Xu Yili, Zhu Jiayu, Gao Li, Liu Yun, Shen Jie, Shen Chong, Matfin Glenn, Wu Xiaohong
Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
PLoS One. 2013 Oct 24;8(10):e78206. doi: 10.1371/journal.pone.0078206. eCollection 2013.
Recent data have suggested that serum uric acid (SUA) level is positively associated with the development of type 2 diabetes (T2DM). Whether SUA is also independently associated with the development of vascular complications and mortality in T2DM is controversial.
A computerized literature search of MEDLINE, Embase and PubMed database was conducted and the odds ratio (OR) or hazard ratio (HR) for per 0.1 mmol/l increase in SUA in each study was calculated. Cochrane's Q and I(2) statistics were used to evaluate heterogeneity among studies and pooling OR and HR with 95% confidence intervals (CIs) were calculated using random-effects models and fixed-effects models. The pooled analysis was performed using Stata 10.0.
Our search yielded 9 eligible articles (16 ORs and HRs) including 20,891 T2DM patients. Pooled estimates for the relationship suggested that each 0.1 mmol/l increase in SUA resulted in a 28% increase in the risk of diabetic vascular complications and a 9% increase in the risk of diabetic mortality. In stratification-analysis, the positive relationship between SUA and vascular complications remained significant irrespective of mean age, adjustment for metabolic variables and medications. However, it was inconsistent in different populations (significantly positive in the Asian but not in Australian and Italian population) and sample sizes (significantly positive in the relatively large sample size [≥1000] but non-significant in the small sample size [<1000]).
Results of this meta-analysis supported elevated SUA as an independent predictor of vascular complications and mortality in T2DM patients. SUA-lowering therapies might be helpful for prevention and treatment of vascular complications in this population.
近期数据表明，血清尿酸（SUA）水平与2型糖尿病（T2DM）的发生呈正相关。SUA是否也与T2DM血管并发症的发生及死亡率独立相关仍存在争议。
对MEDLINE、Embase和PubMed数据库进行计算机文献检索，并计算每项研究中SUA每升高0.1 mmol/l的比值比（OR）或风险比（HR）。采用Cochrane's Q和I²统计量评估研究间的异质性，并使用随机效应模型和固定效应模型计算合并的OR和HR及其95%置信区间（CI）。使用Stata 10.0进行汇总分析。
我们的检索得到9篇符合条件的文章（16个OR和HR），包括20891例T2DM患者。关系的合并估计表明，SUA每升高0.1 mmol/l，糖尿病血管并发症风险增加28%，糖尿病死亡率风险增加9%。在分层分析中，无论平均年龄、代谢变量和药物调整情况如何，SUA与血管并发症之间的正相关关系仍然显著。然而，在不同人群（在亚洲人群中显著为正，但在澳大利亚和意大利人群中不显著）和样本量（在相对大样本量[≥1000]中显著为正，但在小样本量[<1000]中不显著）中情况不一致。
这项荟萃分析的结果支持SUA升高是T2DM患者血管并发症和死亡率的独立预测因素。降低SUA的治疗可能有助于预防和治疗该人群的血管并发症。
