2型糖尿病患者血尿酸水平与胰岛素抵抗的相关性分析

Correlation analysis of serum uric acid with insulin resistance in type 2 diabetic patients

目的:探讨2型糖尿病患者血尿酸水平与胰岛素抵抗的相关性。方法:纳入2015年1月至2017年12月在南京中医药大学附属中西医结合医院内分泌科住院的208例2型糖尿病患者,根据体重指数分为体重正常组(体重指数<25 kg/m^2)、超重组(25 kg/m^2≤体重指数<28 kg/m^2)、肥胖组(体重指数≥28 kg/m^2),测定血尿酸、总胆固醇、甘油三酯、低密度脂蛋白-胆固醇(LDL-C)、空腹血糖、餐后血糖、HbA1c、空腹胰岛素(FINS)水平,并计算稳态模型评估-胰岛素抵抗指数(HOMA-IR),比较各指标的组间差异。根据HbA1c是否大于7%分为达标组和未达标组,根据HOMA-IR和血尿酸水平采用四分位法再分为亚组(Q1~Q4),比较各亚组指标之间的差异。对血尿酸水平与血糖、HbA1c、血脂、胰岛素等进行相关性分析,并做线性回归分析。 结果:与体重正常组相比,超重组与肥胖组血尿酸、HOMA-IR、空腹血糖、餐后血糖、HbA1c、甘油三酯、LDL-C、FINS水平逐渐上升( F=0.911~36.668, P均<0.05);HbA1c未达标组血尿酸、空腹血糖和餐后血糖水平明显高于HbA1c达标组( t=1.444、2.204、2.083, P均<0.05);从Q1组到Q4组,随着HOMA-IR的升高,血尿酸、体重指数、空腹血糖、甘油三酯水平逐渐上升( F=2.867、29.625、30.398、17.134, P均<0.05)。从Q1组到Q4组,伴随血尿酸水平升高,体重指数、空腹血糖、餐后血糖、甘油三酯、FINS水平上升( F=9.428、8.707、12.409、39.010, P均<0.05)。血尿酸水平与空腹血糖( r=0.186, P=0.008)、餐后血糖( r=0.234, P=0.009)、HbA1c( r=0.183, P=0.009)、甘油三酯( r=0.449, P<0.001)、FINS( r=0.259, P<0.001)、体重指数( r=0.239, P=0.001)、HOMA-IR( r=0.161, P=0.022)呈正相关。线性回归分析提示甘油三酯( T=3.195,95% CI: 4.213~17.806, P<0.05)、体重指数( T=2.793,95% CI: 1.172~6.805, P<0.05)、HbA1c( T=2.320,95% CI: 0.693~8.542, P<0.05)是2型糖尿病患者发生血尿酸水平升高的危险因素。 结论:2型糖尿病患者血尿酸水平升高与肥胖、糖脂代谢异常导致的胰岛素抵抗增加有关。

Objective To investigate the correlation between serum level of uric acid(SUA)and insulin resistance in type 2 diabetic patients.Methods A total of 208 patients with type 2 diabetes who were admitted to the Department of Endocrinology,the Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine from January 2015 to December 2017 were included.All patients were divided into normal body weight group[body mass index(BMI)<25 kg/m^2],over weight group(25 kg/m^2≤BMI<28 kg/m^2)and obesity group(BMI≥28 kg/m^2)according to BMI.The SUA,total cholesterol,triglycerides(TG),low density lipoprotein-cholesterol(LDL-C),fasting blood glucose(FBG),postprandial blood glucose(PBG),HbA1c,and fasting insulin(FINS)level were measured.The homeostasis model assessment of insulin resistance(HOMA-IR)was also calculated.Differences among groups were compared.And according to whether their HbA1c was more than 7%,patients were divided into HbA1c-target-achieved group and HbA1c-target-not-achieved group.Then patients were further divided into 4 groups(Q1-Q4)according to the quartiles of HOMA-IR and SUA.Correlation between SUA and blood glucose,HbA1c,blood lipids,insulin and other indicators was analyzed,and linear regression analysis was also used.Results Compared with normal body weight group,the levels of SUA,HOMA-IR,FBG,PBG,HbA1c,TG,LDL-C and FINS were increased(F=0.911-36.668,all P<0.05).SUA,FBG and PBG in HbA1c-target-not-achieved group were significantly higher than those of the HbA1c-target-achieved group(t=1.444,2.204,2.083,all P<0.05).From Q1 group to Q4 group,with the increase of HOMA-IR,the level of SUA,BMI,FBG and TG were gradually increased(F=2.867,29.625,30.398,17.134,all P<0.05).From Q1 group to Q4 group,with the increase of SUA,the level of BMI,FBG,PBG,TG and FINS level were increased(F=9.428,8.707,12.409,39.010,all P<0.05).The level of SUA was positively correlated with FBG(r=0.186,P=0.008),PBG(r=0.234,P=0.009),HbA1c(r=0.183,P=0.009),TG(r=0.449,P<0.001),FINS(r=0.259,P<0.001),BMI(r=0.239,P=0.001)and HOMA-IR(r=0.161,P=0.022).Linear regression analysis suggested that TG(T=3.195,95%CI:4.213-17.806,P<0.05),BMI(T=2.793,95%CI:1.172-6.805,P<0.05)and HbA1c(T=2.320,95%CI:0.693-8.542,P<0.05)were risk factors for the increase of SUA in patients with type 2 diabetes mellitus.Conclusion The increase of SUA in type 2 diabetes mellitus is associated with increased insulin resistance caused by obesity and abnormal glucose and lipid metabolism.