糖尿病和非糖尿病人群血清尿酸与肾损伤的关联分析

Association of serum uric acid with risk of renal injury among diabetic vs.non-diabetic individuals

目的 分析并比较糖尿病和非糖尿病人群血清尿酸(sUA)水平与肾损伤的关联特征。方法 本研究为横断面研究。研究对象来源于中国健康与营养调查数据库2009年纳入的18~75岁糖尿病患者(糖尿病组)617例和按照年龄、性别1∶2匹配的非糖尿病人群(非糖尿病组)1 234例。采用单因素、多因素logistic回归模型和线性回归模型分析sUA与肾损伤患病的关联。模型依次为模型1为未校正,模型2为校正年龄(作为连续变量)、性别、BMI、腰臀比(WHR)和高血压,模型3为校正年龄(作为连续变量)、性别、BMI、WHR、高血压、吸烟、饮酒和蛋白质摄入量。计算危险因素OR值及其95%CI。采用线性回归模型计算平均差(MD)及其95%CI。应用相加交互作用模型评估sUA和糖尿病对肾损伤患病风险的交互作用,并采用相加交互指标,即相对超额危险度比(RERI)、归因比(AP)和交互作用指数(SI)进行评估。结果 糖尿病组肾损伤患病率(19.0%)显著高于非糖尿病组(14.8%,P=0.02)。当糖尿病和高sUA水平同时存在时,两因素具有正相加交互作用。RERI、AP和SI分别为0.485(95%CI为0.190~0.780)、0.188(95%CI为0.087~0.289)和1.443(95%CI为1.158~1.789)。校正了年龄、性别、BMI、WHR、高血压、吸烟、饮酒、蛋白质摄入量的多因素logistic回归模型显示,糖尿病组sUA第2、3、4分位水平与肾损伤关联的OR值分别为3.5(95%CI为1.2~10.4)、6.4(95%CI为2.3~17.8)和14.4(95%CI为5.2~39.5);非糖尿病组sUA第2、3、4分位水平与肾损伤关联的OR值分别为2.1(95%CI为1.0~4.1)、4.0(95%CI为2.1~7.7)和9.6(95%CI为5.0~18.6)。单因素线性回归模型显示,糖尿病组中相对于sUA第1分位水平,第2、3、4分位水平与估算的肾小球滤过率(eGFR)的MD分别为-8.2(95%CI为-12.1~-4.3)、-12.3(95%CI为-16.2~-8.4)和-12.2(95%CI为-15.8~-8.6);非糖尿病组中相对于sUA第1分位水平,第2、3、4分位水平与eGFR的MD分别为-2.9(95%CI为-5.1~-0.8)、-8.7(95%CI为-10.8~-6.6)和-11.5(95%CI为-13.8~-9.3)。多因素logistic回归分析显示,两组人群中仅年龄和sUA水平升高是肾损伤患病的独立危险因素,其中糖尿病组sUA第4分位水平OR值为14.5(95%CI为5.2~40.4),年龄每增加5岁,肾损伤患病风险的OR值为1.8(95%CI为1.5~2.1);非糖尿病组sUA第4分位水平OR值为10.7(95%CI为5.4~21.0),年龄每增加5岁,肾损伤患病风险的OR值为1.9(95%CI为1.6~2.2)。结论 sUA水平和糖尿病协同增加肾损伤的患病风险。糖尿病患者sUA水平轻微上升即可导致明显的肾功能减退。需常规监测糖尿病患者sUA水平,以早期发现肾损伤,进而降低其患病风险。

ObjectiveTo explore the association between serum uric acid(sUA)and renal injury among diabetic vs.non-diabetic individuals.MethodsThis cross-sectional evaluation included 617 diabetic and 1234 non-diabetic participants,aged 18-75 years and frequency-matched by age and sex,from the China Health and Nutrition Survey(CHNS)in 2009.Univariable and multivariable logistic regression analyses were used to explore the association between sUA level and renal injury.Models were sequentially showed as:(1)model 1(unadjusted);(2)model 2(age[as a continuous variable],sex,body mass index[BMI],waist-hip ratio[WHR]and hypertension were adjusted);(3)model 3(variables in model 2 plus smoking,drinking and protein intake adjusted).Linear regression analyses were used to calculate the mean difference(MD)and corresponding 95%confidence interval(CI)of sUA levels for renal injury in the diabetic and non-diabetic groups.The synergistic effect of sUA and diabetes on kidney injury was quantified,and relative excess risk due to interaction(RERI),attributable proportion due to interaction(AP),and synergy index(SI)were calculated.ResultsDiabetic individuals had higher prevalence of renal injury than non-diabetic individuals(19.0%vs.14.8%,P=0.020).A significant synergistic effect of high level of sUA and diabetes on renal injury was found,and the AP,RERI and SI were 0.485(95%CI:0.190-0.780),0.188(95%CI:0.087-0.289)and 1.443(95%CI:1.158-1.789),respectively.Multivariable logistic models showed that Q2(OR=3.5,95%CI:1.2-10.4),Q3(OR=6.4,95%CI:2.3-17.8),and Q4(OR=14.4,95%CI:5.2-39.5)of sUA were positively associated with renal injury in the diabetes individuals;Q2(OR=2.1,95%CI:1.0-4.1),Q3(OR=4.0,95%CI:2.1-7.7),and Q4(OR=9.6,95%CI:5.0-18.6)of sUA were positively associated with renal injury in the non-diabetes individuals.In univariate linear regression analyses,the MD of Q2,Q3 and Q4 of sUA were-8.2(95%CI:-12.1--4.3),-12.3(95%CI:-16.2--8.4),and-12.2(95%CI:-15.8--8.6)in the diabetic individuals;and the MD were-2.9(95%CI:-5.1--0.8),-8.7(95%CI:-10.8--6.6),and-11.5(95%CI:-13.8--9.3)in the non-diabetic individuals.In multivariable logistic models,age and increased sUA were independent risk factors for kidney injury in both diabetic individuals(Q4 of sUA:OR=14.5,95%CI:5.2-40.4.Every 5 years of age increase:OR=1.8,95%CI:1.5-2.1)and non-diabetic individuals(Q4 of sUA:OR=10.7,95%CI:5.4-21.0.Every 5 years of age increase:OR=1.9,95%CI:1.6-2.2).ConclusionThere is a significant synergistic effect of sUA and diabetes on renal injury.A slightly elevated sUA level is significantly correlated with renal injury among diabetic individuals.It is necessary to routinely monitor sUA in diabetes patients,so as to predict and reduce the risk of renal injury.