2型糖尿病患者血尿酸水平与内脏脂肪肥胖症的相关性

Correlation between Serum Uric Acid Level and Visceral Fat Obesity in Patients with Type 2 Diabetes Mellitus

目的分析2型糖尿病(T2DM)患者血尿酸(SUA)水平与内脏脂肪肥胖症(VFO)的相关性。方法选取2020年7月至2021年5月山东第一医科大学附属济南市中心医院收治的376例确诊T2DM的住院患者作为研究对象,依据内脏脂肪面积(VFA)分为VFO组(VFA≥100 cm^(2),219例)和非VFO组(VFA<100 cm^(2),157例)。比较两组一般资料及实验室指标,应用Spearman相关系数分析SUA水平与相关临床指标的相关性,采用Logistic回归法分析T2DM患者VFO的影响因素,绘制受试者工作特征曲线(ROC曲线),分析SUA水平对T2DM患者VFO的预测价值。结果VFO组的体质量指数(BMI)、VFA、空腹C肽(FCP)、三酰甘油(TG)、小而密低密度脂蛋白胆固醇(sdLDL-C)、游离脂肪酸、SUA、肌酐(Cr)水平高于非VFO组,而空腹血糖(FPG)、餐后2 h血糖(2 h PPG)、糖化血红蛋白(HbA_(1c))、高密度脂蛋白胆固醇(HDL-C)水平低于非VFO组(P<0.05或P<0.01)。两组性别、吸烟史、饮酒史占比以及年龄、T2DM病程比较差异无统计学意义(均P>0.05)。Spearman相关系数分析显示,SUA水平与BMI、吸烟史、饮酒史、VFA、FCP、TG、sdLDL-C、Cr呈正相关(P≤0.01),与FPG、2 h PPG、HbA_(1c)、HDL-C呈负相关(P<0.05或P<0.01)。以VFA为因变量(VFA≥100 cm^(2)=1,VFA<100 cm^(2)=0)进行多因素二元Logistic回归分析,结果显示,SUA水平、BMI是T2DM患者VFO的独立危险因素(P<0.01),HDL-C是T2DM患者VFO的独立保护因素(P<0.01)。ROC曲线分析结果显示,SUA预测VFO的最佳临界值为322.5μmol/L(曲线下面积为0.658,95%CI 0.602~0.714,P<0.01),特异度为0.720,灵敏度为0.525。结论T2DM患者SUA水平与VFO密切相关,且SUA高水平是T2DM患者VFO发生的独立危险因素。

Objective To analyze the correlation between serum uric acid(SUA)level and visceral fat obesity(VFO)in patients with type 2 diabetes mellitus(T2DM).Methods A total of 376 hospitalized T2DM patients admitted to Jinan Central Hospital,Shandong First Medical University from Jul.2020 to May 2021 were included as subjects.According to the visceral fat area(VFA),they were divided into a VFO group(VFA≥100 cm^(2),219 cases)and a non-VFO group(VFA<100 cm^(2),157 cases).The general data and laboratory indicators of the two groups were compared.Spearman correlation coefficient was used to analyze the correlation between SUA level and relevant clinical indicators.Logistic regression method was used to analyze the influencing factors of VFO in T2DM patients,receiver opera-ting characteristic curve(ROC curve)was drawn to analyze the predictive value of SUA level on VFO in T2DM patients.Results The body mass index(BMI),VFA,fasting C-peptide(FCP),triglyceride(TG),small dense low density lipoprotein cholesterol(sdLDL-C),free fatty acid,SUA and creatinine(Cr)levels in the VFO group were higher than those in the non-VFO group.The levels of fasting blood glucose(FPG),2 h postprandial blood glucose(2 h PPG),glycosylated hemoglobin(HbA_(1c))and high density lipoprotein cholesterol(HDL-C)were lower than those in the non-VFO group(P<0.05 or P<0.01).There were no significant differences in gender,smoking history,drinking history,age and T2DM course between the two groups(all P>0.05).Spearman correlation coefficient analysis showed that SUA level was positively correlated with BMI,smoking history,drinking history,VFA,FCP,TG,sdLDL-C and Cr(P≤0.01),and negatively correlated with FPG,2 h PPG,HbA_(1c) and HDL-C(P<0.05 or P<0.01).Multivariate binary Logistic regression analysis using VFA as the dependent variable(VFA≥100 cm^(2)=1,VFA<100 cm^(2)=0)showed that SUA level and BMI were independent risk factors for VFO in T2DM patients(P<0.01).HDL-C was an independent protective factor for VFO in T2DM patients(P<0.01).ROC curve analysis showed that the optimal threshold for SUA to predict VFO was 322.5μmol/L(AUC=0.658,95%CI 0.602-0.714,P<0.01),with a specificity of 0.720,and a sensitivity of 0.525.Conclusion SUA level is closely related to VFO in T2DM patients,and high SUA level is an independent risk factor for VFO in T2DM patients.