Choi H K, Ford E S
Division of Rheumatology, Department of Medicine, University of British Columbia, Arthritis Research Centre of Canada, 895 West 10th Avenue, Vancouver, BC V5Z 1L7, Canada.
Rheumatology (Oxford). 2008 May;47(5):713-7. doi: 10.1093/rheumatology/ken066. Epub 2008 Apr 5.
To evaluate haemoglobin A1c (HbA1c), fasting glucose, serum C-peptide and insulin resistance in relation to serum uric acid levels in a nationally representative sample of men and women.
Using data from 14,664 participants aged 20 yrs and older in The US Third National Health and Nutrition Examination Survey (1988-1994), we examined the relation between the levels of HbA1c, other biomarkers and serum uric acid levels using multivariate linear regressions stratified by gender.
The serum uric acid levels increased with increasing serum HbA1c levels up to the category of 6-6.9%, and thereafter decreased with further increasing HbA1c levels (a bell-shaped relation). Compared with a HbA1c level of < 5%, the multivariate differences among women were 26.8 micromol/l for HbA1c of 6-6.9% and -25.6 micromol/l (95% CI -42.8, -8.3) for HbA1c > or = 9%. The corresponding multivariate differences among men were 8.3 micromol/l (95% CI -3.0, 19.6) and -64.8 micromol/l (95% CI -46.0, -84.5), which were both significantly different from those among women (P-values for interaction by sex <0.001). Fasting glucose levels also showed a bell-shaped relation with serum uric acid levels. Individuals with diabetes showed lower serum uric acid levels and the association was larger among men (P-value for interaction, 0.007). Serum uric acid levels increased linearly with increasing fasting serum C-peptide levels, serum insulin levels or insulin resistance (multivariate P-values for trend, <0.001).
Individuals with moderately elevated HbA1c levels (i.e. pre-diabetes) may be at a higher risk of hyperuricaemia and gout, particularly in women, whereas individuals with diabetes or highly elevated HbA1c levels may be at a lower risk of these conditions, particularly in men.
在一个具有全国代表性的男性和女性样本中，评估糖化血红蛋白（HbA1c）、空腹血糖、血清C肽和胰岛素抵抗与血清尿酸水平之间的关系。
利用美国第三次全国健康和营养检查调查（1988 - 1994年）中14664名20岁及以上参与者的数据，我们使用按性别分层的多元线性回归分析了HbA1c水平、其他生物标志物与血清尿酸水平之间的关系。
血清尿酸水平随着血清HbA1c水平升高至6 - 6.9%类别而增加，此后随着HbA1c水平进一步升高而降低（呈钟形关系）。与HbA1c水平<5%相比，女性中HbA1c为6 - 6.9%时的多元差异为26.8微摩尔/升，HbA1c≥9%时为 - 25.6微摩尔/升（95%可信区间 - 42.8， - 8.3）。男性中相应的多元差异为8.3微摩尔/升（95%可信区间 - 3.0，19.6）和 - 64.8微摩尔/升（95%可信区间 - 46.0， - 84.5），两者均与女性中的差异显著不同（性别交互作用的P值<0.001）。空腹血糖水平与血清尿酸水平也呈钟形关系。糖尿病患者的血清尿酸水平较低，且这种关联在男性中更大（交互作用的P值，0.007）。血清尿酸水平随着空腹血清C肽水平、血清胰岛素水平或胰岛素抵抗的增加而线性升高（趋势的多元P值，<0.001）。
HbA1c水平中度升高（即糖尿病前期）的个体可能有更高的高尿酸血症和痛风风险，尤其是女性，而糖尿病患者或HbA1c水平高度升高的个体可能有较低的这些疾病风险，尤其是男性。
