CAJ | 학술논문

目的了解不同年龄不同性别中老年2型糖尿病合并高尿酸血症的特点.方法对2003年9月至2011年12月于我科就诊的3768例年龄≥40岁的2型糖尿病患者临床资料进行分析,根据尿酸水平将患者分为高尿酸组(A组,男性尿酸＞ 420μmol/L,女性尿酸＞357 μmol/L)和尿酸正常组(B组),排序后再进行五分位分组；年龄按40 ～ 70岁每5岁分组共分为7组,比较各组高尿酸血症患病率、BMI、腰臀比(WHR)、血压和生化指标.尿酸与血糖、HbA1c、胰岛素抵抗指数(HOMA-IR)的相关性采用Pearson相关分析,采用logistic回归方法分析尿酸的影响因素.结果男性尿酸水平明显高于女性(t=-11.091,P＜0.05),随年龄变化为先下降后上升；女性尿酸随着年龄增长而上升.男性A组较女性A组平均年龄小、高密度脂蛋白胆固醇(HDL-C)低(t=2.526、2.764,均P＜0.05).女性A组空腹、餐后血糖和男性A组HbA1c均低于B组(t=2.147、3.284、2.982,均P＜0.05),男女A组空腹、餐后胰岛素、HOMA-IR和甘油三酯(TG)、尿素氮(BUN)、肌酐(Scr)均明显高于B组(均P＜0.05),而HDL-C、肾小球滤过率(e-GFR)明显低于B组(均P＜0.05).男性A组白蛋白/肌酐(Alb/Cr)明显高于B组(t=-3.922;P＜0.05),女性两组无差异.logistic回归分析示男性尿酸与BMI、TG、Alb/Cr呈正相关(OR=1.128、1.231、1.004,均P＜0.05),与HbA1c和e-GFR呈负相关(OR =0.811、0.973,均P＜0.05)；女性尿酸与BMI、TG、HDL-C呈正相关(OR=1.171、1.179、0.264,均P＜0.05),与e-GFR呈负相关(OR:0.978；P ＜0.05).结论糖尿病合并高尿酸血症的患者有更严重的胰岛素抵抗、血脂异常以及e-GFR下降.男女糖尿病患者的尿酸水平及其年龄、体重、血压等对尿酸水平的影响有所不同.
목적 료해불동년령불동성별중노년2형당뇨병합병고뇨산혈증적특점.방법 대2003년9월지2011년12월우아과취진적3768례년령≥40세적2형당뇨병환자림상자료진행분석,근거뇨산수평장환자분위고뇨산조(A조,남성뇨산＞ 420μmol/L,녀성뇨산＞357 μmol/L)화뇨산정상조(B조),배서후재진행오분위분조；년령안40 ～ 70세매5세분조공분위7조,비교각조고뇨산혈증환병솔、BMI、요둔비(WHR)、혈압화생화지표.뇨산여혈당、HbA1c、이도소저항지수(HOMA-IR)적상관성채용Pearson상관분석,채용logistic회귀방법분석뇨산적영향인소.결과 남성뇨산수평명현고우녀성(t=-11.091,P＜0.05),수년령변화위선하강후상승；녀성뇨산수착년령증장이상승.남성A조교녀성A조평균년령소、고밀도지단백담고순(HDL-C)저(t=2.526、2.764,균P＜0.05).녀성A조공복、찬후혈당화남성A조HbA1c균저우B조(t=2.147、3.284、2.982,균P＜0.05),남녀A조공복、찬후이도소、HOMA-IR화감유삼지(TG)、뇨소담(BUN)、기항(Scr)균명현고우B조(균P＜0.05),이HDL-C、신소구려과솔(e-GFR)명현저우B조(균P＜0.05).남성A조백단백/기항(Alb/Cr)명현고우B조(t=-3.922;P＜0.05),녀성량조무차이.logistic회귀분석시남성뇨산여BMI、TG、Alb/Cr정정상관(OR=1.128、1.231、1.004,균P＜0.05),여HbA1c화e-GFR정부상관(OR =0.811、0.973,균P＜0.05)；녀성뇨산여BMI、TG、HDL-C정정상관(OR=1.171、1.179、0.264,균P＜0.05),여e-GFR정부상관(OR:0.978；P ＜0.05).결론 당뇨병합병고뇨산혈증적환자유경엄중적이도소저항、혈지이상이급e-GFR하강.남녀당뇨병환자적뇨산수평급기년령、체중、혈압등대뇨산수평적영향유소불동.
Objective To investigate the characteristics of hyperuricemia in the type 2 diabetes patients aged over 40 years old.Methods A total of 3768 type 2 diabetes patient over 40 years old who visit the clinics of the 306 th Hospital during the period from September,2003 to December,2011 were enrolled in the study.The subjects were divided into 2 groups based on the blood uric acid (BUA),which were group A with hyperuricemia (＞ 420 μmol/L in the male and ＞357 μmol/L in the female) and group B with normal BUA level.The quinquepartite method was used after sorting the BUA level.The subjects were stratified by age into 7 groups with every 5 yrs differences from 40 to 70 years old.The prevalence of hyperuricemia,BMI,WHR (waist-to-hip ratio),BP (blood pressure) and biochemical parameters were compared among these groups.The spearman analysis was used to explore the correlation between BUA and blood glucose,HbA1c and insulin-resistance index.The logistic regression analysis was applied to investigate the related risk factors of hyperuricemia.Results BUA was significantly higher in the male than in the female(t=-11.091,P ＜0.05).In the males,the level of BUA was initially decreased with age followed by an increase when aged over 65 yrs,while the level of BUA kept increasing with age in the female.In group A,the male were younger and with lower level of HDL-C(t =2.526,2.764,all P ＜0.05)than the female.Compared with group B,the female had lower fasting and post prandial glucose level(t =2.147,3.284,all P ＜0.05),and the male had lower HbA1c (t =2.982,P ＜0.05) in group A.in Higher fasting and post-prandial insulin level and higher insulin-resistance index were observed in group A than in group B (all P ＜ 0.05).In both the male and the female of group A,the levels of blood TG,BUN,and creatinine were higher,while the HDL-C and e-GFR were lower than those in group B (all P ＜ 0.05).The urine Alb/Cr ratio was significantly higher in group A than that in group B for the male(t =-3.922; P ＜0.05),but not for the female.Logistic regression analysis showed that BUA was positively correlated with BMI,TG,and Alb/Cr (OR:1.128,1.231,1.004; all P ＜ 0.05),while negatively correlated with HbA1 c and e-GFR (OR:0.811,0.973 ; all P ＜ 0.05) for the male.In the female,BUA was showed to be positively correlated with BMI,TG,HDL-C (OR:1.171,1.179,0.264; all P ＜0.05),while negatively correlated with e-GFR(OR:0.978; P ＜ 0.05).Conclusions The patients with diabetes and hyperuricemia have more severe insulin resistance,lipids abnormalities and decrease of e-GFR.The level of BUA itself and the impact of age,BMI and blood pressure on the level of BUA differ in the male and in the female.