血尿酸对糖代谢异常患者肾功能的影响

Effect of Serum Uric Acid on Renal Function of Patients with Abnormal Glucose Metabolism

目的 探讨高尿酸血症（HUA）对糖代谢异常患者肾功能的影响,研究干预尿酸水平在防治此人群肾功能不全中的临床价值。方法 选取2014年5月在我院体检中心行健康体检者1 495例,检测血清血糖、肾功能指标和血脂,计算估计肾小球滤过率（eGFR）。糖尿病（DM）组〔空腹血糖（FPG）≥7.0mmol/L〕,共253例（男性227例,女性26例）;空腹血糖受损（IFG）组（FPG水平为6.1~7.0mmol/L）,共692例（男性556例,女性136例）;对照组为FPG水平正常的体检者（正常FPG组）550例（男性405例,女性145例）。进一步根据血尿酸水平将上述3组各分为血尿酸正常和HUA亚组,统计HUA的患病情况,分析比较各组肾功能和血脂水平。用eGFR≤50mL/（min·1.73m2）和血清肌酐（SCr）≤1.7μg/mL作为评估标准,计算患者的肾功能不全检出率。结果1 495例研究人群中,IFG合并HUA者197例,占13.18%,男女比为4.05∶1;DM合并HUA者66例,占4.41%,男女比为7.25∶1。正常FPG组、IFG组和DM组内,与血尿酸正常亚组相比,HUA亚组尿素氮（BUN）、SCr均升高,eGFR均降低,差异有统计学意义（P〈0.05）。HUA对正常FPG组和IFG组的血脂水平影响更大（两组组内比较,P〈0.05）,但对DM组的血脂水平影响不大（DM组内比较,P〉0.05）。在IFG合并HUA组,其肾功能和血脂指标均差于单纯DM组（P〈0.05）。两种评估标准均发现IFG合并HUA组的肾功能不全检出率高于单纯IFG组,DM合并HUA组的肾功能不全检出率高于单纯DM组,两组差异有统计学意义（P〈0.05）。结论 男性在IFG合并HUA者和DM合并HUA者的比例较高。HUA对糖代谢异常患者肾功能影响较大,对HUA的干预可以从IFG合并HUA阶段开始。

Objective To determine the effect of serum uric acid on renal function of patients with abnormal glucose metabolism. Methods A total of 1 495 people who took physical examinations in West China Hospital of Sichuan University in May 2014 were recruited in this study. Serum nitrogen （BUN）, creatinine （SCr）, triglycerides （TG）, cholesterol （TC）, high-density lipoprotein （ HDL-C）, low-density lipoprotein （LDL-C） and uric acid （SUA） of the participants were detected by an automatic biochemical analyzer. The glomerular filtration rate （eGFR） was calculated with CKD-EPI. According to hyperuriceima （HUA）, the participants were divided into groups with impaired fasting glucose （IFG）, diabetes （DM）, IFG with hyperuicimia, and DM with hyperuricemia. The participants with normal fasting plasma glucose served as controls. Renal dysfunction was detected using eGFR≤50 mL/（min · 1. 73 m^2） and SCr≤1. 7 μg/mL. Results About 13. 18% （197/1 495） participants were identified as IFG with HUA： male （158） /female （39） ratio =4.05; 4.41% （66/1 495） as DM with HUA： male （58） /female （8） ratio = 7.25. Participants with HUA in the control, IFG and DM groups had higher levels of BUN and SCr and lower levels of eGFR than those without HUA （P〈0.05）. HUA was more likely to be associated with serum lipid in the control and IFG groups （most P〈0. 05） than in the DM group （P〉0.05）. DM patients without HUA had better renal function and serum lipid levels than those who had HUA in their early stage of abnormal glucose metabolism （IFG with HUA） （P〈0.05）. The prevalence of renal dysfunction of IFG patients with HUA was significantly higher than those without HUA, similar to the prevalence of renal dysfunction of DM patients with HUA （P〈0.05）. Conclusion Higher percentage of men was found in IFG patients with HUA and DM patients with HUA. HUA is associated with renal dysfunction in patients with abnormal glucose metabolism. HUA intervention should be considered in IFG patients with HUA.