血尿酸水平对糖尿病前期人群新发糖尿病的影响

Effects of serum uric acid on newly onset of diabetes in the population with prediabetes mellitus

目的探讨糖尿病前期(PreDM)人群血尿酸水平对新发糖尿病的影响。方法为前瞻性队列研究。选取2011年7至12月在大连地区基线诊断为PreDM并完成3年随访的社区居民为研究对象,收集所有研究对象性别,以及其基线及3年后的年龄、体重、腰围、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FPG)、餐后2 h血糖(2hPG)、空腹胰岛素(FINS)、血尿酸、糖化血红蛋白(HbA1c)等,计算患者稳态模型评估胰岛素抵抗指数(HOMA-IR)等。依据完成3年随访时研究对象血糖水平将其分为糖尿病组与非糖尿病组。根据研究对象基线血尿酸水平三分位数将其分为3组,第一分位(S1)组:血尿酸≤287μmol/L,第二分位(S2)组:287μmol/L<血尿酸≤342μmol/L,第三分位(S3)组:血尿酸>342μmol/L。采用t检验或χ2检验对组间基线资料进行比较,采用多因素logistic回归分析法分析血尿酸水平与糖尿病发病风险之间的关系。结果纳入研究对象1349例。其中,男性338例,女性1011例;糖尿病组153例,非糖尿病组1196例。与非糖尿病组相比,糖尿病组研究对象基线血尿酸水平升高(t=-3.83,P<0.001)。S1、S2、S3组3年后糖尿病累计发病率分别为7.7%(35/454)、11.8%(53/448)和14.5%(65/447),差异有统计学意义(χ2=10.62,P<0.01)。logistic回归分析结果显示,在调整了年龄、性别、体重、腰围、HDL-C、FPG、2hPG及HOMA-IR混杂因素后,与S1组相比,S2与S3组糖尿病发病风险分别增加至其1.472倍(95%CI 0.928~2.377)和1.698倍(95%CI 1.047~2.752)。结论随着基线血尿酸水平增高,PreDM人群3年后糖尿病的累计发病率增高,血尿酸水平增高可增加其糖尿病发病风险。

Objective To explore the effects of serum uric acid(SUA)on the incidence of prediabetes mellitus(PreDM)population.Methods This study was a prospective cohort study.Community residents who were diagnosed with PreDM at baseline in Dalian from July to December 2011 and completed a three-year follow-up were selected as the research objects.The sex was collected.The age,weight,waist circumference,high-density lipoprotein-cholesterol(HDL-C),fasting plasma glucose(FPG),2 h-postprandial plasma glucose(2hPG),fasting insulin(FINS),blood uric acid,glycated hemoglobin A1c(HbA1c)of all subjects at baseline and three years later were collected,and then the patients′homeostasis model assessment of insulin resistance(HOMA-IR),were calculated.The subjects were divided into diabetes group and non-diabetes group according to their blood glucose level at the completion of 3 years.The subjects were divided into three groups according to the tertiles of baseline blood uric acid level.The first quartile(S1)group(SUA≤287μmol/L),second quantile(S2)group(287μmol/L<SUA≤342μmol/L),third quartile(S3)group(SUA>342μmol/L).Comparisons between the diabetic and non-diabetic groups were performed using two independent samples t-tests and chi-square.Multiple logistic regression analysis was used to analyze the relationship between SUA and incidence of diabetes in PreDM population.Results A total of 1349 subjects with PreDM attended the follow up survey,included 338 males and 1011 females.There were 153 cases in diabetes group and 1196 cases in non-diabetes group.Compared with the non-diabetes group,the baseline SUA level of subjects in the diabetes group increased(t=-3.83,P<0.001).The cumulative incidence of diabetes in S1,S2 and S3 groups after 3 years was 7.7%(35/454),11.8%(53/448)and 14.5%(65/447),respectively,with statistically significant difference(χ2=10.62,P<0.01).Logistic regression analysis showed that,after adjusting for age,sex,weight,waist circumference,HDL-C,FPG,2hPG and HOMA-IR confounding factors,the risk of diabetes in S2 and S3 groups increased to 1.472 times(95%CI 0.928-2.377)and 1.698 times(95%CI 1.047-2.752)respectively compared with S1 group.Conclusions With the increase of baseline SUA level,the cumulative incidence rate of diabetes in PreDM population increased after 3 years.Elevated SUA level might increase the risk of diabetes.