2型糖尿病伴微量白蛋白尿患者尿酸与内皮功能紊乱的关系探讨  

Uric acid is an independent factor associated with endothelial dysfunction in type 2 diabetic patients with microalbuminuria

作　　者：谢超[1] 田杰[2] 梁敏[3] 叶佩仪[1] 孔耀中[1] XIE Chao;TIAN Jie;LIANG Min;YE Pei-yi;KONG Yao-zhong(Department of Nephrology, the First People's Hospital of Foshan City, Foshan 528000, China)

机构地区：[1]广东省佛山市第一人民医院肾内科,528000 [2]广东省佛山市妇幼保健院病理科,528000 [3]南方医科大学南方医院肾内科,广州510515

出　　处：《临床肾脏病杂志》2018年第12期743-747,共5页Journal Of Clinical Nephrology

基　　金：佛山市医学类科技攻关项目(No.0024061120613033)

摘　　要：目的对比研究有无微量白蛋白尿的2型糖尿病患者尿酸与内皮功能紊乱的关系。方法采用横断面调查研究,于2010年3月—2011年5月在南方医科大学3所附属医院(南方医院、江都医院、珠江医院)招募无大血管疾病的2型糖尿病患者共149例,根据24h尿微量白蛋白是否≥30 mg将患者分为两组,其中112例患者24h尿蛋白<30 mg为糖尿病肾病(DN)(-)组,37例患者尿白蛋白在30～300 mg为DN(+)组,同时招募49例年龄、性别相匹配的健康人群为对照组,分析一般人口学指标、生化指标与内皮功能紊乱指标;可溶性血管细胞间黏附分子1(sVCAM-1)的关系。结果DN(+)组尿酸高于其余两组[DN(+)vs DN(-)vs正常人=(370.3±116.1)μmol/L vs (334.2±100.0μmol/L)vs(324.5±63.7)μmol/L,P=0.083],DN(+)组sVCAM-1显著高于另外两组[DN(+)vs DN(-)vs正常人=(519.4±130.9)ng/ml vs(466.2±108.7)ng/ml vs(435.5±70.3)ng/ml,P=0.002]。通过多元回归分析发现,血尿酸在DN(+)组是sVCAM-1唯一独立的正相关因素(β=0.35,P=0.044),而在DN(-)组二者无显著相关性(β=0.052,P=0.593)。结论伴微量白蛋白尿的2型糖尿病患者,血尿酸较正常人显著升高,且与患者内皮功能紊乱呈显著正相关,而在无微量白蛋白尿的2型糖尿病患者这种关系并不显著,提示在出现微量白蛋白尿的2型患者需要更加严格控制尿酸水平。Objective To study the relationship between uric acid and endothelial dysfunction in type 2 diabetic patients with or without microalbuminuria.Methods From March 2010 to May 2011,we recruited 149 cases of type 2 diabetic mellitus without macrovascular disease from 3 affiliated hospitals of Southern Medical University(Nanfang hospital,Jiangdu hospital,Zhujiang hospital).Patients were divided into two groups in term of the 24-h urinary microalbumin excretion rate:112 patients with 24-h urinary microalbumin excretion rateless than 30 mg was the DN(-)group,and 37 patients with 24-h urinary microalbumin excretion rate between 30 mg and 300 mg was the DN(+)group.49 age- and gender-matched healthy people served as the control group.The demographic indexes,biochemical indexes,and the marker of endothelial dysfunction:soluble vascular cell adhesion molecule 1(sVCAM-1)were analyzed.Results Serum uric acid in DN(+)group was much higher than the other two group[DN(+)vs DN(-)vs health control=(370.3±116.1)μmol/L vs(334.2±100.0)μmol/L vs(324.5±63.7)μmol/L,P=0.083],sVCAM-1 level was significantly higher in DN(+)group than the other two groups[DN(+)vs DN(-)vs health control=(519.4±130.9)ng/ml vs(466.2±108.7)ng/ml vs(435.5±70.3)ng/ml,P=0.002],Multivariate regression analysis showed that serum uric acid was the only independent factor positively correlated to sVCAM-1 in DN(+)group(β=0.35,P=0.044),but this relationship was not significant in DN(-)group(β=0.052,P=0.593).Conclusions Serum uric acid was significantly higher in type 2 diabetic patients with microalbuminuria than that in healthy people,and significantly correlated to endothelial dysfunction,but this relationship was not significant in type 2 diabetes mellitus patients without microalbuminuria,suggesting that we should more strictly control of the uric acid level in type 2 diabetes patients with microalbuminuria.

关 键 词：糖尿病肾病 尿酸 SVCAM-1 内皮功能紊乱 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]