尿酸是既往妊娠期糖尿病与日后发生2型糖尿病之间缺失的环节吗？
Is Uric Acid a Missing Link between Previous Gestational Diabetes Mellitus and the Development of Type 2 Diabetes at a Later Time of Life?
作者信息
Molęda Piotr, Fronczyk Aneta, Safranow Krzysztof, Majkowska Lilianna
机构信息
Department of Diabetology and Internal Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland.
Department of Biochemistry and Medical Chemistry, Pomeranian Medical University in Szczecin, Szczecin, Poland.
出版信息
PLoS One. 2016 May 11;11(5):e0154921. doi: 10.1371/journal.pone.0154921. eCollection 2016.
INTRODUCTION
A high level of uric acid (UA) is a strong, independent risk factor for type 2 diabetes mellitus. The relationship between UA levels and the development of type 2 diabetes in women with previous gestational diabetes mellitus (pGDM) remains unclear. The aim of study was to evaluate the UA levels in pGDM women in relation to their current nutritional status and carbohydrate metabolism.
MATERIAL AND METHODS
199 women with pGDM diagnoses based on oral glucose tolerance tests (OGTTs) 5-12 years previously and a control group of 50 women without pGDM. The assessment included anthropometric parameters, body composition (Tanita SC-330S), current OGTT, insulin resistance index (HOMA-IR), β-cell function (HOMA-%B), HbA1c, lipids, and uric acid.
RESULTS
No differences between groups were found in terms of age, time from the index pregnancy, anthropometric parameters, lipids or creatinine levels. The incidences of overweight and obesity were similar. Carbohydrate abnormalities were more frequent in the pGDM group than the control group (43.2% vs 12.0% p<0.001). The women with pGDM had significantly higher fasting glucose, HbA1c, glucose and insulin levels in the OGTTs, but similar HOMA-IR values. Their UA levels were significantly higher (258±58 vs 230±50 μmol/L, p<0.005) and correlated with BMI and the severity of carbohydrate disorders. The normal weight and normoglycemic pGDM women also demonstrated higher UA levels than a similar control subgroup (232±48 vs 208±48 μmol/L, p<0.05). Multivariate analysis revealed significant correlations of UA level with BMI (β = 0.38, 95% CI 0.25-0.51, p<0.0001), creatinine level (β = 0.23, 95% CI 0.11-0.35, p<0.0005), triglycerides (β = 0.20, 95% CI 0.07-0.33, p<0.005) and family history of diabetes (β = 0.13, 95% CI 0.01-0.25, p<0.05). In logistic regression analysis, the association between higher UA level (defined as value ≥297 μmol/L) and presence of any carbohydrate metabolism disorder (IFG, IGT or diabetes) was statistically significant (odds ratio 3.62 [95% CI 1.8-7.3], p<0.001).
CONCLUSIONS
Higher UA levels may be associated with the development of type 2 diabetes in pGDM women, also in these with normal body weights.
引言
高尿酸（UA）水平是2型糖尿病的一个强大的独立危险因素。既往有妊娠期糖尿病（pGDM）的女性中，尿酸水平与2型糖尿病发生之间的关系仍不明确。本研究的目的是评估pGDM女性的尿酸水平与其当前营养状况和碳水化合物代谢的关系。
材料与方法
199例基于5至12年前口服葡萄糖耐量试验（OGTT）诊断为pGDM的女性，以及50例无pGDM的女性作为对照组。评估内容包括人体测量参数、身体成分（百利达SC-330S）、当前OGTT、胰岛素抵抗指数（HOMA-IR）、β细胞功能（HOMA-%B）、糖化血红蛋白（HbA1c）、血脂和尿酸。
结果
两组在年龄、距本次妊娠时间、人体测量参数、血脂或肌酐水平方面无差异。超重和肥胖的发生率相似。pGDM组碳水化合物异常比对照组更常见（43.2%对12.0%，p<0.001）。pGDM女性在OGTT中的空腹血糖、HbA1c、血糖和胰岛素水平显著更高，但HOMA-IR值相似。她们的尿酸水平显著更高（258±58对230±50μmol/L，p<0.005），且与体重指数和碳水化合物紊乱的严重程度相关。体重正常且血糖正常的pGDM女性的尿酸水平也高于类似的对照组亚组（232±48对208±48μmol/L，p<0.05）。多变量分析显示尿酸水平与体重指数（β = 0.38，95%可信区间0.25 - 0.51，p<0.0001）、肌酐水平（β = 0.23，95%可信区间0.11 - 0.35，p<0.0005）、甘油三酯（β = 0.20，95%可信区间0.07 - 0.33，p<0.005）和糖尿病家族史（β = 0.13，95%可信区间0.01 - 0.25，p<0.05）有显著相关性。在逻辑回归分析中，较高的尿酸水平（定义为值≥297μmol/L）与任何碳水化合物代谢紊乱（空腹血糖受损、糖耐量受损或糖尿病）之间的关联具有统计学意义（优势比3.62 [95%可信区间1.8 - 7.3]，p<0.001）。
结论
较高的尿酸水平可能与pGDM女性发生2型糖尿病有关，体重正常的女性也是如此。
Zotero 插件