上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2019, Vol. 39 ›› Issue (7): 783-.doi: 10.3969/j.issn.1674-8115.2019.07.017

• 论著·临床研究 • 上一篇    下一篇

上海地区糖尿病人群高尿酸血症的易患因素及肾功能预后分析

赵芳雅 1，陆俊茜 2，张磊 2，陈海冰 1   

  1. 1.上海市第八人民医院内分泌科，上海 200030；2.上海交通大学附属第六人民医院内分泌代谢科，上海市糖尿病研究所，上海 200030
  • 出版日期:2019-07-28 发布日期:2019-08-26
  • 通讯作者: 陈海冰，电子信箱：18930173813@163.com。
  • 作者简介:赵芳雅（1989—），女，住院医师，硕士；电子信箱： 18817821752@163.com。

Analysis of risk factors of hyperuricemia and its outcomes of renal function in diabetes mellitus in Shanghai

ZHAO Fang-ya1, LU Jun-qian2, ZHANG Lei2, CHEN Hai-bing1   

  1. 1. Department of Endocrinology, Shanghai Eighth Peoples Hospital, Shanghai 200030, China; 2. Department of Endocrinology and Metabolism, Shanghai Sixth Peoples Hospital, Shanghai Jiao Tong University; Diabetes Research Institute, Shanghai 200030, China
  • Online:2019-07-28 Published:2019-08-26

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摘要： 目的 ·分析上海人群中糖尿病合并高尿酸血症（ hyperuricemia, HUA）的流行情况、易患因素及肾功能预后。方法 ·选取 2011年 7月— 2014年 9月在上海市糖尿病临床中心住院的糖尿病患者，符合入选标准者共 3 454例。分析糖尿病患者中 HUA的患病率、易患因素及肾功能情况。患者分为 HUA组（n548）及血清尿酸（ serum uric acid，SUA）正常组（ n2 906），比较 2组患者的一般特征和临床参数。采用 Pearson相关分析、多元 Logistic回归分析 SUA与糖尿病患者肾功能不全及异常蛋白尿发生之间的关系。结果 ·上海地区糖尿病患者中， HUA的患病率为 15.87%，男性为 14.52%，女性为 17.80%。肾小球滤过率、空腹 C肽、性别、尿微量白蛋白与肌酐比值的自然对数、年龄、糖化白蛋白、三酰甘油、高密度脂蛋白胆固醇及体质量指数（ body mass index，BMI）与 SUA独立相关（均 P<0.05）。在合并 HUA的糖尿病患者中， SUA水平每增加 1 SD（94 mmol/L），肾功能不全的患病率增加 0.8%，异常蛋白尿的患病率增加 0.3%，超滤过患病率降低 0.5%（均 P<0.05）。结论 ·糖尿病对 HUA具有重要影响，积极改善胰岛素抵抗、控制血糖或可改善 HUA。HUA是糖尿病肾病发生、发展的独立危险因素，监测糖尿病患者 SUA水平对预防糖尿病肾病具有重要意义。

关键词: 高尿酸血症, 血清尿酸, 蛋白尿, 肾功能不全

Abstract:

Objective · To analyze the risk factors of hyperuricemia (HUA) and its outcomes of renal function in patients with diabetes mellitus in Shanghai. Methods · A total of 3 454 patients with diabetes who were admitted to the Shanghai Diabetes Clinical Center July 2011 to September 2014 were selected. The prevalence of HUA, predisposing factors and renal function of diabetic patients were analyzed. Patients were divided into HUA group (n548) and normal serum uric acid (SUA) group (n2 906). General characteristics and clinical parameters of diabetic patients were compared between two groups. Pearson correlation analysis and multivariate Logistic regression were used to analyze the relationship between SUA and renal dysfunction and abnormal proteinuria in diabetic patients. Results · In Shanghai patients with diabetes, the prevalence of HUA was 15.87%, 14.52% in men, 17.80% in women. Glomerular filtration rate (GFR), fasting C-peptide, gender, age, natural logarithm of the ratio of microalbuminuria to creatinine (LnACR), glycated albumin (GA), triacylglycerol (TAG), high density lipoprotein cholesterol (HDL-C) and body mass index (BMI) were independently associated with SUA (all P<0.05). In diabetic patients with HUA, 1-SD increment in the SUA level was associated with a 0.8% increased prevalence of renal dysfunction, 0.3% increased prevalence of incident abnormal albuminuria and 0.5% decreased prevalence of hyperfiltration (all P<0.05). Conclusion · Diabetes has an important impact on HUA. Actively improving insulin resistance and controlling blood glucose may improve HUA. HUA is an independent risk factor for the occurrence and development of diabetic nephropathy. Therefore, monitoring the level of SUA in diabetic patients is of great significance in the prevention of diabetic nephropathy.

Key words: hyperuricemia, serum uric acid, albuminuria, renal inadequacy

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