尿酸水平与糖尿病患者亚临床甲状腺功能减退症的关系。

Relation Between URIC Acid Levels and Subclinical Hypothyroidism in Diabetic Patients.

机构信息

Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

出版信息

Endocr Metab Immune Disord Drug Targets. 2022;22(5):532-538. doi: 10.2174/1871530321666211018120419.

DOI:10.2174/1871530321666211018120419

PMID:34666648

Abstract

BACKGROUND AND AIM

Subclinical hypothyroidism (SCH) is frequently seen in diabetic patients. Elevated levels of uric acid (UA) were also reported in diabetic patients. No study assessed the relation between SCH and UA levels in diabetic patients. We aimed to evaluate this relation and the association of both conditions with other clinical and laboratory parameters in diabetic patients.

SUBJECTS AND METHODS

This cross-sectional study included 100 T2DM patients in addition to 50 age and sex matched healthy controls. Diabetic patients comprised 50 patients with SCH and 50 euthyroid patients. All participants were subjected to careful history taking, thorough clinical examination and standard laboratory work up. The performed investigations included fasting and postprandial blood sugar, fasting insulin levels, HbA1c levels, thyroid hormones (FT3, FT4 and TSH), renal profile and serum UA.

RESULTS

Comparison between the studied groups regarding serum UA levels revealed significantly higher levels in the diabetic group (5.4 ± 1.9 versus 4.2 ± 1.0 mg/dl, p<0.001). SCH + DM patients had significantly higher UA levels in comparison to DM group (6.1 ± 1.8 versus 4.8 ± 1.7 mg/dl, p<0.001) and control group (6.1 ± 1.8 versus 4.2 ± 1.0 mg/dl, p<0.001). SCH + DM patients had significantly higher HbA1c levels (8.9 ± 1.1 versus 7.6 ± 1.3%, p<0.001), HOMA-IR (3.9 ± 0.8 versus 2.8 ± 1.0, p<0.001) and UA levels (6.1 ± 1.8 versus 4.8 ± 1.7, p<0.001). Correlation analysis identified a significant direct correlation between serum UA and HOMA-IR in DM + SCH patients (r=0.4,p=0.004). In univariate analysis, presence of SCH [OR (95% CI): 2.57 (1.07-6.15), p=0.034] and nephropathy [OR (95% CI): 4.57 (1.77-11.8), p=0.002] was significant predictors of higher (upper tertile) UA in the studied patients. However, in multivariate analysis, only nephropathy [OR (95% CI): 4.25 (1.62-11.17), p=0.003] continued to be significant while SCH showed a marginal trend [OR (95% CI): 0.43 (0.17-1.08), p=0.073].

CONCLUSION

The present study suggests an association between SCH and increased UA levels in diabetic patients.

摘要

背景与目的

亚临床甲状腺功能减退症（SCH）在糖尿病患者中很常见。糖尿病患者的尿酸（UA）水平也升高。尚无研究评估糖尿病患者中 SCH 和 UA 水平之间的关系。我们旨在评估这种关系以及这两种情况与糖尿病患者其他临床和实验室参数之间的关联。

受试者和方法

这项横断面研究包括 100 名 2 型糖尿病患者和 50 名年龄和性别匹配的健康对照者。糖尿病患者包括 50 名 SCH 患者和 50 名甲状腺功能正常的患者。所有参与者均接受了详细的病史采集、全面的临床检查和标准的实验室检查。进行的检查包括空腹和餐后血糖、空腹胰岛素水平、糖化血红蛋白（HbA1c）水平、甲状腺激素（FT3、FT4 和 TSH）、肾脏谱和血清 UA。

结果

比较各组血清 UA 水平发现，糖尿病组明显更高（5.4 ± 1.9 与 4.2 ± 1.0 mg/dl，p<0.001）。SCH+DM 患者的 UA 水平明显高于 DM 组（6.1 ± 1.8 与 4.8 ± 1.7 mg/dl，p<0.001）和对照组（6.1 ± 1.8 与 4.2 ± 1.0 mg/dl，p<0.001）。SCH+DM 患者的 HbA1c 水平（8.9 ± 1.1 与 7.6 ± 1.3%，p<0.001）、HOMA-IR（3.9 ± 0.8 与 2.8 ± 1.0，p<0.001）和 UA 水平（6.1 ± 1.8 与 4.8 ± 1.7，p<0.001）明显更高。相关性分析显示 DM+SCH 患者血清 UA 与 HOMA-IR 之间存在显著正相关（r=0.4，p=0.004）。在单因素分析中，SCH 的存在[OR（95%CI）：2.57（1.07-6.15），p=0.034]和肾病[OR（95%CI）：4.57（1.77-11.8），p=0.002]是 UA 较高（上三分位）的显著预测因素。然而，在多因素分析中，只有肾病[OR（95%CI）：4.25（1.62-11.17），p=0.003]仍然显著，而 SCH 则呈边缘趋势[OR（95%CI）：0.43（0.17-1.08），p=0.073]。