2型糖尿病合并高尿酸血症患者动脉粥样硬化的影响因素

目的研究2型糖尿病合并高尿酸血症(HUADM)患者颈动脉内膜中层厚度(IMT)与脂联素、C反应蛋白(CRP)的关系。方法选择2型糖尿病患者85例,按血尿酸水平分为:HUADM组43例、血尿酸正常糖尿病(NUADM)组42例,分析2组空腹血糖(FPG)、空腹胰岛素(FINS)、脂联素、CRP、糖化血红蛋白(HbA1c)及餐后2h血糖、餐后2h胰岛素,IMT,计算胰岛素抵抗指数(HOMA-IR),并且进行多元逐步回归分析。结果与NUADM组比较,HUADM组患者FPG、餐后2h血糖、FINS、餐后2h胰岛素、HbA1c、IMT、尿酸和lgHOMA-IR均明显升高,脂联素明显降低(P0.05,P0.01)。HUADM组患者IMT与HOMA-IR、TG、LDL-C和CRP呈正相关,与脂联素呈负相关。结论 HUADM患者存在更明显的代谢紊乱和胰岛素抵抗,且血清脂联素水平降低,CRP水平升高,提示更容易发生动脉粥样硬化。

Influential factors of atherosclerotic disease in patients with type 2 diabetes mellitus and hyperuricemia

Objective To investigate the relationship of carotid intima-media thickness (IMT) to adiponectin(APN) and C-reactive protein(CRP) in patients with type 2 diabetes mellitus(T2DM) and hyperuricemia.Methods Eighty-five patients with T2DM were divided into two groups formal serum uric acid(NUADM,n = 42) group and hyperuricemia(HUADM,n = 43) group.The serum levels of uric acid(UA),fasting plasma glucose(FPG),fasting insulin(FINS),APN,CRP, HDL-C,LDL-C,TC,TG,glycosylated hemoglobin(HbA1c),two hour prandial glucose(2 h PG), two hour prandial insulin(2 h INS) ,and IMT were detected.Body mass index(BMI) ,waist-hip-ratio (WHR) and homeostasis model assessment of insulin resistance(HOMATR) were calculated. A multiple stepwise regression analysis was performed using IMT as the dependent variable,and the levels of APN,CRP,FINS,HDL-C,LDL-C,TC,TG,HbA1c,BMI,WHR,HOMA-IR as the independent variables.All participants gave written informed consent.Results Compared with NUADM group,risk marker levels for atherosclerosis were higher in the HUADM group (P < 0.05,P<0.O1).In HUADM group,HOMA-IR,TG、LDL-C and CRP were correlated positively with IMT,while APN was correlated negatively with IMT.Conclusions Type 2 diabetic individuals with hyperuricemia are characterized by both metabolic disorder and insulin resistance.Low APN level and high CRP level are related to development and progression of atherosclerotic disease in type 2 diabetic patients with hyperuricemia.