降尿酸治疗与 2 型糖尿病风险的关联。
Associations between urate-lowering therapy and the risk of type 2 diabetes mellitus.
机构信息
Department of Public Health, China Medical University, Taichung, Taiwan.
Center for General Education, Hsuan Chuang University, Hsinchu City, Taiwan.
出版信息
PLoS One. 2019 Jan 7;14(1):e0210085. doi: 10.1371/journal.pone.0210085. eCollection 2019.
BACKGROUND
Gout is independently associated with increased risk of type 2 diabetes mellitus (T2DM). Urate-lowering therapy (ULT) might be beneficial in lowering the risks of T2DM. Therefore, we conducted a nested case-control study to evaluate the associations between ULT and T2DM.
METHODS
This study retrieved the data of 29,765 gout patients from the period of 1998-2010 by using data from Taiwan's National Health Insurance Research Database. Controls (n = 59,530) were matched at a 1:2 ratio by age, sex, and region. Multivariate Cox proportional hazards regression were performed to examine the dose-dependent relationship between ULT and T2DM.
RESULTS
The adjusted Hazard ratio (HR) for the association of T2DM with allopurinol or benzbromarone exposure was 1.17 (95% confidence interval (CI) 1.07-1.28) and1.09 (95% CI 1.03-1.15), respectively. The HR for the cumulative allopurinol dose was 0.87 (95% CI 0.71-1.07) for patients with dose ≤1.3 mg/day and was 1.31 (95% CI 1.13-1.52) for those with a dose >15.2 mg/day. Similarly, the HR for the cumulative benzbromarone dose was 0.85(95% CI 0.75-0.96) for patients with a dose ≤1.3 mg/day and 1.42 (95% CI 1.30-1.55) for patients with a dose>9.4 mg/day, respectively. Moreover, the average exposure dose of >100 mg/day for allopurinol and >100 mg/day for benzbromarone was associated with a 1.28-fold (95% CI 1.11-1.48) and 1.47-fold (95% CI 1.23-1.76) T2DM risk respectively. The HR for patients in aged >50 years group with cumulative dose ≤1.3 mg/day of allopurinol or benzbromarone had lower risk of T2DM (HR = 0.74, 95% CI 0.58-0.94 for allopurinol; HR = 0.79, 95% CI 0.69-0.90 for benzbromarone).
CONCLUSION
Gout patients with prolonged ULT and a high dose of ULT were associated with a significant increase in T2DM risk. Although gout patients with age greater than 50 years and a lower dose of ULT may be beneficial in lowering T2DM risk, further clinical studies need to be confirmed these associations.
背景
痛风与 2 型糖尿病（T2DM）风险增加独立相关。降低尿酸治疗（ULT）可能有益于降低 T2DM 的风险。因此，我们进行了一项巢式病例对照研究，以评估 ULT 与 T2DM 之间的关联。
方法
本研究通过使用台湾全民健康保险研究数据库的数据，于 1998-2010 年期间检索了 29765 例痛风患者的数据。对照（n=59530）按年龄、性别和地区以 1:2 的比例匹配。采用多变量 Cox 比例风险回归分析来检验 ULT 与 T2DM 之间的剂量依赖性关系。
结果
别嘌醇或苯溴马隆暴露与 T2DM 相关的调整后的危害比（HR）分别为 1.17（95%置信区间（CI）1.07-1.28）和 1.09（95% CI 1.03-1.15）。累积别嘌醇剂量与 T2DM 的 HR 对于剂量≤1.3mg/天的患者为 0.87（95% CI 0.71-1.07），对于剂量>15.2mg/天的患者为 1.31（95% CI 1.13-1.52）。同样，累积苯溴马隆剂量与 T2DM 的 HR 对于剂量≤1.3mg/天的患者为 0.85（95% CI 0.75-0.96），对于剂量>9.4mg/天的患者为 1.42（95% CI 1.30-1.55）。此外，别嘌醇>100mg/天和苯溴马隆>100mg/天的平均暴露剂量与 T2DM 风险分别增加 1.28 倍（95% CI 1.11-1.48）和 1.47 倍（95% CI 1.23-1.76）。对于累积剂量≤1.3mg/天的年龄>50 岁的患者，别嘌醇或苯溴马隆的 HR 较低（对于别嘌醇为 0.74，95% CI 0.58-0.94；对于苯溴马隆为 0.79，95% CI 0.69-0.90）。
结论
痛风患者长期接受 ULT 和高剂量 ULT 与 T2DM 风险显著增加相关。尽管年龄>50 岁和 ULT 剂量较低的痛风患者可能有助于降低 T2DM 的风险，但需要进一步的临床研究来证实这些关联。
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