非酒精性脂肪性肝病并发2型糖尿病患者血尿酸水平变化及其临床意义  

Changes and clinical implication of serum uric acid levels in patients with nonalcoholic fatty liver disease and type 2 diabetes mellitus

作　　者：赵晓春[1] 钟庆[1] 刘书宏[1] 梁尘格 郭熙清[1] 温林[2] Zhao Xiaochun;Zhong Qing;Liu Shuhong(Department of Liver Diseases,Three Gorges Central Hospital,Chongqing 404000,China)

机构地区：[1]重庆三峡中心医院肝病科,重庆市404000 [2]内蒙古医科大学附属医院肝病科

出　　处：《实用肝脏病杂志》2021年第1期55-58,共4页Journal of Practical Hepatology

基　　金：重庆市自然科学基金资助项目(编号:cstc2019jcyj-msxmx0677)。

摘　　要：目的探讨非酒精性脂肪性肝病(NAFLD)并发2型糖尿病(T2DM)患者血尿酸(SUA)水平变化及其临床意义。方法2015年6月~2019年12月我院收治NAFLD患者316例,其中并发T2DM患者218例,未并发T2DM患者98例,采用单因素和多因素Logistic回归分析确定与T2DM发生相关的独立危险因素。结果并发T2DM组男性比例显著高于非T2DM组(59.6%对42.9%,P<0.05),体质指数(BMI)为(27.2±2.9)kg/m^2,显著高于非T2DM组[(24.5±3.2)kg/m^2,P<0.05],糖化血红蛋白(HbA1C)水平为(9.2±2.1)%,显著高于非T2DM组[(7.2±1.9)%,P<0.05],血高密度脂蛋白(HDL)水平为(0.9±0.2)mmol/L,显著低于非T2DM组[(1.1±0.3)mmol/L,P<0.05],甘油三酯(TG)水平为(1.9±0.5)mmol/L,显著高于非T2DM组[(1.6±0.5)mmol/L,P<0.05],SUA水平为(335.8±72.6)μmol/L,显著高于非T2DM组[(304.5±68.0)μmol/L,P<0.05],估算的肾小球滤过率(eGFR)为(158.4±40.6)ml/min/1.73m^2,显著高于非T2DM组[(148.5±36.8)ml/min/1.73m^2,P<0.05],空腹胰岛素(FINS)水平为(5.1±2.6)mIU/L,显著高于非T2DM组[(3.6±2.8)mIU/L,P<0.05],胰岛素抵抗指数(HOMA-IR)为(1.9±1.1),显著高于非T2DM组[(1.3±1.0),P<0.05];将性别、BMI、HbA1c、HDL、TG、SUA、eGFR、FINS和HOMA-IR作为自变量,将NAFLD患者是否并发T2DM作为因变量,纳入多因素Logistic回归分析,结果显示性别、HbA1c、SUA、FINS和HOMA-IR是NAFLD并发T2DM的独立危险因素(P<0.05),而BMI、HDL、TG和eGFR并不是影响NAFLD并发T2DM的独立危险因素(P>0.05);根据不同SUA水平将其从低到高分为SUA-1、SUA-2和SUA-3组,结果在218例合并糖尿病患者中,3组人群糖尿病占比分别为21.5%、32.1%和46.3%,差异显著(P<0.05),在88例女性NAFLD并发2型糖尿病患者中,其占比分别为10.2%、28.4%和61.4%,也具有显著性差异(P<0.05),但在130例男性人群,其占比分别为29.2%、34.6%和36.2%,无显著性统计学差异(P>0.05)。结论NAFLD患者存在一些并发T2DM的危险因素,SUA就是一个重要的指标。在早期识别和防止这些危险因素�Objective The aim of this study was to investigate the changes of serum uric acid(SUA)levels and its clinical implication in patients with nonalcoholic fatty liver disease((NAFLD))and type 2 diabetes mellitus(T2DM).Methods The study enrolled 316 patients with NAFLD in our hospital from June 2015 through December 2019,including 218 patients with NAFLD and T2DM,and 98 NAFLD patients without T2DM.The univariate and multivariate Logistic regression analysis was performed in patients with NAFLD to determine the independent risk factors related to T2DM occurrence.Results The proportion of male cases in patients with NAFLD and T2DM was 59.6%,significantly higher than 42.9%(P<0.05)in those without T2DM,the body mass index(BMI)was(27.2±2.9)kg/m^2,significantly higher than[(24.5±3.2)kg/m^2,P<0.05],blood HbA1c was(9.2±2.1)%,significantly higher than[(7.2±1.9)%,P<0.05],blood high density lipoprotein(HDL)level was(0.9±0.2)mmol/l,significantly lower than[(1.1±0.3)mmol/l,P<0.05],blood triglyceride(TG)level was(1.9±0.5)mmol/l,significantly higher than[(1.6±0.5)mmol/l,P<0.05],the SUA was(335.8±72.6)mol/L,significantly higher than[(304.5±68.0)mol/L,P<0.05],the estimated glomerular filtration rate(eGFR)was(158.4±40.6)ml/min/1.73 m^2,significantly higher than[(148.5±36.8)ml/min/1.73 m^2,P<0.05],the fasting insulin(FINS)level was(5.1±2.6)MIU/L,significantly higher than[(3.6±2.8)MIU/L,P<0.05],and the insulin resistance index(HOMA-IR)was(1.9±1.1),significantly higher than[(1.3±1.0),P<0.05]in NAFLD patients without T2DM;we taken gender,BMI,HbA1c,HDL,TG,SUA,eGFR,FINS and HOMA-IR as independent variables,and the multivariate Logistic regression analysis showed that the gender,HbA1c,SUA,FINS and HOMA-IR were(P<0.05)the independent risk factors,while the BMI,HDL,TG and eGFR were not(P>0.05)the independent risk factors for T2DM occurrence in patients with NAFLD;we divided SUA into three groups based on its levels from low to high as SUA-1,SUA-2 and SUA-3,and in 218 NAFLD patients with T2DM,the percentages of T2DM were 21.5%,3

关 键 词：非酒精性脂肪性肝病 2型糖尿病 血尿酸 LOGISTIC回归分析 危险因素 

分 类 号：R587.2[医药卫生—内分泌] R575.5[医药卫生—内科学]