高尿酸血症患者血尿酸水平与2型糖尿病发病风险的关系

Relationship Between Serum Uric Acid Level and Risk of Type 2 Diabetes in Patients with Hyperuricemia

目的探讨高尿酸血症患者血尿酸(SUA)水平与2型糖尿病发病的相关性及2型糖尿病发病风险增加时SUA水平的切点值。方法选取2020年9月至2021年5月于郑州市第一人民医院南院区进行健康体检及内分泌科门诊就诊的156例患者,按照SUA水平四分位数将研究对象分成4组,分别为Q1组<467μmol·L^(-1),467μmol·L^(-1)≤Q2组≤492μmol·L^(-1),492μmol·L^(-1)<Q3组≤522μmol·L^(-1),Q4组>522μmol·L^(-1),分析比较不同组别生化指标及2型糖尿病发病率情况;分析高尿酸血症患者2型糖尿病发病的影响因素以及不同SUA水平对2型糖尿病发病的影响;应用受试者工作特征(ROC)曲线评价SUA水平对2型糖尿病筛查的意义,分析2型糖尿病发病风险增加时SUA水平的切点值。结果高尿酸血症患者总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、肌酐(SCr)、舒张压(DBP)组间差异有统计学意义(P<0.05)。随访发现有37例发生2型糖尿病,发病率为23.71%;其中男23例,女14例,发病率分别为14.74%、8.97%;4组2型糖尿病发病率分别为13.51%、10.81%、35.14%、40.54%,提示高水平SUA组2型糖尿病发病率高(P<0.05)。单因素非条件logistic回归分析结果显示,SUA水平、体质量指数异常、血脂异常为高尿酸血症患者发生2型糖尿病的危险因素(P<0.05);控制混杂因素后,高水平SUA是高尿酸血症患者发生2型糖尿病的危险因素(P<0.05)。ROC曲线显示,SUA水平切点值为508.5μmol·L^(-1)时,敏感度和特异度分别为58.1%和66.4%,高于该切点值时2型糖尿病发生风险增加。结论高水平SUA是高尿酸血症患者发生2型糖尿病的影响因素,当SUA水平高于508.5μmol·L^(-1)时,可能增加2型糖尿病的发生风险。

Objective To investigate the correlation between serum uric acid(SUA)level and type 2 diabetes mellitus in patients with hyperuricemia and analyse the tangent value of SUA level when the risk of type 2 diabetes mellitus increases.Methods A total of 156 patients who underwent physical examination and treated in Endocrinology Outpatient Department in the South District of Zhengzhou First People’s Hospital from September 2020 to May 2021 were selected.According to the quartile of SUA,the subjects were divided into four groups:group Q1<467μmol·L^(-1),467μmol·L^(-1)≤group Q2≤492μmol·L^(-1),492μmol·L^(-1)<group Q3≤522μmol·L^(-1),Q4 group>522μmol·L^(-1).Biochemical indexes and incidence of type 2 diabetes mellitus in different groups were analyzed and compared.The influencing factors of type 2 diabetes mellitus in patients with hyperuricemia and the influence of screening different SUA levels on type 2 diabetes mellitus were analyzed.Receiver operating characteristic(ROC)curve was used to evaluate the clinical significance of SUA level screening for type 2 diabetes mellitus,and to analyze the cut-off point value of SUA level when the risk of type 2 diabetes mellitus was increased.Results There were statistically significant differences in total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),serum creatinine(SCr)and diastolic blood pressure(DBP)among hyperuricemia patients(P<0.05).The results of followed up showed that there were 37 patients developed type 2 diabetes mellitus,with an incidence of 23.71%.There were 23 males and 14 females,with incidence rates of 14.74%and 8.97%,respectively.The incidence of type 2 diabetes mellitus in the four groups was 13.51%,10.81%,35.14%and 40.54%,respectively,indicating that the incidence of type 2 diabetes mellitus in the high level of SUA group was high(P<0.05).Univariate non-conditional logistic regression analysis showed that high SUA level,abnormal body mass index and dyslipidemia were risk factors for type 2 diabetes mellitus(P<0.05).High SUA level was a risk factor for type 2 diabetes mellitus in patients with hyperuricemia after controlling for confounding factors(P<0.05).ROC curve results showed that the sensitivity and specificity of SUA were 58.1%and 66.4%when the horizontal tangent point of SUA was 508.5μmol·L^(-1),and above this cut-off point,the risk of type 2 diabetes mellitus was increased.Conclusion High SUA level is a contributing factor for type 2 diabetes mellitus in patients with hyperuricemia.When SUA level is higher than 508.5μmol·L^(-1),it may increase the risk of type 2 diabetes mellitus in patients with hyperuricemia.