血尿酸水平与糖尿病前期及2型糖尿病患者胰岛功能的相关分析

Serum Uric Acid and Islet β-cell Function in Patients with Pre-diabetes and Type 2 Diabetes Mellitus

目的研究糖尿病前期及2型糖尿病(T2DM)患者的血尿酸(SUA)水平与胰岛功能的关系。方法纳入受试者4 112例,根据口服葡萄糖耐量试验(OGTT)将受试者分为3组:正常糖调节组(NGR)493例、糖调节受损组(IGR)1 251例和T2DM组2 368例,分别测定3组SUA、空腹胰岛素(FIns)、餐后2h胰岛素(2h-Ins)水平,计算胰岛素抵抗指数(HOMA-IR),比较3组间SUA、胰岛素水平及HOMA-IR的差异;进一步对不同性别的SUA水平进行分层,比较各分层组间胰岛功能;通过双变量关联性分析IGR患者中SUA与胰岛功能异常的相关性。结果 IGR组SUA水平高于NGR及T2DM组(P<0.000 1),同时IGR组2h-Ins水平高于NGR组及T2DM组(P<0.0001);T2DM组FIns、HOMA-IR及糖化血红蛋白(HbA1c)水平高于NGR及IGR组(P<0.000 1)。对SUA水平分层分析发现,在男性不同SUA水平组,2h-Ins水平在IGR组最高,而HOMA-IR及HbA1c在T2DM组最高。在女性不同SUA水平组,均是2h-Ins水平在IGR组最高,而FIns、HOMA-IR及HbA1c在T2DM组最高。在男性和女性各SUA分组中,FIns及2h-Ins随SUA水平的增高呈上升趋势。HOMA-IR在各SUA水平分组中,也随SUA增高呈上升趋势,且T2DM组最高。在相关性分析中,IGR组及T2DM组的FIns、2h-Ins及HOMA-IR均与SUA有相关性,而HbA1c仅在T2DM组与SUA呈负相关。结论SUA水平可能与糖尿病前期患者胰岛功能异常相关,因此SUA水平的检测对评估糖尿病前期患者进展为T2DM有潜在的应用价值。

Objective To determine the correlation between serum uric acid （SUA） and insulin secretion function in patients with pre-diabetes and type-2 diabetes mellitus （T2DM）. Methods A total of 4 112 adult people participated in this study. They were divided into three groups according to the results of oral glucose tolerance test （OGTT）： 493 with normal glucose regulation （NGR）, 1 251 with impaired glucose regulation （IGR）, and 2 368 with T2DM. Their levels of SUA, fasting insulin （Fins）, 2 h post-meal insulin （2 h-Ins）, and insulin resistance index （HOMA-IR） were determined. Correlations between SUA and insulin secretion and HOMA-IR were estimated. Results IGR patients had higher levels of SUA and 2 h-Ins compared with those with NGR and T2DM （P^0. 000 1）. T2DM patients had higher levels of Fins, glucosylated hemoglobin （HbAlc） and HOMA-IR compared with those with NGR and IGR （P〈0. 000 1）. In both male and female participants, the highest level of 2 h-Ins appeared in those with IGR, while T2DM had the highest level of HOMA-IA and HbAlc. Fins, 2 h-Ins and HOMA-IR increased with SUA in both patients with IGR and T2DM. HbAlc decreased with SUA in T2DM patients. Conclusion High serum SUA is correlated with islet β-cell dysfunction. It may become an indicator of progression from pre-diabetes to T2DM.