Division of Nephrology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada;
Division of Nephrology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada;
Am J Physiol Renal Physiol. 2015 Jan 15;308(2):F77-83. doi: 10.1152/ajprenal.00555.2014. Epub 2014 Nov 5.
Plasma uric acid (PUA) is associated with metabolic, cardiovascular, and renal abnormalities in patients with type 2 diabetes but is less well understood in type 1 diabetes (T1D). Our aim was to compare PUA levels and fractional uric acid excretion (FEUA) in patients with T1D vs. healthy controls (HC) during euglycemia and hyperglycemia. PUA, FEUA, blood pressure (BP), glomerular filtration rate (GFR-inulin), and effective renal plasma flow (ERPF-paraaminohippurate) were evaluated in patients with T1D (n = 66) during clamped euglycemia (glucose 4-6 mmol/l) and hyperglycemia (9-11 mmol/l), and in HC (n = 41) during euglycemia. To separate the effects of hyperglycemia vs. increased glycosuria, parameters were evaluated during clamped euglycemia in a subset of T1D patients before and after sodium glucose cotransporter 2 (SGLT2) inhibition for 8 wk. PUA was lower in T1D vs. HC (228 ± 62 vs. 305 ± 75 μmol/l, P < 0.0001). In T1D, hyperglycemia further decreased PUA (228 ± 62 to 199 ± 65 μmol/l, P < 0.0001), which was accompanied by an increase in FEUA (7.3 ± 3.8 to 11.6 ± 6.7, P < 0.0001). In T1D, PUA levels correlated positively with SBP (P = 0.029) and negatively with ERPF (P = 0.031) and GFR (P = 0.028). After induction of glycosuria with SGLT2 inhibition while maintaining clamped euglycemia, PUA decreased (P < 0.0001) and FEUA increased (P < 0.0001). PUA is lower in T1D vs. HC and positively correlates with SBP and negatively with GFR and ERPF in T1D. Glycosuria rather than hyperglycemia increases uricosuria in T1D. Future studies examining the effect of uric acid-lowering therapies should account for the impact of ambient glycemia, which causes an important uricosuric effect.
血浆尿酸(PUA)与 2 型糖尿病患者的代谢、心血管和肾脏异常有关,但在 1 型糖尿病(T1D)中了解较少。我们的目的是比较 T1D 患者与健康对照(HC)在血糖正常和高血糖期间的 PUA 水平和尿酸排泄分数(FEUA)。在 T1D 患者(n=66)中评估了 PUA、FEUA、血压(BP)、肾小球滤过率(GFR-菊粉)和有效肾血浆流量(ERPF-对氨基马尿酸),在血糖正常(葡萄糖 4-6 mmol/l)和高血糖(9-11 mmol/l)期间,在 HC(n=41)中评估了血糖正常期间的 PUA、FEUA、BP、GFR-菊粉和 ERPF-对氨基马尿酸。为了分离高血糖与尿糖增加的影响,在 T1D 患者中评估了在 SGLT2 抑制 8 周前后的 PUA 在血糖正常期间的参数。T1D 患者的 PUA 低于 HC(228±62 对 305±75 μmol/l,P<0.0001)。在 T1D 中,高血糖进一步降低了 PUA(228±62 对 199±65 μmol/l,P<0.0001),同时 FEUA 增加(7.3±3.8 对 11.6±6.7,P<0.0001)。在 T1D 中,PUA 水平与 SBP 呈正相关(P=0.029),与 ERPF(P=0.031)和 GFR(P=0.028)呈负相关。在 SGLT2 抑制诱导尿糖增加的同时保持血糖正常时,PUA 降低(P<0.0001),FEUA 增加(P<0.0001)。T1D 患者的 PUA 低于 HC,与 T1D 中的 SBP 呈正相关,与 GFR 和 ERPF 呈负相关。在 T1D 中,尿糖增加而非高血糖增加了尿酸排泄。未来研究应考虑到环境血糖对尿酸降低治疗效果的影响,因为环境血糖会导致重要的尿酸排泄作用。
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