【摘要】 目的 探讨2型糖尿病患者血尿酸水平与肾小球滤过率(GFR)、尿微量白蛋白(mALB)排出量的关系。方法 将686例2型糖尿病患者按GFR水平分成3组,A组:GFR≥90 ml/(min·1.73 m~2),191例;B组:60 ml/(min·1.73 m~2)≤GFR<90 ml/(min·1.73 m~2),383例;C组:GFR<60 ml/(min·1.73 m~2),112例;分析不同肾功能状态组的临床特征。再将尿酸值从小到大排序,按四分位数分成4组,尿酸<214.7μmol/L组,171例;尿酸214.7~271.6μmol/L组,172例;尿酸271.7~329.4μmol/L组,172例;尿酸>329.4μmol/L组,171例;分析不同血尿酸水平患者的GFR、24 h尿mALB(mALB/24 h)的变化及相关性。结果 按GFR水平分成的A、B、C组患者的年龄、病史、肌酐、尿酸、总胆固醇、mALB/24 h的差异均有统计学意义[年龄:(53±13)、(61±1 1)、(68±9)岁,病史:(6.0±2.3)、(7.9±3.3)、(14.0±4.5)年,肌酐:(57±9)、(62±16)、(137±83)μmol/L,尿酸:(258±83)、(282±80)、(345±96)μmol/L,总胆固醇:(5.0±1.1)、(5.3±1.2)、(5.7±1.4)mmol/L,ln(mALB/24 h):(1.9±0.8)、(2.0±0.6)、(2.6±0.9)](P<0.01或P<0.05)。根据尿酸水平的分组并进行Pearson相关分析表明,尿酸与GFR呈负相关(r=-0.248,P<0.01);尿酸与mALB/24 h呈正相关(r=0.254,P<0.01);GFR与mALB/24 h呈负相关(r=-0.352,P<0.01)。Logistic回归分析结果表明,尿酸、年龄、病史、总胆固醇是肾功能不全的危险因素[比值比(OR)=1.013、OR=1.093、OR=1.097、OR=1.369,P<0.01或P<0.05];尿酸、年龄、总胆固醇是异常蛋白尿的危险因素(OR=1.004、OR=1.029、OR=1.073,均P<0.05)。结论 2型糖尿病患者的肾小球滤过率及尿mALB排出量与血尿酸相关,且血尿酸是异常蛋白尿和肾功能不全的危险因素。更多还原

【Abstract】 Objective To study the relation among glomerular filtration rate(GFR),urinary albumin execretion and serum uric acid(UA) in patients with type 2 diabetes mellitus.Methods MDRD equation was used to calculate the GFR.A total of 686 patients with type 2 diabetes mellitus were divided into 3 groups according to their GFR.Group A GFR≥90 ml/(min·1.73 m~2),191 cases;group B:60 ml/(min·1.73 m~2) s=GFR <90 ml/(min·1.73 m~2),383 cases;group C:GFR < 60 ml/(min·1.73 m~2),112 cases and clinical features were analyzed.The patients were categorized into four groups based on quartiles of the serum uric acid level to evaluate the diversity and the correlation of GFR and 24 h urinary albumin execretion(24h-UAE).UA <214.7 |xmol/L group,171 cases;UA 214.7-271.6 μmol/L geoup,172 cases;UA 271.6-329.4 μmol/L group,172 cases;UA>329.4 μmol/L group,171 cases.Results The age,history,creatinine,UA,triglycerides and 24h-UAE were significantly different among group A,B,C segregated by GFR[age:(53 ±13),(61 ±11),(68 ±9) years old,history:(6.0±2.3),(7.9±3.3),(14.0±4.5)years,creatinine;(57 ±9),(62 ± 16),(137 ±83) μmol/L,UA:(258 ±83),(282 ±80),(345 ±96) μmol/L,triglycerides:(5.0 ± 1.1),(5.3 ± 1.2),(5.7 ± 1.4) mmol/L,ln(mALB/24 h):(1.9 ±0.8),(2.0 ±0.6),(2.6 ±0.9)](P <0.01 or P <0.05).Pearson correlation showed that serum uric acid was negatively correlated with GFR(r =-0.248,P <0.01);serum uric acid was positively correlated with 24h-UAE(r = 0.254,P <0.01);GFR was negatively correlated with 24h-UAE(r=-0.352,P<0.01).Logistic regression analysis suggested that UA,age,history triglycerides were the independent risk factors for renal insufficiency(OR = 1.013,OR = 1.093,OR = 1.097,OR = 1.369,P<0.01 or P <0.05);UA,age,history and triglycerides were the independent risk factors for abnormal albuminuria(OR- 1.004,OR = 1.029,OR = 1.073,all P < 0.05).Conclusions There is an association among glomerular filtration rate,urinary albumin execretion and serum UA in patients with type 2 diabetes mellitus.Serum UA level is one of the independent risk factors for abnormal albuminuria and renal insufficiency.更多还原