1型糖尿病患者血尿酸与尿微量白蛋白及肾小球滤过率相关性研究

Correlation between serum uric acid with microalbuminuria and glomerular ?ltration rate in patients with type 1 diabetes

目的评估1型糖尿病(type I diabetes mellitus, T1DM)患者血尿酸、尿微量白蛋白、肾小球滤过率,探讨T1DM患者血尿酸与糖尿病肾病的关系。方法纳入2017—2018年在北京协和医院内分泌科住院的64例诊断明确的T1DM患者,收集详细的人口学资料,人体测量学指标,以及血脂、血糖、C肽、血尿酸、血肌酐、尿微量白蛋白、尿肌酐等指标,计算尿微量清蛋白与肌酐的比值(albumin to creatinine ratio,ACR)、肾小球滤过率,通过Pearson相关性分析、多元线性回归探讨血尿酸与ACR及肾小球滤过率的关系。结果 64例T1DM患者中,男性占37.5%,中位年龄为38.5岁,中位糖尿病病程为4年,平均糖化血红蛋白为9.2%。Pearson相关分析发现,血尿酸与ACR呈正相关(r=0.397,P=0.001),与估算的肌酐清除率呈负相关(r=-0.449,P<0.001)。在多元线性回归中通过逐步回归法构建回归方程发现,血尿酸每增加一个标准差,ACR升高1.2倍(P=0.001),估算的肾小球滤过率下降15.764ml/(min·1.73m^2)(P<0.001)。结论血尿酸是T1DM患者ACR升高、肾小球滤过率下降的独立危险因素。

Objective To evaluate the relationship between serum uric acid, microalbuminuria and glomerular filtration rate in patients with type 1 diabetes mellitus, and to explore the relationship between serum uric acid and diabetic nephropathy in patients with type 1 diabetes.Method Sixty-four patients with type 1 diabetes diagnosed were enrolled, and detailed demogra phic data, ergonomic indicators, blood lipids, blood glucose, C-peptide, blood uric acid, serum creatinine, urine microalbumin, urine creatinine and other indicators were collected.The relationship between uric acid with urine albumin creatinine ratio and glomerular filtration rate was analyzed by Pearson correlation and multiple linear regression. Result In sixty-four patients with type 1 diabetes, men accounted for 37.5% of the patients, with a median age of 38.5 years. The median duration of diabetes was 4 years, with an average HbA1 c of 9.2%. Pearson correlation analysis found that blood uric acid was positively correlated with urinary albumin creatinine ratio(r=0.397, P=0.001), and negatively correlated with estimated creatinine clearance(r=-0.449, P<0.001). The regression equation was constructed by stepwise regression in multiple linear regression. It was found that for every standard deviation increacement of blood uric acid, the urinary microalbumin creatinine ratio was increased by 1.2 times(P=0.001),and the estimated glomerular filtration rate decreased by 15.764 ml/(min·1.73 m^2)(P<0.001). Conclusion Blood uric acid is an independent risk factor for the increase of urinary microalbumin creatinine ratio and decrease of glomerular filtration rate in patients with type 1 diabetes.