探讨血尿酸控制疗法对2型糖尿病患者早期肾功能损伤的影响

Effect of serum uric acid control therapy on early renal damage in patients with type 2 diabetes mellitus

目的：分析血尿酸水平与2型糖尿病患者早期肾功能损伤的相关性，探讨血尿酸控制疗法对2型糖尿病患者早期肾功能损伤的影响。方法筛选2005年1月至2015年1月收治的2型糖尿病患者442例为研究对象，所有患者均确诊为2型糖尿病，且尿蛋白排泄率（ UAER）均﹤200μg/min。根据患者血尿酸（ BUA）水平将其分为高血尿酸组（n＝218）与低血尿酸组（n＝224），比较两组患者肾小球滤过率（GFR）。采用随机数表法将高血尿酸组分为治疗组与对照组，对照组行常规血糖控制疗法，治疗组在对照组基础上进行尿酸控制，比较两组患者GFR及生存时间。结果低血尿酸组患者GFR水平为（112.3±26.7）ml/（min·1.73 m2），明显高于高血尿酸组的（95.3±20.8）ml/（ min·1.73 m2），差异有统计学意义（ P﹤0.05）；以GFR为因变量进行多因素回归分析，结果显示血糖、血脂、性别因素比较差异未见统计学意义时，年龄、血尿酸浓度、病程、体质量指数均与 GFR浓度呈负相关（ r＝-0.445，P﹤0.05），血红蛋白浓度与GFR浓度呈正相关（r＝0.617，P﹤0.05）；生存分析研究中，患者血尿酸浓度越低，其出现肾功能损伤的概率更低，生存时间更长，并且高血尿酸组患者经尿酸控制治疗可降低肾功能损伤发生率，延长生存时间。结论高血尿酸水平可作为2型糖尿病患者早期肾功能损伤的独立危险预测因素，并且高尿酸血症可直接影响糖尿病肾病的发生与发展，积极进行尿酸控制治疗对预防2型糖尿病患者肾功能损伤以及延长生存时间具有重要价值。

Objective To analyze the correlation between serum uric acid level and early renal damage in patients with type 2 diabetic mellitus,to investigate the effect of serum uric acid control thera-py on early renal damage in patients with type 2 diabetes mellitus. Methods Four hundred and forty-two patients with type 2 diabetes from January 2005 to January 2015 were selected as the research objects. All patients were diagnosed as type 2 diabetes,and urinary albumin excretion rate（ UAER）were less than 200 μg/min,according to the patient’s blood uric acid（ BUA）were divided into high blood uric acid group（n=218）and low blood uric acid group（n=224）,the glomerular filtration rate（GFR）of the two groups were compared. Using random table highblood uric acid were divided into the treatment group and the control group. The control group received routine therapy to control blood glucose,and the treatment group received uric acid control on the basis of routine therapy,the GFR and survival time of the two groups were compared. Results The level of GFR in low serum uric acid group was（112.3 ± 26.7）ml/（min·1.73 m^2）,which was significantly higher than that in the high blood uric acid group [（95.3 ±20.8）ml/（min·1. 73 m^2）]（P﹤0.05）. Multi factor regression analysis with GFR as the dependent variable,the results showed the blood glucose,blood lipid,gender,age,blood uric acid con-centration,duration and body mass index were negatively correlated with the concentration of GFR（ r=-0.445,P﹤0.05）,hemoglobin and hemoglobin concentration were positively correlated with GFR. In the survival analysis,the lower the blood uric acid concentration（r=0.617,P﹤0.05）,the lower the probability of renal function injury,and longer survival time. Conclusions High blood uric acid levels can be used as an independent predictor of early renal impairment in patients with type 2 diabetes,and hyperuricemia can directly affect the occurrence and development of diabetic nephropathy,positive control of uric acid has＆amp;nbsp;important value in preventing renal function injury and prolonging survival time of type 2 diabetic patients.