糖代谢正常人群血尿酸水平与胰岛β细胞功能的相关性研究

Serum uric acid levels are associated with islet β cell function in normal glucose metabolism

目的:探究正常糖代谢人群血尿酸(SUA)水平与胰岛素原(PI)的关系,评估SUA对早期胰岛β细胞功能的影响。方法:收集2018年4至12月于海南省海口市和万宁市经75 g口服葡萄糖耐量试验确认的999例糖代谢正常的成年人,其中男337例,女662例,平均年龄(44.45±12.97)岁。所有受试者均接受问卷调查,并检测SUA、空腹血糖、空腹胰岛素等生化指标。采用空腹PI(FPI)、FPI/胰岛素比值(FPI/I)评估胰岛β细胞功能,稳态模型评估胰岛素抵抗指数(HOMA-IR)评估胰岛素抵抗程度。将受试者根据SUA水平四分位分为4组:组1(SUA<283μmol/L,246例),组2(283μmol/L≤SUA<336μmol/L,249例),组3(336μmol/L≤SUA<400μmol/L,253例)和组4(SUA≥400μmol/L,251例),各组间临床指标的差异采用方差分析和秩和检验进行比较。运用多重线性回归模型分析SUA对胰岛β细胞功能指标的影响。结果:共有190例被诊断为高尿酸血症,其中男性159例,女性31例。高尿酸水平组(组4)FPI、FPI/I明显高于低尿酸水平组(组1)[13.43(13.34)和9.26(7.96)pmol/L;0.25(0.20)和0.19(0.20),均P<0.01]。校正年龄、性别、体质指数、腰围、空腹血糖、空腹胰岛素、HOMA-IR等干扰因素后,多重线性回归分析显示,SUA仍与FPI水平呈正相关(β=0.013,P<0.01)。SUA每升高100μmol/L,总体受试者FPI平均升高1.3 pmol/L。性别分层后,无论男女亚组在校正各类混杂因素后,SUA仍与FPI呈正相关(男性β=0.014,P<0.05;女性β=0.010,P<0.01),而和FPI/I无明显相关性(P>0.05)。结论:糖代谢正常人群SUA和FPI呈线性正相关,应及早关注高尿酸血症患者早期胰岛β细胞功能变化。

Objective To investigate the relationship between serum uric acid(SUA)levels and proinsulin(PI)in subjects with normal glucose metabolism.Methods A total of 999 adults with normal glucose metabolism confirmed by 75 g oral glucose tolerance test in Haikou City and Wanning City of Hainan Province from April to December 2018 were collected,including 337 males and 662 females with an average age of(44.45±12.97)years.All subjects received questionnaire survey,and their SUA,fasting blood glucose level,fasting insulin level and other laboratory parameters were detected.Fasting PI(FPI)and FPI to insulin ratio(FPI/I)were used to evaluate isletβcell function,and homeostasis model assessment of insulin resistance(HOMA-IR)was used to assess insulin resistance level.According to SUA quartiles,the subjects were divided into four groups:group 1(SUA<283μmol/L,n=246),group 2(283μmol/L≤SUA<336μmol/L,n=249),group 3(336μmol/L≤SUA<400μmol/L,n=253)and group 4(SUA≥400μmol/L,n=251).The clinical indexes between different groups were compared with analysis of variance and rank sum test.Additionally,multiple linear regression analysis was performed to investigate the effect of SUA on isletβcell function.Results A total of 190 people were diagnosed with hyperuricemia,including 159 males and 31 females.Theβcell function indexes in patients with higher SUA level(group 4),including FPI and FPI/I,were higher than those in patients with lower SUA level(group 1)[13.43(13.34)vs 9.26(7.96)pmol/L;0.25(0.20)vs 0.19(0.20),both P<0.01].Multiple linear regression analysis showed that the plasma SUA level was linearly related to FPI level even after adjusting for age,gender,body mass index,waist circumference,fasting plasma glucose,fasting insulin and HOMA-IR(β=0.013,P<0.01).For every 100μmol/L increase in SUA,FPI increased by 1.3 pmol/L on average in all subjects.However,when analyzed in gender-specific subgroups,the SUA level was still linearly correlated with FPI but not with FPI/I after adjustment for potential confounding factors(maleβ=0.014,P<0.05;femaleβ=0.010,P<0.01).Conclusion There is a positive linear correlation between SUA and FPI in patients with normal glucose metabolism.We should pay attention to the early changes of isletβcell function in hyperuricemia patients.