2型糖尿病患者血尿酸水平与血浆致动脉硬化指数的关系

Relationship between blood uric acid level and plasma atherogenic index in patients with type 2 diabetes

目的探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者血尿酸水平与血浆致动脉硬化指数(atherogenic index of plasma,AIP)之间的相关性。方法回顾性分析2019年8月至2021年8月在秦皇岛市第一医院住院的485例T2DM患者,以AIP=0.06为切分点分为致动脉硬化表型组(病例组:AIP≥0.06,n=326)和非致动脉硬化表型组(对照组:AIP<0.06,n=159)。比较两组间年龄、性别、体质量指数、尿酸、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、糖化血红蛋白、吸烟史、冠心病史,统计分析采用独立样本t检验和χ^(2)检验,并进行Pearson相关分析和多因素Logistic回归分析。结果病例组体质量指数(27.7±3.6)kg/m^(2)、收缩压(138.4±17.5)mmHg、尿酸(351.6±93.0)μmol/L、甘油三酯(3.0±3.4)mmol/L以及男性(61.6%,201/326)、冠心病史(24.3%,79/326)、吸烟史(33.5%,109/326)比例均显著高于对照组[(25.8±3.5)kg/m^(2)、(132.2±17.7)mmHg、(291.6±73.8)μmol/L、(1.0±0.3)mmol/L、51.6%(82/159)、15.7%(25/159)、19.5%(31/159)],高密度脂蛋白胆固醇(1.1±0.3)mmol/L显著低于对照组(1.3±0.3)mmol/L,差异均有统计学意义(t=5.43,P<0.001;t=3.64,P<0.001;t=7.70,P=0.001;t=10.40,P<0.001;χ^(2)=4.47,P=0.034;χ^(2)=4.60,P=0.032;χ^(2)=10.11,P=0.001;t=5.18,P<0.001)。病例组高尿酸血症的患病率(21.5%,70/326)是对照组(5.0%,8/159)的4.3倍。AIP与体质量指数(r=0.300,P<0.001)、尿酸(r=0.343,P<0.001)、收缩压(r=0.117,P=0.010)、舒张压(r=0.119,P=0.009)、甘油三酯(r=0.724,P<0.001)、总胆固醇(r=0.226,P<0.001)呈正相关,与高密度脂蛋白胆固醇(r=-0.185,P<0.001)呈负相关。Logistic回归分析结果显示,在排除了其他因素的干扰作用后,尿酸仍然与AIP有关(OR=3.727,95%CI=1.702~8.158,P=0.001),尿酸水平升高,AIP升高的危险度增加。结论T2DM患者血尿酸水平和AIP相关,高尿酸是T2DM患者AIP的独立危险因素。

Objective To explore the correlation between serum uric acid level and atherogenic index of plama(AIP)in patients with type 2 diabetes mellitus(T2DM).Methods A retrospective analysis of 485 T2DM patients hospitalized in the First Hospital of Qin Huangdao was performed in August 2019 to August 2021.They were divided into atherogenic phenotype group(the case group,AIP≥0.06,n=326)and non atherogenic phenotype group(the control group,AIP<0.06,n=159)with AIP=0.06 as the cut-off point.The age,sex,body mass index,uric acid,triglyceride,total cholesterol,high density lipoprotein-cholesterol,low density lipoprotein-cholesterol,glycosylated hemoglobin,smoking history and coronary heart disease history were compared between the two groups.The data processing using sample t-test and chi-square test.Pearson correlation analysis and multivariate logistic regression analysis were performed.Results Body mass index(27.7±3.6)kg/m^(2),systolic pressure(138.4±17.5)mmHg,uric acid(351.6±93.0)μmol/L,triglyceride(3.0±3.4)mmol/L and the proportion of men(61.6%(201/326)),coronary heart disease history(24.3%(79/326))and smoking history(33.5%(109/326))in case group were higher than those in control group(25.8±3.5)kg/m^(2),(132.2±17.7)mmHg,(291.6±73.8)μmol/L,(1.0±0.3)mmol/L,(51.6%(82/159)),(15.7%(25/159)),(19.5%(31/159))and the level of high density lipoprotein-cholesterol(1.1±0.3)mmol/L was lower than that in control group(1.3±0.3)mmol/L,with all statistically significant differences(t=5.43,P<0.001;t=3.64,P<0.001;t=7.70,P=0.001;t=10.40,P<0.001;χ^(2)=4.47,P=0.034;χ^(2)=4.60,P=0.032;χ^(2)=10.11,P=0.001;t=5.18,P<0.001).The prevalence of hyperuricemia in case group(21.5%(70/326))was 4.3 times higher than that in control group(5.0%(8/159)).AIP was positively correlated with body mass index(r=0.300,P<0.001),uric acid(r=0.343,P<0.001),systolic pressure(r=0.117,P=0.010),diastolic pressure(r=0.119,P=0.009),triglyceride(r=0.724,P<0.001),total cholesterol(r=0.226,P<0.001),while that was negatively correlated with high density lipoprotein-cholesterol(r=-0.185,P<0.001).Logistic regression analysis showed that after excluding the interference of other factors,uric acid was still related to AIP(OR=3.727,95%CI=1.702-8.158,P=0.001),and the risk of AIP increase increased with the increase of uric acid level.Conclusion The level of serum uric acid in T2DM patients is related to AIP,and high uric acid is an independent risk factor for AIP in T2DM patients.