2型糖尿病患者胰岛素抵抗、血尿酸与肾功能的关系

目的：探讨2型糖尿病患者胰岛素抵抗（IR）、血尿酸（UA）与肾功能的关系。方法：将520例2型糖尿病患者依据肾小球滤过率（GFR）水平进行分组，分析不同肾功能状态组的临床特征；将患者分为IR组和非IR组，分析两组超重、肾功能不全、高尿酸血症的患病率及其相关性。结果：按GFR水平分成的3组，患者的年龄、病史、肌酐（Scr）、UA、血脂、24h尿白蛋白量（mALB／24h）、超重、IR、异常蛋白尿患病率的差异均有统计学意义。IR组与非IR组相比。IR组超重、肾功能不全、高尿酸血症的患病率高，差异有统计学意义。Pearson相关分析表明，GFR与UA、胰岛素抵抗指数（HOMA—IR）、体重指数（BMI）呈负相关，相关系数分别为-0．359，P〈0．01；-0．130，P〈0．01；-0．110，P〈0．05。UA与BMI、HOMA—IR呈正相关，相关系数分别为0．268，P〈0．01；0．260，P〈0．01。HOMA—IR与BMI呈正相关，相关系数为0．304，P〈0．01。肾功能不全影响因素的Logistic回归分析示，年龄、收缩压、BMI、UA、TG、mALB／24h对2型糖尿病患者肾功能不全的影响较大，OR值大于1，P〈0．05。结论：2型糖尿病患者GFR、UA、HOMA—IR、BMI相关；年龄、收缩压、BMI、UA、TG、mALB／24h是肾功能不全的主要危险因素。

Relationship among insulin resistance,serum uric acid and renal function in patients with type 2 diabetes meilitus

Objective： To study the relationship among insulin resistance 0R）,serum uric acid （UA） and renal function in patients with type 2 diabetes mellitus. Methods： MDRD equation was used to calculate the glomerular filtration rate （GFR）. A total of 520 patients with type 2 diabetes mellitus were divided into 3 groups according to their GFR, clinical feature in each group was analyzed. The patients were also categorized into two groups , one was IR,the other one was NOT IR to estimate the prevalence of overweight, renal insufficiency, hyperuricemia and their correlations. Results： The patients＇ age, history, creatinine, UA, blood fat, 24 h-UAE （mALB/24 h） and the prevalence of overweight, renal insufficiency, abnormal albuminuria were significant difference among 3 groups segregated by GFR. Prevalence of overweight, renal insufficiency and hyperuricemia was significantly high in patients with IR compared to those without IR. Pearson correlation showed that GFR was correlated negatively with UA, HOMA-IR and BMI （-0.359,P〈0.01;-0.130, P〈0.01;-0.110, P〈0.05）; UA was correlated positively with BMI, HOMA-IR （0.268,P〈0.01;0.260,P〈0.01）; HOMA-IR was correlated positively with BMI （0.304,P〈0.01）. Logistic regression analysis suggested that age, systolic pressure, UA ,TG, mALB/24 h and BMI level were the main risk factors for renal insufficiency （OR 〉 1, P〈0.01）. Conclusion： There is an association among GFR, UA, HOMA-IR and BMI in patients with type 2 diabetes mellitus. Age, systolic pressure, UA, TG, mALB/24 h and BMI level are the main risk factors for renal insufficiency.