中老年住院2型糖尿病患者血尿酸水平与胰岛素抵抗的相关性研究

The study of the correlation between serum uric acid and insulin resistance in middle-aged and elderly hospitalized patients with type 2 diabetes

目的探讨2型糖尿病患者血尿酸水平与胰岛素抵抗的关系。方法回顾性研究，以728例中老年住院2型糖尿病患者为研究对象。常规测定患者体质指数、腰围、血压、肝肾功能、血尿酸、空腹血糖、糖化血红蛋白（HbA1C）、血脂、空腹C肽等相关临床指标。根据血尿酸水平、代谢综合征发生情况及含有不同组分数目进行分组，分析血尿酸水平与胰岛素抵抗和高尿酸血症与代谢综合征的相关性。结果728例患者中，高尿酸血症发生率为26．9％（196例），代谢综合征发生率为64．6％（470例）。高尿酸血症组体质指数、腰围、收缩压、舒张压、三酰甘油、空腹C肽及胰岛素抵抗指数（HOMA）（C肽）高于正常尿酸组，而高密度脂蛋白胆固醇（HDL-C）则低于正常尿酸组。高尿酸血症组代谢综合征发生率81．6％（160／196），高于正常尿酸组（58．3％，310／532），差异有统计学意义（P〈0．05）。按尿酸水平四分位数分为4组，尿酸水平由低至高含有代谢综合征组分的数目分别为2．1±1．0、3．1±1．1、3．3±1．2、3．7±0．8，对应各组HOMA（C肽）水平、代谢综合征发生率差异有统计学意义（均P〈0．05）。代谢综合征组尿酸水平（377．3±43．5）gmol／L、高尿酸血症发病率（34．0％，160／470）、HOMA（C肽）3．9±0．7，均高于非代谢综合征组（318．2±47．9）μmol／L、14．0％（36／258）、3．6±0．7；按代谢综合征不同组分数目1～5个分5组，各组的血尿酸、HOMA（C肽）水平比较，差异有统计学意义（均P〈0．05）。Pearson相关分析，血尿酸水平与年龄、腰围、体质指数、三酰甘油、收缩压、空腹C肽、HOMA（C肽）呈正相关，与HbA1c、HDL-C呈负相关。多元Logistic回归分析示随着血尿酸水平的升高，代谢综合征的发病风险增加（OR=1．033，95％CI：1．026-1．041，P〈0．05）。结论中老年住院2型糖尿病患者中血尿酸水平与胰岛素抵抗密切相关，高尿酸血症是代谢综合征的危险因素之一。

Objective To study the relationship between serum uric acid and insulin resistance in type 2 diabetic patients Methods A total of 728 middle-aged and elderly type 2 diabetic patients were recruited and the anthropometric, clinical and biochemical parameters and fasting serum C-peptide were measured and retrospectively studied. All patients were divided into groups based on the levels of uric acid and on metabolic syndrome diagnosis or not. Results Among a total of 728 patients,the proportion of hyperuricemia was 26.9 %（196 /728） ,and metabolic syndrome（MS） was 64.6%. The levels of body mass index（BMI）, waist circumference（WC）, systolic pressure （SBP）, diastolic pressure （ DBP）, triglyceride （ TG）, fasting C-peptide, HOMA（C-Peptide） were significantly higher in hyperuricemia group than in normal uric acid group, while the level of HDL was lower in hyperuricemia group than in normal uric acid group. The proportion of MS was statistically higher in hyperuricemia group （ 81.6 %） than in normal uric acid group （ 58.3 %, P 〈 0.05 ） . Groups Ⅰ,Ⅱ, Ⅲ, Ⅳ-the four quartiles of serum uric acid from low-to high-levd were correlated with MS component number of 2.1±1.0,3.1±1.1,3.3±1.2,3.7±0. 8,separately,and with HOMA（CP）of 3.7± 0. 8,3. 7±0. 8,4. 0-0.6,4. 1±0. 9, separately（all P〈0.05）. When all patients were divided into groups based on with or without MS, the level of uric acid in MS group was（377.3 ± 43.5） μmol/L, and the proportion of hyperuricemia was 34. 0 % （160/470）, and HOMA（CP） was 3.90 ± 0.72, all were significantly higher than those of non-MS group[（318. 2±47.9）tamol/L, 14.0% （36/258）,3.64±0.67]. The levels of serum uric acid in groups with 1-5 components of MS were（285.0±62.8）μmol/L,（335.7±62.7）μmol/L,（367.1±45.0）μmol/L, （377.9±40. 2）μmol/L, （389.8±46.6）μmol/L, and HOMA（CP）was 3.6±0.6, 3. 7±0. 7,3. 9±0. 8,3. 9±0. 7,4. 310. 7 separately（P〈0. 05）. Serum uric acid was positively correlated with age, WC, BMh TG, SBP, fasting C-peptide, and HOMA （CP）, while negatively correlated with glycosylated hemoglobin（HbA1C）, high density lipoprotein cholesterol（HDL-C）. Binary logistic regression showed that the OR value of MS was 1. 033 with the increase of serum uric acid,and 95 %CI：1. 026-1. 041, P〈0.05. Conclusions Serum uric acid is correlated with insulin resistance in middle-aged and elderly hospitalized patients with type 2 diabetes. Hyperurieemia might be a new risk factor for MS.