Li Lian-Xi, Wang Ai-Ping, Zhang Rong, Li Ting-Ting, Wang Jun-Wei, Bao Yu-Qian, Jia Wei-Ping
Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, 600 Yishan Road, Shanghai, 200233, China.
Department of Endocrinology, The 454th Hospital of Chinese PLA, Nanjing, 210002, China.
Cardiovasc Diabetol. 2015 Apr 15;14:36. doi: 10.1186/s12933-015-0199-y.
The associations between urine uric acid excretion (UUAE) and chronic kidney disease (CKD)/atherosclerosis have not been investigated. Our aims were to investigate the relationships between UUAE and CKD and carotid atherosclerotic lesions in hospitalized Chinese patients with type 2 diabetes.
This was a cross-sectional study that was conducted with 2627 Chinese inpatients with type 2 diabetes. UUAE was determined enzymatically using a single 24-h urine collection. The subjects were stratified into quartiles according to their UUAE levels. Carotid atherosclerotic lesions, including carotid intima-media thickness (CIMT), plaque and stenosis, were assessed by Doppler ultrasound. Both CKD and carotid atherosclerotic lesions were compared between the UUAE quartile groups.
After adjustment for confounding factors, there was a significant decrease in the prevalence of CKD in the patients with type 2 diabetes across the UUAE quartiles (16.9%, 8.5%, 5.9%, and 4.9%; p < 0.001). Multiple logistic regression analyses revealed that the UUAE quartiles were significantly and inversely associated with the presence of CKD (p < 0.001). Compared with the diabetics in the highest UUAE quartile, those in the lowest quartile exhibited a nearly 4.2-fold increase in the risk of CKD (95% CI: 2.272-7.568; p < 0.001). The CIMT value (0.91 ± 0.22 mm for the diabetics with CKD and 0.82 ± 0.20 mm for the diabetics without CKD, p = 0.001) and the prevalence of carotid plaques (62.1% for the diabetics with CKD and 41.8% for the diabetics without CKD, p = 0.025) were significantly higher in the diabetics with CKD than in those without CKD. However, there was no obvious difference in carotid atherosclerotic lesions across the UUAE quartiles after controlling for the confounding factors.
Decreased UUAE was closely associated with the presence of CKD but not with carotid atherosclerotic lesions in hospitalized Chinese patients with type 2 diabetes. Our results suggest that UUAE is an independent risk factor for CKD in type 2 diabetes. In selected populations, such as patient with type 2 diabetes, the role of uric acid in atherosclerosis might be the result of other concomitant atherosclerotic risk factors, such as CKD.
尿尿酸排泄量（UUAE）与慢性肾脏病（CKD）/动脉粥样硬化之间的关联尚未得到研究。我们的目的是调查住院的中国2型糖尿病患者中UUAE与CKD以及颈动脉粥样硬化病变之间的关系。
这是一项对2627名中国2型糖尿病住院患者进行的横断面研究。通过收集单次24小时尿液，采用酶法测定UUAE。根据UUAE水平将受试者分为四分位数组。通过多普勒超声评估颈动脉粥样硬化病变，包括颈动脉内膜中层厚度（CIMT）、斑块和狭窄情况。比较了UUAE四分位数组之间的CKD和颈动脉粥样硬化病变情况。
在对混杂因素进行调整后，2型糖尿病患者中CKD的患病率在UUAE四分位数组中显著降低（分别为16.9%、8.5%、5.9%和4.9%；p<0.001）。多因素逻辑回归分析显示，UUAE四分位数与CKD的存在显著负相关（p<0.001）。与UUAE四分位数最高的糖尿病患者相比，四分位数最低的患者患CKD的风险增加了近4.2倍（95%CI：2.272 - 7.568；p<0.001）。CKD糖尿病患者的CIMT值（0.91±0.22mm）显著高于无CKD的糖尿病患者（0.82±0.20mm，p = 0.001），且颈动脉斑块的患病率也显著更高（CKD糖尿病患者为62.1%，无CKD糖尿病患者为41.8%，p = 0.025）。然而，在控制混杂因素后，UUAE四分位数组之间的颈动脉粥样硬化病变无明显差异。
在住院的中国2型糖尿病患者中，UUAE降低与CKD的存在密切相关，但与颈动脉粥样硬化病变无关。我们的结果表明，UUAE是2型糖尿病中CKD的独立危险因素。在特定人群中，如2型糖尿病患者，尿酸在动脉粥样硬化中的作用可能是其他伴随的动脉粥样硬化危险因素（如CKD）导致的结果。
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