血尿酸水平变异性与2型糖尿病肾病和视网膜病变进展的相关性

Correlation between variability of blood uric acid level and progression of type 2 diabetic nephropathy and retinopathy

目的探讨血尿酸水平变异性与2型糖尿病肾病和视网膜病变进展的相关性。方法采用回顾性研究的方法,选取北京市平谷区医院2015年建立的2型糖尿病肾病队列中的240例患者进行分析。测定患者的血尿酸水平,计算尿酸水平变异性,并根据患者尿酸变异性的四分位数分为A组、B组、C组、D组,每组各60例;对研究对象进行随访,收集受试者的一般资料、生化指标及糖尿病肾病、糖尿病视网膜病变等情况,根据随访的糖尿病肾病及视网膜病变情况分为进展组和非进展组,进一步明确血尿酸水平变异性与糖尿病肾病和视网膜病变进展的相关性。结果截止至末次随访日期2022年7月,A组失访24例,B组失访27例,C组失访20例,D组失访22例,最终A组纳入36例,B组纳入33例,C组纳入40例,D组纳入38例。四组患者年龄、性别、体质量指数、收缩压、舒张压、胆固醇、三酰甘油、低密度脂蛋白胆固醇、空腹血糖、糖化血红蛋白及血肌酐比较差异无统计学意义(P>0.05)。单变量分析结果显示,随着患者尿酸变异性的四分位数的增加,2型糖尿病患者糖尿病肾病和视网膜病变进展发生率升高(A、B、C、D组进展发生率分别为16%、49%、63%、79%,F=0.95,P<0.05)。Pearson相关分析结果显示,血尿酸水平变异性与糖尿病肾病和视网膜病变进展呈正相关(r=0.482、0.501,P<0.05)。Logistic回归分析结果显示,随着患者尿酸变异性的四分位数的增加,2型糖尿病患者糖尿病肾病(OR=3.521、5.226、6.548,P<0.05)和视网膜病变(OR=3.733、4.844、5.872,P<0.05)进展风险逐渐增加。结论血尿酸水平变异性与2型糖尿病肾病和视网膜病变进展呈正相关,随着血尿酸水平变异性的四分位数的增加,糖尿病肾病和视网膜病变进展风险越高,定期监测2型糖尿病患者的血尿酸水平至关重要。

Objective To investigate the correlation between the variability of blood uric acid level and the progression of type 2 diabetic nephropathy and retinopathy.Methods A total of 240 patients with type 2 diabetic nephropathy were selected from a cohort established in Pinggu District Hospital of Beijing in 2015 for retrospective analysis.The blood uric acid level of the patients was measured,the variability of uric acid level was calculated,and the patients were divided into group A,group B,group C and group D according to the quartile of uric acid variability,with 60 cases in each group.The subjects were followed up,and their general information,biochemical indicators,diabetic nephropathy and diabetic retinopathy were collected.According to the diabetic nephropathy and retinopathy during follow-up,the subjects were divided into progressive group and non-progressive group,so as to further clarify the correlation between the variability of blood uric acid level and the progression of diabetic nephropathy and retinopathy.Results Up to the last follow-up date in July 2022,a total of 24 cases were lost to follow-up in group A,27 cases in group B,20 cases in group C,and 22 cases in group D.Finally,36 cases were included in group A,33 cases in group B,40 cases in group C,and 38 cases in group D.There was no significant difference in age,gender,body mass index,systolic blood pressure,diastolic blood pressure,cholesterol,triglyceride,low density lipoprotein cholesterol,fasting blood glucose,glycated hemoglobin and serum creatinine among four groups(P>0.05).Univariate analysis showed that the incidence of diabetic nephropathy and retinopathy progression increased with the increase of the quartile of uric acid variability in patients with type 2 diabetes(the incidences of progression in A,B,C and D groups were 16%,49%,63%and 79%,F=0.95,P<0.05).Pearson correlation analysis showed that blood uric acid variability was positively correlated with the progression of diabetic nephropathy and retinopathy(r=0.482 and 0.501,P<0.05).Logistics regression analysis showed that with the increase of the quartile of uric acid variability,the progression risk of diabetic nephropathy(OR=3.521,5.226 and 6.548;P<0.05)and retinopathy(OR=3.733,4.844 and 5.872;P<0.05)in type 2 diabetes patients increased gradually.ConclusionsThe variability of blood uric acid level is positively correlated with the progression of type 2 diabetic nephropathy and retinopathy.The higher the risk of progression of diabetic nephropathy and retinopathy with the increase of quartile of blood uric acid level variability,the more important it is to regularly monitor the blood uric acid level of type 2 diabetic patients.