2型糖尿病人群中高尿酸血症与心血管病死亡风险的队列研究

目的 探讨2型糖尿病(type 2 diabetes mellitus,T2DM)队列人群中高尿酸血症与心血管病死亡风险的关系。方法 研究对象为江苏省常熟市的T2DM队列人群。应用Cox 回归模型分析基线不同尿酸水平T2DM队列人群心血管病死亡的HR值和95%CI。结果 10 246名T2DM队列人群中累积随访59 032.86人年,平均随访6年,随访期间因心血管病死亡260人。调整潜在的混杂因素后,以基线正常尿酸组为参照,高尿酸血症组发生心血管病死亡的HR(95%CI)为1.753(1.299~2.366)。在男性患者、女性患者、年龄≤60岁、年龄＞60岁、无中心性肥胖、血脂正常、血脂异常、高血压组中,与正常尿酸组相比,高尿酸血症组均可使T2DM患者发生心血管病死亡风险增加,差异有统计学意义(HR分别为1.780、1.756、5.583、2.065、1.964、1.705、1.579和1.748,P<0.05)。排除基线时患有心血管疾病和肾病的患者,剩下的8 686名T2DM患者进行敏感性分析。以基线正常尿酸组为参照,高尿酸血症组发生心血管病死亡的HR(95%CI)为1.250(1.043~1.498)。结论 高尿酸血症可以独立增加T2DM患者心血管病死亡的风险。

Cohort study on hyperuricemia and the risk of cardiovascular disease mortality in patients with type 2 diabetes mellitus

Objective To explore the relationship of hyperuricemia with the risk of cardiovascular disease mortality in a cohort of patients with type 2 diabetes mellitus(T2 DM).Methods All participants were selected from a cohort study of T2 DM patients in Changshu City,Jiangsu Province.Multivariate Cox regression models were used to analyze the hazard ratio(HR)and 95%confidence interval(CI)of cardiovascular disease mortality in T2 DM patients with different baseline levels of uric acid.Results Among the 10,246 T2 DM patients,follow-ups were accumulatively conducted in 59,032.86 person-years.The median of follow-ups was 6 years,and 260 patients died of cardiovascular disease during the follow-ups.After adjusting for potential confounding factors,the hazard ratio(95%confidence interval)of cardiovascular disease mortality in the hyperuricemia group was 1.753(1.299-2.366)compared with the baseline normal uric acid group.In the groups with male patients,with female patients,aged≤60 years,aged>60 years,without central obesity,with normal blood lipid,with dyslipidemia and hypertension,compared with the normal uric acid group,the hyperuricemia group increased the risk of death from cardiovascular disease in the T2 DM patients,with statistically significant differences(HR=1.780,HR=1.756,HR=5.583,HR=2.065,HR=1.964,HR=1.705,HR=1.579,HR=1.748,all P<0.05).After excluding patients with cardiovascular disease and kidney disease at baseline,the remaining 8,686 patients with T2 DM underwent sensitivity analysis.Compared with the baseline normal uric acid group,the HR(95%CI)of cardiovascular mortality in the hyperuricemia group was 1.250(1.043-1.498).Conclusion Hyperuricemia is independently associated with increased cardiovascular disease mortality risk in patients with T2 DM.