台湾2型糖尿病患者尿酸与尿白蛋白排泄率的相关性

Correlation of uric acid and urinary albumin excretion rate in patients with type 2 diabetes mellitus in Taiwan.

作者信息

Tseng Chin-Hsiao

机构信息

Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

出版信息

Kidney Int. 2005 Aug;68(2):796-801. doi: 10.1111/j.1523-1755.2005.00459.x.

DOI:10.1111/j.1523-1755.2005.00459.x

PMID:16014058

Abstract

BACKGROUND

Uric acid is detrimental to the kidneys in animal models. However, its role in human diabetic nephropathy has not been extensively studied. This study evaluated the association between serum uric acid and urinary albumin-to-creatinine ratio (ACR) among patients with type 2 diabetes mellitus in Taiwan.

METHODS

A total of 343 patients (144 men and 199 women), aged 62.8 +/- 10.8 years and not using uric acid-lowering agents, diuretics, or alcohol, were recruited. Serum uric acid and urinary ACR were determined. Normoalbuminuria, microalbuminuria, and macroalbuminuria were defined as ACR <30.0, 30.0 to 299.9, and > or =300.0 microg/mg, respectively.

RESULTS

The respective uric acid levels for normoalbuminuria (N= 166), microalbuminuria (N= 130), and macroalbuminuria (N= 47) were 5.2 +/- 1.6 mg/dL, 5.6 +/- 1.9 mg/dL, and 6.7 +/- 2.1 mg/dL (P < 0.001). The mean +/- SD (minimum-maximum) values of uric acid for the first to the fourth quartile were 3.4 +/- 0.6 (1.7-4.2), 4.9 +/- 0.4 (4.3-5.4), 6.0 +/- 0.3 (5.5-6.5), and 8.1 +/- 1.2 (6.6-12.2), respectively. Prevalence of abnormal albuminuria (microalbuminuria plus macroalbuminuria) for the respective quartiles were 38.4%, 51.2%, 50.6%, and 66.3% (P trend <0.01). In men, uric acid correlated positively with triglycerides and natural logarithmic [ln (ACR)] (gamma= 0.168, P < 0.05). In women, uric acid correlated positively with triglycerides, ln (ACR) (gamma= 0.277, P < 0.01) and body mass index (borderline significant P < 0.1), but negatively with calculated creatinine clearance. The standardized regression coefficient for ln (ACR) and the odds ratio for abnormal albuminuria for every 1 mg/dL increment of uric acid after adjusting for calculated creatinine clearance and other confounders were 0.138 (P < 0.05) and 1.183 (1.025-1.364), respectively. The results after excluding 127 cases with a history of hypertension were similar.

CONCLUSION

Serum uric acid is an independent correlate of urinary ACR in Taiwanese patients with type 2 diabetes mellitus.

摘要

背景

在动物模型中，尿酸对肾脏有害。然而，其在人类糖尿病肾病中的作用尚未得到广泛研究。本研究评估了台湾2型糖尿病患者血清尿酸与尿白蛋白肌酐比值（ACR）之间的关联。

方法

共招募了343例患者（144例男性和199例女性），年龄为62.8±10.8岁，未使用降尿酸药物、利尿剂或酒精。测定血清尿酸和尿ACR。正常白蛋白尿、微量白蛋白尿和大量白蛋白尿分别定义为ACR<30.0、30.0至299.9和≥300.0μg/mg。

结果

正常白蛋白尿（N = 166）、微量白蛋白尿（N = 130）和大量白蛋白尿（N = 47）的尿酸水平分别为5.2±1.6mg/dL、5.6±1.9mg/dL和6.7±2.1mg/dL（P<0.001）。第一至第四四分位数尿酸的平均值±标准差（最小值 - 最大值）分别为3.4±0.6（1.7 - 4.2）、4.9±0.4（4.3 - 5.4）、6.0±0.3（5.5 - 6.5）和8.1±1.2（6.6 - 12.2）。各四分位数异常白蛋白尿（微量白蛋白尿加大量白蛋白尿）的患病率分别为38.4%、51.2%、50.6%和66.3%（P趋势<0.01）。在男性中，尿酸与甘油三酯和自然对数[ln(ACR)]呈正相关（γ = 0.168，P<0.05）。在女性中，尿酸与甘油三酯、ln(ACR)（γ = 0.277，P<0.01）和体重指数呈正相关（临界显著P<0.1），但与计算的肌酐清除率呈负相关。调整计算的肌酐清除率和其他混杂因素后尿酸每增加1mg/dL，ln(ACR)的标准化回归系数和异常白蛋白尿的比值比分别为0.138（P<0.05）和1.183（1.025 - 1.364）。排除127例有高血压病史的病例后的结果相似。