2型糖尿病患者血清尿酸、血浆同型半胱氨酸、肾小球滤过率等水平与脑微出血的相关性研究

The correlation between serum uric acid,plasma homocysteine,glomerular filtration rate etc. levels and cerebral microbleeds in patients with T2DM

目的探讨2型糖尿病(T2DM)患者血清尿酸(UA)、血浆同型半胱氨酸(Hcy)、肾小球滤过率(GFR)等变量水平与脑微出血(CMBs)的相关性。方法回顾性分析T2DM患者的一般情况、病史、化验和影像资料,依据颅脑磁共振磁敏感序列(MR-SWI)对CMBs进行诊断和病灶计数,记录入选患者的年龄、性别、民族、身体质量指数(BMI)、既往病史、血压、血清UA、血浆Hcy、GFR估算值(e GFR)、血脂、凝血功能等变量,应用Spearman相关分析、Logistic回归分析研究各变量和CMBs的关系。结果最终纳入T2DM患者325例,其中CMBs组107例、非CMBs组218例;CMBs组患者的年龄、脑卒中病史比例、高血压患病率及血压值、血清UA、血浆Hcy、e GFR、血清尿素(Ur)、血清肌酐(Cr)、国际标准化比值(INR)的统计量与非CMBs组存在显著差异(P<0.05),年龄与CMBs程度显著相关(P<0.05);多因素Logistic回归分析提示血清UA水平增高、高龄、有高血压或脑卒中病史、舒张压增高是T2DM患者发生CMBs的危险因素。结论血清UA水平增高、高龄、有高血压或脑卒中病史可能是T2DM患者发生CMBs的独立危险因素,其中血清UA浓度增高可能是代偿性结果;CMBs作为T2DM的颅内微小血管并发症,与T2DM肾病可能存在相似的发病机制及病理改变。

Objective To investigate the correlation between serum uric acid(UA),plasma homocysteine(Hcy),glomerular filtration rate(GFR)etc.levels and cerebral microbleeds(CMBs)in patients with T2DM.Methods The clinical and imaging data of patients with T2DM were analyzed retrospectively.CMBs were diagnosed and the lesion-numbers of CMBs were counted according to the results of brain magnetic resonance with magnetic sensitive sequence(MR-SWI).The patients'information was recorded including age,gender,nationality,body mass index(BMI),overall medical history,blood pressure value,serum UA,plasma Hcy,eGFR,blood fat,blood coagulation function etc.Spearman correlation analysis and Logistic regression analysis were used to analyze the correlation between each index and CMBs.Results A total of325cases of in-patients with T2DM were selected and divided into CMBs group(107cases)and non-CMBs group(218cases).There were significant differences in patients'age,proportion of stroke history,morbidity of hypertension,serum UA,plasma Hcy,eGFR,serum urea(Ur),serum creatinine(Cr)and international normalized ratio(INR)between the CMBs group and the non-CMBs group(P<0.05),while the age was significantly correlated with the degree of CMBs(P<0.05).Multivariable Logistic regression analysis revealed that high concentration of serum UA,advanced age,history of hypertension or stroke and high DBP were the risk factors of CMBs for patients with T2DM.Conclusion Increased concentration of serum UA,advanced age,and history of hypertension or stroke are the independent risk factors of CMBs for patients with T2DM,while the increasing of serum UA may be a compensatory result.As an encranial microvascular complication of T2DM,CMBs perhaps exist some similar pathogenesis and pathologic changes compared with diabetic nephropathy.