不同血尿酸水平的糖尿病患者病情进展比较及其影响因素分析

目的: 了解不同血尿酸水平的糖尿病患者病情进展情况,探讨糖尿病并发高尿酸血症的相关影响因素,为糖尿病并发高尿酸血症的预防及治疗提供科学依据。方法: 利用EpiData 3.0建立2型糖尿病住院患者的病例资料数据库,纳入完整病例资料1 411例,按血尿酸水平将2型糖尿病患者分为高尿酸(HUA)组和正常尿酸(NUA)组,比较2组患者临床指标及糖尿病并发症发生率的差异,并采用单因素分析和多因素Logistic回归分析筛选糖尿病并发高尿酸血症的影响因素。结果: HUA组患者中大血管并发症和微血管并发症的发生率均高于NUA组(P<0.05),糖尿病患者神经病变发生率组间比较差异无统计学意义(P>0.05);单因素分析,性别、体质量指数(BMI)、收缩压(SBP)、舒张压(DBP)和血清门冬酰胺氨基转移酶(AST)、丙氨酰胺基转移酶(ALT) 、谷氨酰转肽酶(GGT) 、胆碱酯酶(CHE)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)和糖化血红蛋白(HbA1c)水平2组间比较差异均有统计学意义(P<0.05);多因素分析,女性、高HbA1c、高HDL-C可能是糖尿病患者并发高尿酸血症的保护性因素(女性:OR=0.705,95%CI=0.501~0.993,P<0.05; HbA1c:OR=0.912,95%CI=0.840~0.991,P<0.05;HDL-C:OR=0.539,95%CI=0.335~0.868,P<0.05),BMI≥25 kg·m^-2、高SBP和高TG可能是糖尿病患者并发高尿酸血症的危险性因素(BMI:OR=2.107,95%CI=1.473~3.014,P<0.05;SBP:OR=1.767,95%CI=1.210~2.581,P<0.05;TG:OR=1.111,95%CI=1.057~1.168,P<0.05)。结论: 对于糖尿病并发高尿酸血症的患者应重点筛查大血管及微血管并发症;控制体质量,同时将血压和TG控制在正常范围内,可以有效预防糖尿病并发高尿酸血症的发生。

Comparison of progression between diabetic patients with different levels of uric acid and analysis on influencing factors

Objective To understand the progression of the diabetic patients with different levels of uric acid and to analyze its influencing factors, and to provide evidence for the prevention and treatment of diabetes complicated with hyperuricemia. Methods A clinical record database for type 2 diabetes mellitus (T2DM) patients was established with EpiData 3.0 software and 1 411 cases of complete data were selected. According to serum uric acid (SUA) levels, 1 411 cases of T2DM patients were divided into high uric acid (HUA)group and normal uric acid (NUA)group. The differences of the main clinical indicators and the incidence of complications of the patients between two groups were compared. Univariate and multivariate Logistic regression were carried out to analyze the influencing factors of diabetes complicated with hyperuricemia. Results The incidences of diabetic macroangiopathy and diabetic microvasculopathy of the patients in HUA group were significantly higher than those in NUA group (P<0.05), but there was no significant difference of the incidence of dabetic neuropathy between two groups(P>0.05).Univariate analysis showed that there were significant differences of the gender, body mass index(BMI), systolie pressure(SBP), diastolic pressure(DBP), asparagine aminotransferase(AST), alaninamide transferase (ALT), gamma-glutamyltransferase (GGT), cholinesterase(CHE), triglyeerides(TG), low-density lipoprotein(LDL-C), high-density lipoprotein(HDL-C), gycosylated hemoglobin(HbA1c) between two groups(P<0.05). The multivariable non-conditional Logistic analysis results showed that female, higher HbA1c, higher HDL-C were the protective factors of diabetes complicated with hyperuricemia (female:OR=0.705, 95%CI=0.501-0.993, P<0.05;HbA1c:OR=0.912, 95%CI=0.840-0.991, P<0.05;HDL-C:OR=0.539, 95%CI=0.335-0.868, P<0.05); but the BMI≥25 kg·m^-2, higher SBP, and higher TG were the risk factors of diabetes complicated with hyperuricemia(BMI:OR=2.107, 95%CI=1.473-3.014, P<0.05;SBP:OR=1.767, 95%CI=1.210-2.581, P<0.05;TG:OR=1.111, 95%CI=1.057-1.168, P<0.05). Conclusion The macrovascular and microvascular complications for the patients with diabetes complicated with hyperuricemia should be screened;the BMI of the patients should be controlled as well as SBP and TG, so the incidence of diabetes complicated with hyperuricemia should be prevented.