Bo S, Cavallo-Perin P, Gentile L, Repetti E, Pagano G
Department of Internal Medicine, University of Torino, Torino, Italy.
Eur J Clin Invest. 2001 Apr;31(4):318-21. doi: 10.1046/j.1365-2362.2001.00812.x.
Conflicting data exist about uric acid levels in type 2 diabetes mellitus, as low levels were found in diabetic patients, while elevated serum uric acid is a feature of hyperinsulinemia and impaired glucose tolerance. The present study was addressed to evaluate the relation between uric acid and metabolic parameters, creatinine clearance and albumin excretion rate in a cohort of type 2 diabetic patients.
Hyperuricemic patients were older and had higher values of body mass index (BMI), systolic and diastolic blood pressure, triglycerides, albumin excretion rate, C-peptide and prevalence of hypertension, metabolic syndrome and macroalbuminuria and lower values of high-density lipoprotein (HDL)-cholesterol, creatinine clearance and glycated haemoglobin (HbA1c). The correlations between uric acid levels and triglycerides, BMI, systolic blood pressure, albumin excretion rate, C-peptide, creatinine clearance, HDL-cholesterol and HbA1c remained significant in a multiple regression analysis after adjustment for age, sex and duration of diabetes. After performing multiple logistic regression analyses, uric acid levels were independently associated with hypertension [odds ratio (OR) = 1.8; 95% confidence interval (CI) 1.6--2], after adjustment for age, sex, duration of diabetes and macroalbuminuria (OR = 1.5; 95% CI 1.1--2.0), after adjustment for age, sex, HbA1c levels, creatinine clearance, duration of diabetes and blood pressure levels and the metabolic syndrome (OR = 1.6; 95% CI 1.5--1.8), after adjustment for age, sex and creatinine clearance.
In type 2 diabetes, hyperuricemia seems to be associated with the insulin-resistant syndrome and with early onset or increased progression to overt nephropathy, while hypouricemia is associated with worse metabolic control, hyperfiltration and a late onset or decreased progression to overt nephropathy.
关于2型糖尿病患者尿酸水平的数据存在矛盾，因为糖尿病患者中发现尿酸水平较低，而血清尿酸升高是高胰岛素血症和糖耐量受损的一个特征。本研究旨在评估一组2型糖尿病患者中尿酸与代谢参数、肌酐清除率及白蛋白排泄率之间的关系。
高尿酸血症患者年龄较大，体重指数（BMI）、收缩压和舒张压、甘油三酯、白蛋白排泄率、C肽水平较高，高血压、代谢综合征和大量白蛋白尿的患病率较高，而高密度脂蛋白（HDL）胆固醇、肌酐清除率和糖化血红蛋白（HbA1c）水平较低。在对年龄、性别和糖尿病病程进行校正后的多元回归分析中，尿酸水平与甘油三酯、BMI、收缩压、白蛋白排泄率、C肽、肌酐清除率、HDL胆固醇和HbA1c之间的相关性仍然显著。在进行多元逻辑回归分析后，校正年龄、性别、糖尿病病程和大量白蛋白尿后，尿酸水平与高血压独立相关[比值比（OR）=1.8；95%置信区间（CI）1.6 - 2]，校正年龄、性别、HbA1c水平、肌酐清除率、糖尿病病程和血压水平及代谢综合征后（OR = 1.6；95%CI 1.5 - 1.8），校正年龄、性别和肌酐清除率后（OR = 1.6；95%CI 1.5 - 1.8）。
在2型糖尿病中，高尿酸血症似乎与胰岛素抵抗综合征以及显性肾病的早期发生或进展加快有关，而低尿酸血症与较差的代谢控制、超滤以及显性肾病的晚发或进展减慢有关。
