血尿酸水平变化及高尿酸血症对2型糖尿病患者肾损害进展影响及性别差异的研究  

Influence of serum uric acid level and change in hyperuricemia status on the progression of renal impairment in patients with type 2 diabetes mellitus and its gender differences

作　　者：潘锦婷 彭娟 赵少俐[2] 杨琦 易斌[1] PAN Jinting;PENG Juan;ZHAO Shaoli(Department of Nephrology,The Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院肾内科,长沙410013 [2]中南大学湘雅三医院内分泌科,长沙410013

出　　处：《中国糖尿病杂志》2023年第3期171-176,共6页Chinese Journal of Diabetes

摘　　要：目的 探讨血尿酸(SUA)水平变化和高尿酸血症(HUA)对T2DM患者肾损害进展的影响及性别差异。方法 选取2009年1月至2017年12月年于中南大学湘雅三医院内分泌科和肾内科就诊的T2DM患者645例,根据末次随访时eGFR分为进展组[eGFR<60 ml/(min·1.73 m^(2)),n=129]和稳定组[e GFR≥60 ml/(min·1.73 m^(2)),n=516]。Logistic回归分析T2DM患者肾损害进展的影响因素。受试者工作特征(ROC)曲线分析基线SUA(B-SUA)和时间平均SUA(TA-SUA)对患者肾损害进展的预测价值。结果 进展组SUA水平及HUA患病率高于稳定组(P<0.05)。Logistic回归分析显示,高SUA基线正常而末次随访时存在HUA、基线及末次随访时均存在HUA是患者肾损害进展的影响因素,且SUA水平升高及存在基线和进展为HUA状态变化的女性肾损害进展风险高于男性。ROC曲线分析显示,TA-SUA预测肾损害进展的ROC曲线下面积大于B-SUA(男性0.721 vs0.642,女性0.787 vs 0.644,P<0.05)。结论 SUA升高及持续的HUA是T2DM患者肾损害进展的危险因素,对女性影响大于男性。TA-SUA在预测肾损害进展上优于B-SUA。Objective To explore the impact of serum uric acid(SUA)level and change in hyperuricemia(HUA)status on the progression of renal impairment in patients with type 2 diabetes mellitus(T2DM)and its gender differences.Methods 645 patients with T2DM were selected in The Third Xiangya Hospital of Central South University from January 2009 to December 2017.According to the level of eGFR at the last follow-up,T2DM patients were divided into progressive group[eGFR<60 ml/(min·1.73 m^(2)),n=129]and stable group[eGFR≥60 ml/(min•1.73 m^(2)),n=516].Logistic regression analysis was used to explore the influencing factors of progression of renal impairment in T2DM patients.The predictive value of baseline SUA(B-SUA)and time-average serum uric acid(TA-SUA)for the progression of renal impairment was performed by subject working characteristic(ROC)curve analysis.Results The level of SUA and the prevalence of HUA in the advanced group were higher than those in the stable group(P<0.05).Logistic regression analysis showed that the high SUA level,baseline none but HUA at the last follow-up,and HUA both at baseline and the last follow-up were all the influencing factors on the progression of renal impairment.The risk of renal impairment progression in women with elevated SUA or promoted HUA status was higher than that in men.ROC curve analysis showed that the area under the curve of TA-SUA on predicting the progression of renal impairment was larger than that of B-SUA(0.721 vs 0.642 for men,0.787 vs 0.644 for women,P<0.05).Conclusion High SUA level,continuous and aggravated HUA status are risk factors on the progression of renal impairment in T2DM patients,especially in women.TA-SUA is superior to B-SUA in predicting the progression of renal fimpairment.

关 键 词：糖尿病 2型 血尿酸 高尿酸血症状态变化 肾损害 

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