Am J Epidemiol. 2014 Mar 15;179(6):684-91. doi: 10.1093/aje/kwt320. Epub 2014 Jan 12.
Some observational studies have identified elevated uric acid concentration as a risk factor for diabetes, while others have found an inverse relationship. We examined both the association of uric acid level with incident diabetes and the change in uric acid concentration after a diabetes diagnosis. We analyzed data from the Atherosclerosis Risk in Communities (ARIC) Study and quantified the independent association between uric acid level and incident diabetes via Cox proportional hazards models. The association between duration of diabetes and change in uric acid level was examined via linear regression. Among 11,134 participants without diagnosed diabetes at baseline (1987-1989), there were 1,294 incident cases of diabetes during a median of 9 years of follow-up (1987-1998). Uric acid level was associated with diabetes even after adjustment for risk factors (per 1 mg/dL, hazard ratio = 1.18, 95% confidence interval: 1.13, 1.23), and the association remained significant after adjustment for fasting glucose and insulin levels. Among participants with diabetes (n = 1,510), every additional 5 years' duration of diabetes was associated with a 0.10-mg/dL (95% confidence interval: 0.04, 0.15) lower uric acid level after adjustment. We conclude that uric acid concentration rises prior to diagnosis of diabetes and then declines with diabetes duration. Future studies investigating uric acid as a risk factor for cardiovascular disease should adequately account for the impact and timing of diabetes development.
一些观察性研究已经确定尿酸浓度升高是糖尿病的一个风险因素，而另一些研究则发现了相反的关系。我们研究了尿酸水平与新发糖尿病的相关性，以及糖尿病诊断后尿酸浓度的变化。我们分析了动脉粥样硬化风险社区（ARIC）研究的数据，并通过 Cox 比例风险模型定量分析了尿酸水平与新发糖尿病之间的独立相关性。通过线性回归检验了糖尿病持续时间与尿酸水平变化之间的关系。在基线时（1987-1989 年）没有诊断为糖尿病的 11,134 名参与者中，在中位数为 9 年的随访期间（1987-1998 年）有 1,294 例新发糖尿病病例。即使在调整了危险因素后，尿酸水平与糖尿病仍存在相关性（每增加 1mg/dL，风险比=1.18，95%置信区间：1.13，1.23），在调整了空腹血糖和胰岛素水平后，这种相关性仍然显著。在患有糖尿病的参与者中（n=1,510），在调整后，每增加 5 年的糖尿病持续时间与尿酸水平降低 0.10mg/dL（95%置信区间：0.04，0.15）相关。我们的结论是，尿酸浓度在糖尿病诊断前升高，然后随着糖尿病持续时间的延长而下降。未来研究调查尿酸作为心血管疾病的风险因素时，应充分考虑糖尿病发展的影响和时间。
