2型糖尿病患者尿酸与胰岛素抵抗及其大血管并发症的相关性研究  

The relationship of serum uric acid concentration with insulin resistance and macrovascular complications in type 2 diabetes mellitus

作　　者：陈雅静[1,2] 杨建梅[1] 王虹[1] 邵大霞[1] 陈路增[3] 郭晓蕙[1] 

机构地区：[1]北京大学第一医院内分泌科,100034 [2]河北省保定市第二医院 [3]北京大学第一医院超声诊断科,100034

出　　处：《中国糖尿病杂志》2010年第2期98-101,共4页Chinese Journal of Diabetes

基　　金：国家“十五”科技攻关项目(2004BA702B)

摘　　要：目的研究2型糖尿病(T2DM)中影响尿酸的相关因素,探讨尿酸与胰岛素抵抗及T2DM大血管病变的关系。方法选取T2DM患者166例,根据血尿酸浓度、三分位数、性别分为A组(男:血尿酸<297.1umol/L,女<263.4 umol/L)、B组(男:血尿酸297.1～349.7umol/L,女:263.4～303.1umol/L)、C组(男:血尿酸>349.7umol/L,女:>303.1 umol/L)。测量身高、体重、血压、血脂、肌酐、糖化血红蛋白、尿白蛋白/肌酐(UAlb/Cr),测空腹血糖、空腹胰岛素,计算体质指数(BMI)、平均动脉压、胰岛素敏感指数(ISI)、胰岛素抵抗指数(HOMA-IR)及肾小球滤过率(eGFR),高分辨血管外超声检测颈动脉内中膜厚度(IMT),比较三组间上述指标及大血管病变的发生率是否存在差异,分析尿酸与上述指标的关系。结果 (1)A、B、c三组BMI分别为:25.33±3.24、24.86±3.14、27.04±3.88,组间比较示C组BMI显著高于A、B两组(P<0.05)。A、B、C三组ISI分别为:0.053±0.11、0.031±0.02、0.035±0.04,组间比较示B组<C组<A组,但差异无统计学意义(P>0.05);A、B、C三组HOMA-IR分别为:1.90±2.09、2.66±3.31、2.48±2.32,组间比较可见B组>c组>A组,但差异无统计学意义(P>0.05);A组eGFR(88.5±14.95 ml/min/1.73 m^2)显著高于C组(80.6±15.0ml/min/1.73 m^2)(P<0.05)。(2)多元逐步回归分析表明,性别、UAlb/Cr、BMI、eGFR是尿酸的独立危险因素。(3)三组间大血管病变的发生率及IMT比较无差异。结论尿酸与肥胖、UA1b/Cr及肾功能等因素密切相关,肥胖、肾小球率过滤下降、尿白蛋白排泄增加可升高T2DM患者的血尿酸水平;不同尿酸水平组大血管病变的发生率无明显差异。Objective To study the factors related to serum uric acid（SUA） in type 2 diabetic patients and to investigate the association of SUA with insulin resistance and diabetic macrovascular complications. Methods A total of 166 diabetic patients were divided into 3 groups by SUA Egroup A： SUA〈297. 1 umol/L（male） or〈 263.4 umol/L （female） ; group B： SUA 297.1 - 349.7 umol/L （male） 263.4-303.1 umol/L （female） ; group C.. SUA〉349.7 umol/L（male） or〉303.1 umol/L （female）. Blood samples were obtained for measuring lipids, hemoglobin A1c, creatinine, fasting blood glucose and insulin. A random urine sample was obtained for urinary albumin/creatinine ratio measurements. HOMAIR,insulin sensitive index（ISI） and eGFR were calculated. Intima medial thickness （IMT） of carotid was evaluated on B-mode ultrasonography. We first compared the above parameters and the incidence of macrovascular complications among groups, then we assessed the independent risk factors for SUA. Results ①Group C versus group A and B showed higher BMI （P〈0. 05）. ISI from group A to C to B showed a graded decrease trend （0. 053 4± 0. 11 and 0. 035 4±0.04 vs 0. 031 4± 0.02） whereas HOMA-IR showed a graded increasing trend from group A to C to B （1. 904±2.09 and 2. 484±2.32 vs 2. 664±3.31） （all P〈0. 053）. In group A,the level of eGFR was significantly higher than that in group C （88.5±14.95 ml/min/1.73m2 versus 80. 64±15.0 ml/min/1.73m2） （P=0. 018）. ②Multiple regression analysis showed that sex, BMI, eGFR, urinary albumin/creatinine ratio were the independent risk fators for SUA. ③No significant difference in IMT and the incidence of macrovascular complications were seen among these three groups. Coaclusions SUA is significantly and positively related to obesity, urinary albumin/creatinine ratio and renal damage, while eGFP may have an adverse effect on the level of SUA. There is no significant difference in the incidence of macrovascular complications among the different

关 键 词：尿酸 胰岛素抵抗 糖尿病 2型 动脉粥样硬化 

分 类 号：R587.1[医药卫生—内分泌] R695.801[医药卫生—内科学]