotein,LDL)、UAER水平明显高于DM组,而高密度脂蛋白(high density lipoprotein,HDL)低于DM组(P<0.05);UAER水平与糖尿病病程、Hb A1c、空腹血糖、血尿酸、TC、TG、LDL、收缩压呈正相关,而与HDL呈负相关。进行多元回归分析,糖尿病病程、糖化血红蛋白、血尿酸、TG、TC、HDL、收缩压进入最后的回归方程。按UAER是否升高、有无高尿酸血症(男性≥420μmol/L,女性≥360μmol/L)形成四格表进行χ2检验,χ2=5.537,P=0.019。结论高尿酸血症是2型糖尿病患者早期糖尿病肾病的一项危险因素。

Objective To discuss the relationship between serum uric acid and the early stage of diabetic nephropa-thy. Method The hospitalized patients with type 2 diabetes were studied and body mass index（ BMI）、blood pres-sure、serum creatinine、fasting blood glucose, lipids, serum unci acid、urinary albumin excretion rates（ UAER） were measured and calculated. The patients were divided into two groups based on the level of UAER：DN group included those whose UAER＆gt;20μg/min but＆lt;200μg/min （172 patients）,while in DM group, UAER＆lt;20μg/min（156 pa-tients） . The characteristics and clinical items were compared, and the relationship between serum uric acid and UAER was statistical analyzed. Result The duration of diabetes、HbA1C、fasting blood glucose、triglyceride （TG）, serum total cholesterol（ TC） , low density lipoprotein （ LDL） and UAER were significantly higher in DN group than in DM group, while high density lipoprotein （ HDL） in DN group was evidently lower than in DM group. The level of UAER was positively correlated with duration of diabetes、HbA1C、fasting blood glucose、uric acid、TC、TG、LDL and systolic blood pressure, but negatively correlated with HDL. After multivariate regression, duration of diabetes、HbA1C、serum uric acid、TG、TC、HDL and systolic blood pressure emerged the final regression equation. All pa-tients were redevised into crosstab based on the levels of UARE and serum uric acid （ hyperuricemia, male≥420μmol/L, female≥360μmol/L）,the data of Chi square test showed that the value of Chi square was 5. 537,P=0. 019. Conclusion Hyperuricemia is a risk factor of the early stage of diabetic nephropathy in type 2 diabetes.