中老年2型糖尿病患者血清尿酸水平与视网膜病变的相关性  

Associations of serum uric acid level with diabetic retinopathy in middle-aged and elderly patients with type 2 diabetes mellitus

作　　者：赵坤 胡静 杨少玲[2] 王凤翎 范林艳 郭美祥[3] ZHAO Kun;HU Jing;YANG Shaoling;WANG Fengling;FAN Linyan;GUO Meixiang(Department of Cardiovascular Ultrasound,Fengxian District Central Hospital Affiliated to Anhui University of Science and Technology,Shanghai 201400,China;Department of Cardiovascular Ultrasonography,South Campus of Shanhai Sixth People's Hospital,Shanghai Jiao Tong University,Shanghai 201400,China;Department of Endocrinology,South Campus of Shanghai Sixth People's Hospital,Shanghai Jiao Tong University,Shanghai 201400,China)

机构地区：[1]安徽理工大学附属奉贤区中心医院心脏血管超声科,上海201400 [2]上海交通大学附属第六人民医院南院心脏血管超声科,上海201400 [3]上海交通大学附属第六人民医院南院内分泌科,上海201400

出　　处：《同济大学学报（医学版）》2022年第1期70-76,共7页Journal of Tongji University(Medical Science)

基　　金：上海市科学技术委员会引导项目(18411970000);上海市卫生与计划生育委员会课题(201740053)。

摘　　要：目的探讨中老年2型糖尿病患者血清尿酸(serum uric acid,SUA)水平与视网膜病变的相关性。方法选取2015年9月—2020年9月于安徽理工大学附属奉贤区中心医院内分泌科住院治疗且经过眼科会诊的中老年2型糖尿病(type 2 diabetes,T2DM)患者,共540例,根据SUA水平四分位数分为4组,分别为G1组(SUA≤290μmol/L,共135例)、G2组(SUA为291~344μmol/L,共136例)、G3组(SUA为345~395μmol/L,共132例)、G4组(SUA≥396μmol/L,共137例)。比较4组一般资料、糖尿病视网膜病变(diabetic retinopathy,DR)发生率及随着SUA水平四分位数升高发生DR的风险。受试者工作特征(receiver operating characteristic,ROC)曲线评价单因素及多因素Logistic回归模型诊断DR效能。结果4组间一般资料比较,患者糖尿病病程、体质量指数、空腹C肽、三酰甘油、高密度脂蛋白、直接胆红素、胱抑素C和估算肾小球滤过率指标之间差异有统计学意义(P<0.05);4组间DR发生率比较,随着SUA水平四分位数升高,DR发生比例逐渐升高(P<0.01)。多因素Logistic回归分析显示,与G1组相比,随着SUA水平四分位数升高患DR的风险逐渐增加(G2:OR=2.370,P=0.004;G3:OR=3.579,P=0.000;G4:OR=4.688,P=0.000)。ROC显示,单因素变量中SUA诊断DR效能(AUC=0.657,P<0.01);多因素Logistic回归模型诊断DR效能(AUC=0.751,P=0.000)。结论SUA是DR重要危险因素,降低SUA水平应为DR治疗的重要环节之一。本研究所建立的多因素Logistic回归模型在预测中老年T2DM患者DR发生具有一定的临床参考价值。Objective To investigate the relationship between serum uric acid(SUA)level and retinopathy in middle-aged and elderly patients with type 2 diabetes(T2DM).Methods A total of 540 middle-aged and elderly T2DM patients who were hospitalized in the Department of Endocrinology admitted in Fengxian District Central Hospital from September 2015 to September 2020 were enrolled in the study.Patients were divided into four groups according to SUA quartiles:group1(SUA≤290μmol/L,n=135),group2(SUA 291-344μmol/L,n=136),group3(SUA 345-395μmol/L,n=132),and group4(SUA≥396μmol/L,n=137).The incidence of diabetic retinopathy(DR)was compared among the groups.The factors related to DR were identified by using the multivariate logistic regression analysis and the performance of Logistic regression model was evaluated with receiver operating characteristic curve(ROC).Results There were significant differences in diabetes duration,body mass index(BMI),fasting C-peptide,triacylglycerol,high-density lipoprotein,direct bilirubin,cystatin C and estimated glomerular filtration rate among four groups(P<0.05).The prevalence of DR increased with increasing SUA level(P for trend<0.01).Multivariate logistic regression analysis showed that higher levels of SUA were associated with greater risk for DR;compared with the lowest quartile level(G1)(G2:OR=2.370,P=0.004;G3:OR=3.579,P<0.001;G4:OR=4.688,P<0.001,respectively).SUA had better diagnostic efficiency for DR among univariate variables(AUC=0.657,P<0.01);the AUC of SUR for diagnosis of DR in multivariate logistic regression model was 0.751(P<0.001).Conclusion The study indicates that SUA is an important risk factor for DR;it may be used for predicting risk of DR in middle-aged and elderly patients with T2DM;and reducing SUA levels may be an essential part of DR treatment.

关 键 词：血清尿酸 糖尿病 2型 中老年 糖尿病视网膜病变 

分 类 号：R774.1[医药卫生—眼科]