糖尿病前期患者尿酸水平与胰岛素敏感性关系的研究

Relationship between serum uric acid and insulin sensitivity in pre-diabetic patients

目的:利用高胰岛素-正葡萄糖钳夹试验评估胰岛素敏感性,探讨糖尿病前期患者血清尿酸(SUA)水平与胰岛素敏感性的关系。方法:纳入患者108例,根据2011年美国糖尿病协会的诊断标准将患者分为2组:正常糖调节组(normal glucose regulation,NGR)66例及糖调节受损组(impaired glucose regulation,IGR)42例,分别检测2组血清尿酸水平及其他生化指标。所有患者均行高胰岛素-正葡萄糖钳夹试验,胰岛素敏感性以葡萄糖输注速率(glucose infusion rate,GIR)表示。结果:IGR组体重指数(BMI)、腰围(WC)、甘油三酯(TG)、胆固醇(TC)、空腹胰岛素(FINS)、空腹C肽(CP)、SUA水平均高于NGR组,高密度脂蛋白胆固醇(HDL-C)、GIR低于NGR组(P<0.05)。在相关性分析中,IGR组BMI、WC、SUA均与GIR呈负相关。将患者根据SUA水平三分位间距分为3组,GIR随着SUA水平的升高而降低。Logistic回归分析显示SUA水平是胰岛素抵抗的危险因素[OR=1.008,95%CI:1.004～1.013,P<0.001]。结论:糖尿病前期患者SUA水平与胰岛素敏感性密切相关,尿酸水平越高,胰岛素敏感性越低。

Objective:To investigate the relationship between serum uric acid and insulin sensitivity in pre-diabetic patients through hyperinsulinemic-euglycemic clamp.Methods:A total of 108 pre-diabetic subjects were included in the study.The subjects were divided into normal glucose regulation(NGR)group(66 cases)and impaired glucose regulation(IGR)group(42 cases)according to the diagnostic criteria in 2011 American Diabetes Association.Uric acid and other biochemical markers were measured from fasting blood sample.All the patients underwent hyperinsulinemic-euglycemic clamp,and glucose infusion rate(GIR)was calculated to assess insulin sensitivity.Results:Compared with NGR patients,IGR patients had higher levels of BMI,WC,TG,TC,FINS,CP,SUA and lower levels of HDL-C and GIR(P<0.05).GIR was negatively correlated to BMI,WC,SUA(P<0.05)in IGR patients.GIR was gradually and significantly decreased with increase of serum SUA level.Logistic regression analysis showed that serum SUA was a risk factor for insulin resistance(OR=1.008,95%CI:1.004~1.013,P<0.001)Conclusion:In the pre-diabetic patients,there is a negative correlation between serum uric acid and insulin sensitivity.The higher serum uric acid is,the lower insulin sensitivity is.