血尿酸与胰岛β细胞分泌功能在2型糖尿病周围神经病变患者中交互作用的研究  

To explore the interaction between serum uric acid and pancreaticβ-cell secretory function in patients with type 2 diabetic peripheral neuropathy

作　　者：赵振国 许继炜 洪娟 ZHAO Zhenguo;XU Jiwei;HONG Juan(Department of General Medicine,The First People's Hospital of Wuhu City,Wuhu 241000,China)

机构地区：[1]芜湖市第一人民医院全科医学科,241000

出　　处：《中国糖尿病杂志》2024年第11期813-820,共8页Chinese Journal of Diabetes

摘　　要：目的探讨血尿酸(SUA)与胰岛β细胞分泌功能的交互作用对T2DM合并的糖尿病神经病变(DPN)发生发展的影响。方法选取2019年1月至2023年5月于芜湖市第一人民医院全科医学科诊治的T2DM患者122例,根据震动感觉值(VPT)分为≤15 V单纯T2DM组(n=30)、16~24 V轻度DPN组(L-DPN,n=30)、25~39 V中度DPN组(M-DPN,n=36)及≥40 V重度DPN组(H-DPN,n=26)。比较各组一般资料及生化指标。Logistic多因素分析SUA和胰岛β细胞分泌功能与DPN进展的相关性。Logistic回归分析T2DM患者DPN进展的影响因素。采用逐步回归方法筛选DPN的相关因素,构建列线图模型并进行验证。分析SUA和胰岛β细胞分泌功能交互作用对T2DM合并DPN的影响。结果多因素Logistic回归分析结果显示,年龄、SUA、天冬氨酸氨基转移酶、HDL-C、Hb Alc、胰岛β细胞分泌功能(C2/C0)、胰岛素抵抗指数(HOMA-IR)是T2DM患者DPN进展的影响因素。SUA、C2/C0、HOMA-IR、Hb Alc、HDL-C预测模型在训练集和验证集上的C指数分别为0.776和0.769,与DPN加重关联性最高。列线图模型预测DPN进展风险,验证前后曲线下面积分别为0.928(95%CI 0.856~0.986)和0.917(95%CI 0.843~0.977),绘制校准曲线平均绝对误差均为0.013,可预测DPN进展风险。交互作用分析结果显示,SUA和胰岛β细胞分泌功能存在相乘及相加交互作用。结论SUA和胰岛β细胞分泌功能的交互作用,是T2DM患者DPN进展的危险因素,临床上可根据列线图模型对危险因素及时预警,进行针对性预防和治疗。Objective To investigate the interaction between serum uric acid(SUA)and isletβcell function,and its influence in the development of diabetic peripheral neuropathy(DPN)in patients with type 2diabetes mellitus(T2DM).Methods A total of 122 patients with T2DM who visited General Medicine Department of our hospital from January 2019 to May 2023 were enrolled in this study and divided into two groups according to whether they had DPN:T2DM group(n=30)and DPN group(n=92).Patients in DPN group were further divided into three groups according to the severity of DPN:mild DPN group(L-DPN,n=30),moderate DPN group(M-DPN,n=36)and severe DPN group(H-DPN,n=26).The clinical data and biochemical indexes were compared and analyzed among the four groups.Logistic multivariate analysis was used to analyze the relationship between SUA and isletβcell secretory function and severe DPN.Multivariate logistic regression was used to analyze the risk factors for the severity of DPN.Stepwise regression method was used to screen the most important related factors for the severity of DPN,and a nomogram model was constructed and validated.The interaction between SUA and isletβcell function,and its influence in the development of DPN in T2DM patients were analyzed.Results Multivariate logistic regression analysis showed that age,SUA,aspartate aminotransferase,HDL-C,Hb Alc,isletβcell secretion function(C2/C0)and insulin resistance index(HOMA-IR)were all independent influencing factors for the severity of DPN(P<0.05).The C indices of SUA,C2/C0,HOMA-IR,Hb Alc and HDL-C prediction models were 0.776 and 0.769 on the training set and validation set respectively,which were most correlated with the aggravation of DPN degree.The area under the curve of the nomogram model for predicting the risk of DPN severity was 0.928(95%CI 0.856~0.986)and 0.917(95%CI 0.856~0.986)before and after validation respectively.The mean absolute error of the calibration curve was 0.013,which could be used as a risk tool to predict the risk of DPN aggravation.The results of i

关 键 词：血尿酸 胰岛Β细胞分泌功能 糖尿病 2型 糖尿病周围神经病变 交互作用 

分 类 号：R587.2[医药卫生—内分泌] R745[医药卫生—内科学]