Deutsches Herzzentrum, Technische Universität, Munich, Germany.
Clin Sci (Lond). 2013 Feb;124(4):259-68. doi: 10.1042/CS20120336.
Studies investigating the prognostic role of UA (uric acid) in patients with Type 2 diabetes mellitus have given conflicting findings. We undertook the present study to assess the association between UA and outcome in patients with Type 2 diabetes mellitus and CAD (coronary artery disease). The study included 3705 patients with diabetes mellitus and angiography-proven CAD. UA was measured before coronary angiography. The primary outcome was 1-year all-cause mortality. The UA concentration [median (25th-75th quartiles)] was 6.44 mg/dl (5.40-7.70 mg/dl). There were 264 deaths (7.1%) during follow-up: 45 deaths in patients of the first UA quartile, 43 deaths in patients of the second UA quartile, 51 deaths in patients of the third UA quartile and 125 deaths in patients of the fourth UA quartile {Kaplan-Meier estimates of mortality, 5.1, 4.8, 5.6 and 14.0% respectively; unadjusted HR (hazard ratio), 2.81 [95% CI (confidence interval), 2.21-3.58]; P<0.001 for fourth quartile compared with first-third quartiles combined}. In the multivariable analysis, UA predicted all-cause mortality with an adjusted HR of 1.29 (95% CI, 1.12-1.48; P<0.001), for each S.D. increase in the logarithmic scale of UA level. The inclusion of UA in the multivariable model alongside known cardiovascular risk factors and other relevant variables increased the discriminatory power of the model regarding prediction of all-cause mortality [absolute and relative IDI (integrated discrimination improvement) 0.034 and 20.5% respectively; P<0.001]. In conclusion, in patients with Type 2 diabetes mellitus and confirmed CAD, elevated levels of UA predict mortality independently of known cardiovascular risk factors.
研究表明，UA（尿酸）在 2 型糖尿病患者中的预后作用存在矛盾。我们进行本研究旨在评估 UA 与 2 型糖尿病合并 CAD（冠状动脉疾病）患者的预后的关系。该研究纳入了 3705 例经冠状动脉造影证实的糖尿病合并 CAD 患者。在冠状动脉造影前测量 UA。主要终点为 1 年全因死亡率。UA 浓度[中位数（25-75 四分位数）]为 6.44mg/dl（5.40-7.70mg/dl）。随访期间发生 264 例死亡（7.1%）：第 1UA 四分位数组 45 例死亡，第 2UA 四分位数组 43 例死亡，第 3UA 四分位数组 51 例死亡，第 4UA 四分位数组 125 例死亡{死亡率的 Kaplan-Meier 估计值分别为 5.1%、4.8%、5.6%和 14.0%；未调整的 HR（危险比）分别为 2.81[95%CI（置信区间）为 2.21-3.58]；第 4UA 四分位数组与第 1-3UA 四分位数组比较，P<0.001}。在多变量分析中，UA 每增加 1 个 SD，对数标度的 UA 水平升高，预测全因死亡率的调整 HR 为 1.29（95%CI，1.12-1.48；P<0.001）。UA 与已知心血管危险因素和其他相关变量一起纳入多变量模型，增加了模型对全因死亡率预测的区分能力[绝对和相对 IDI（综合区分改善）分别为 0.034 和 20.5%；P<0.001]。结论：在 2 型糖尿病合并确诊 CAD 的患者中，UA 水平升高可独立于已知心血管危险因素预测死亡率。
