2型糖尿病血尿酸浓度与未来出现肾病终点的非干预性观察性研究

doi:10.3969/j.issn.1006-7795.2014.01.015

摘要/Abstract

摘要：

目的本研究旨在探讨血尿酸控制对2型糖尿病出现早期肾功能下降的影响，为其防治提供临床依据。方法选取2002年4月至2012年2月于首都医科大学附属北京同仁医院内分泌科住院治疗的尿蛋白排泄率（urinary protein excretion rate，UAER）<200 μg/min的2型糖尿病患者512名。根据不同血尿酸（serum uric acid，SUA）浓度分组，比较2组患者的肾小球滤过率估计（estimated glomerular filtration rate，eGFR），并进行多元回归分析。从上述患者中选取观察起点时eGFR>70 mL·min^-1·1.73 m^-2的2型糖尿病患者，对其进行2~10年的随访，共计466名，进行生存分析。结果 1血尿酸浓度低组肾小球滤过率更高，肾功能更好。2以eGFR为因变量进行多因素回归分析，结果显示：在校正了血糖、血脂、性别因素后，年龄、血尿酸浓度、病程、体质量指数（body mass index，BMI）均与eGFR浓度成负相关，血红蛋白（hemoglobin，HGB）浓度与eGFR浓度成正相关；3生存分析研究中，患者血尿酸浓度越低，其出现肾功能下降的概率更低，生存时间更长。结论高尿酸血症是糖尿病肾病进展的独立危险因素，血尿酸浓度可以作为2型糖尿病患者早期肾功能下降的预测因子。

关键词: 2型糖尿病, 糖尿病肾病, 血尿酸, 早期肾功能下降, 估算肾小球滤过率, 生存曲线

Abstract:

Objective To investigate the effect of serum uric acid on early function decline in type 2 diabetes mellitus. Methods Totally 512 inpatients with type 2 diabetes mellitus with urinary albumin excretion rate(UAER) under 200 μg/min were included in this study. The subjects were divided into groups base on the different levels of serum uric acid. Estimated glomerular filtration rate (eGFR) of both groups were compared, 466 Type 2 diabetes mellitus inpatients without renal function decline eGFR>70 mL/(min·1.73 m²) at the starting point participated in the 2-10 years follow up study. Terminal event was defined as eGFR <60 mL/(min·1.73 m²), and survival curves were made.Results The subjects were divided into 2 groups based on the level of serum uric acid. Low serum uric acid group had higher glomerular filtration rate with better renal function. Multivariate regression analysis showed that eGFR was negatively correlated with age, serum uric acid, disease duration, body mass index(BMI),and positively correlated with bedy mass index (HGB). In the follow up study, the subjects were divided into 2 groups based on the level of serum uric acid. The lower the serum uric acid of patients is, the lower the probability of a drop in kidney function, and survival time was longer. Conclusion In patients with type 2 diabetes mellitus, high uric acid will play a key role in the progression of diabetic nephropathy as an independent risk factor. Serum uric acid levels are a strong predictor of the development of early renal function decline in patients with type 2 diabetes mellitus.

Key words: type 2 diabetes mellitus, serum uric acid, diabetic nephropathy, early renal function decline, estimated glomerular filtration rate, survival curve

中图分类号:

R587.1

孙小蒙, 王莹莹, 刘畅, 冯建萍, 徐援, 杨金奎. 2型糖尿病血尿酸浓度与未来出现肾病终点的非干预性观察性研究[J]. 首都医科大学学报, 2014, 35(1): 67-72.

Sun Xiaomeng, Wang Yingying, Liu Chang, Feng Jianping, Xu Yuan, Yang Jinkui. Effect of serum uric acid control on nephropathic end point in type 2 diabetes mellitus non-intervention[J]. Journal of Capital Medical University, 2014, 35(1): 67-72.

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