2型糖尿病患者血尿酸水平与胰岛β细胞功能的相关性  

Correlation between serum uric acid levels and pancreaticβ-cell function in patients with type 2 diabetes mellitus

作　　者：李尚建 罗秀梅 陆志强 陈宁 LI Shang-jian;LUO Xiu-mei;LU Zhi-qiang;CHEN Ning(Department of Endocrinology,Zhongshan Hospital,Fudan University(Xiamen Branch),Xiamen 361015,Fujian,China)

机构地区：[1]复旦大学附属中山医院厦门医院内分泌科,厦门361015

出　　处：《中国临床医学》2023年第2期251-256,共6页Chinese Journal of Clinical Medicine

基　　金：福建省自然科学基金(2022J011426)。

摘　　要：目的探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者血尿酸水平与胰岛β细胞功能的相关性。方法选取2018年1月至2020年4月复旦大学附属中山医院厦门医院收治的T2DM患者304例,根据血尿酸水平将患者分为2组:正常尿酸组(NUA组,n=245)和高尿酸血症组(HUA组,n=59)。采用精氨酸刺激试验评估胰岛β细胞功能,比较2组患者的临床特征和β细胞功能,采用多元线性回归模型分析血尿酸水平与胰岛β细胞功能的关系。结果HUA组患者体质量、体质量指数(BMI)、腰围、臀围、稳态模型评估的胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)均显著高于NUA组(P<0.05);糖化血红蛋白(HbA1c)、血肌酐(CREA)、估算的肾小球滤过率(eGFR)、高密度脂蛋白胆固醇(HDL-C)均显著低于NUA组(P<0.05)。HUA组0-min胰岛素(I0)、2-min胰岛素(I2)、4-min胰岛素(I4)、6-min胰岛素(I6)、0-min C肽(CP0)、2-min C肽(CP2)、4-min C肽(CP4)、6-min C肽(CP6)、胰岛素增值(ΔI)、C肽增值(ΔCP)、胰岛素/血糖的增值(ΔI/G)、C肽/血糖的增值(ΔCP/G)、胰岛素曲线下面积、C肽曲线下面积均高于NUA组,差异有统计学意义(P<0.05)。HUA组0-min血糖(G0)、2-min血糖(G2)、4-min血糖(G4)、6-min血糖(G6)均低于NUA组,差异有统计学意义(P<0.05)。多元线性回归分析显示:在校正了多个潜在影响因素后,血尿酸水平与精氨酸刺激试验下的ΔI显著正相关(β=0.029,95%CI 0.002~0.056,P=0.035)。结论T2DM患者合并高尿酸者胰岛β细胞分泌功能较尿酸正常者更好,其血尿酸水平是胰岛β细胞功能的独立影响因素。Objective To explore the relationship between serum uric acid level andβcells function in patients with type 2 diabetes mellitus(T2DM).Methods A total of 304 patients with T2DM admitted to Zhongshan Hospital,Fudan University(Xiamen Branch)from January 2018 to April 2020 were selected and divided into two groups based on their blood uric acid levels:the normal uric acid group(NUA group,n=245)and the hyperuricemia group(HUA group,n=59).Function ofβcell insulin secretion was identified by the acute insulin response to arginine stimulation.The clinical characteristics and the results ofβ-cell insulin secretion function were compared between the two groups.Multivariable linear regression models were used to examine the association of serum uric acid levels with the insulin secretion function ofβcells.Results The patients in HUA group had significantly higher weight,BMI,waist circumference,hip circumference,HOMA-βand HOMA-IR but lower HbA1c,CREA,eGFR and HDL-C(all P<0.05)than those in NUA group.During the arginine stimulation test,0-min,2-min,4-min and 6-min insulin(I0,I2,I4,I6),0-min,2-min,4-min and 6-min C-peptide(CP0,CP2,CP4,CP6),ΔI,ΔCP,ΔI/G,ΔCP/G,area under curve of insulin and C-peptide were significantly higher in HUA group.And the 0-min,2-min,4-min,6-min plasma glucose(G0,G2,G4,G6)were lower in HUA group than those in the NUA group(all P<0.05).Multivariate linear regression analysis showed that after adjusting for multiple related risk factors,the serum uric acid levels were positively correlated withΔI(β=0.029,95%CI 0.002-0.056,P=0.035).Conclusions The insulin secretory function of pancreaticβ-cells in T2DM patients with hyperuricemia is better than that in T2DM patients with normal uric acid levels.Serum uric acid level in T2DM patients is an independent influencing factor of pancreaticβ-cell function.

关 键 词：2型糖尿病 高尿酸血症 精氨酸刺激试验 胰岛Β细胞功能 

分 类 号：R587.1[医药卫生—内分泌]