老年2型糖尿病患者正常白蛋白尿糖尿病肾病与高尿酸血症的相关性研究  

Normoalbuminuric diabetic kidney disease and hyperuricaemia in elderly type 2 diabetic patients

作　　者：崔雯霞 张铭瑞 高蕾 施晓婷[1] 李曼 胡云[1] Cui Wenxia;Zhang Mingrui;Gao Lei;Shi Xiaoting;Li Man;Hu Yun(Department of Geriatrics,Nanjing Drum Tower Hospital Clinical College of University Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院老年科,210008

出　　处：《中华内分泌代谢杂志》2022年第10期854-858,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：江苏省老年健康科研资助项目(LR2021038)。

摘　　要：目的:探讨老年2型糖尿病中正常白蛋白尿糖尿病肾病(normoalbuminuric diabetic kidney disease, NADKD)与高尿酸血症的相关性。方法:采用回顾性病例对照研究,选取2015年至2020年于南京鼓楼医院老年内分泌科住院的老年2型糖尿病患者910例。将研究对象分成NADKD组[尿微量白蛋白/肌酐比值(urinary albumin/creatinine,UACR)<30 mg/g且估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)<60 mL·min^(-1)·(1.73 m^(2))^(-1), n=169],白蛋白尿DKD组[UACR≥30 mg/g且eGFR<60 mL·min^(-1)·(1.73 m^(2))^(-1), n=234]和对照组[UACR<30 mg/g且eGFR≥60 mL·min^(-1)·(1.73 m^(2))^(-1), n=507]。对受试者进行病史采集、体格检查和实验室检查。 结果:NADKD组女性占比显著高于白蛋白尿DKD组(50.89%对40.60%, P<0.05)。NADKD组糖尿病病程、HbA 1C、空腹血糖(FPG)、高血压病患病率、高尿酸血症患病率、血尿素氮、血肌酐、血尿酸均显著低于白蛋白尿DKD组(均 P<0.05)。NADKD组尿素氮、血肌酐、三酰甘油、血尿酸、高尿酸血症患病率均显著高于对照组(均 P<0.001);而NADKD组高血压病患病率、收缩压、LDL-C、HbA 1C、FPG则低于对照组(均 P<0.05)。多元线性回归分析结果显示,正常白蛋白尿老年2型糖尿病患者中,eGFR与尿素氮、血尿酸负相关,与HbA 1C呈正相关(均 P<0.001)。 Logistic回归分析结果显示,在校正了体重指数、血压、血脂、血糖等后,高尿酸血症组中NADKD的患病率是无高尿酸血症组的1.963倍(95% CI 1.157~3.332, P=0.012)。 结论:在老年2型糖尿病患者中,NADKD与高尿酸血症显著相关。Objective To assess the correlation between hyperuricaemia and normoalbuminuric diabetic kidney disease(NADKD)in elderly type 2 diabetic patients.Methods This retrospective case-control study enrolled 910 patients with type 2 diabetes mellitus who were hospitalized in the Geriatric Department of Nanjing Drum Tower Hospital from 2015 to 2020.The patients were divided into NADKD group[urinary albumin/creatinine(UACR)<30 mg/g and estimated glomerular filtration rate(eGFR)<60 mL·min^(-1)·(1.73 m^(2))^(-1),n=169],albuminuria DKD group[UACR≥30 mg/g and eGFR<60 mL·min^(-1)·(1.73 m^(2))^(-1),n=234],and control group[UACR<30 mg/g and eGFR≥60 mL·min^(-1)·(1.73 m^(2))^(-1),n=507].Medical history,physical examination,and laboratory tests were collected.Results The proportion of women in the NADKD group was significantly higher than that in the albuminuric DKD group(50.89%vs 40.60%,P<0.05).Duration of diabetes,HbA1C,fasting plasma glucose(FPG),the prevalences of hypertension and hyperuricaemia,blood urea nitrogen,blood creatinine,and blood uric acid were significantly lower in the NADKD group than those in the albuminuric DKD group(all P<0.05).Blood urea nitrogen,serum creatinine,triglycerides,serum uric acid and the prevalence of hyperuricemia were significantly higher in the NADKD group compared the control group(all P<0.001)while the proportion of hypertension,systolic blood pressure,LDL-C,HbA1C,and FPG were lower(all P<0.05).Multivariate linear regression analysis showed that eGFR was negatively associated with urea nitrogen and serum uric acid while positively associated with HbA1C in normoalbuminuric elderly type 2 diabetic patients(all P<0.001).Logistic regression analysis revealed that hyperuricaemia was a risk factor for NADKD in elderly type 2 diabetic patients after adjusting for BMI,blood pressure,lipids,and glucose(OR=1.963,95%CI 1.157-3.332,P=0.012).Conclusion Hyperuricaemia is significantly associated with NADKD in elderly patients with type 2 diabetes.

关 键 词：糖尿病 2型 老年 正常白蛋白尿 糖尿病肾病 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学] R589.7[医药卫生—临床医学]