糖尿病对血清尿酸水平与新发痴呆症之间关联的影响：英国生物银行的一项队列研究

Impact of diabetes on the association between serum urate levels and incident dementia: a cohort study in the UK biobank.

作者信息

Peng Yuwei, Pan Lulu, Zhu Qiuli, Lin Ruilang, Huang Chen, Liu Yahang, Huang Yifang, Li Guochen, Yao Ye, Yu Yongfu, Tang Jianguo

机构信息

Department of Biostatistics, Key Laboratory for Health Technology Assessment, National Commission of Health, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China.

Healthcare-Associated Infection Prevention and Control Office, Shanghai General Hospital, Shanghai 200080, China.

出版信息

J Nutr Health Aging. 2024 Dec;28(12):100399. doi: 10.1016/j.jnha.2024.100399. Epub 2024 Oct 21.

DOI:10.1016/j.jnha.2024.100399

PMID:39437577

Abstract

OBJECTIVES

Diabetes was associated with increased serum urate levels and a higher risk of dementia. However, current evidence regarding the association between serum urate and dementia is controversial.The research gap on how to effectively control urate levels in the population with diabetes still remains. We aim to examine the association of diabetes status and serum urate with dementia incidence, and the differences in this association among participants with different diabetes statuses.

METHODS

A total of 321,896 participants was recruited from the UK Biobank and followed up until 2022. Diabetes status was classified into diabetes, prediabetes and normoglycaemia according to the American Diabetes Association 2023 guideline. Serum urate levels were stratified using gender-specific quartiles of concentrations. All-cause dementia, Alzheimer's disease and vascular dementia were ascertained using the International Classification of Diseases-10th revision (ICD-10). Cox proportional hazards regression models were used to examine the association between serum urate, diabetes status, and dementia incidence.

RESULTS

Of the 321,896 participants (mean age, 57 years old; 43.5% males), 7,087 (2.20%) individuals were diagnosed with dementia during the follow-up period. Diabetes was associated with a 70% 58%, and 134% increased risk for all-cause dementia, Alzheimer's disease, and vascular dementia respectively. Elevated serum urate levels were associated with a lower risk of all-cause and cause-specific dementia regardless of the status of diabetes. Each standard deviation increase in urate concentration was related to a 11% reduced risk for all-cause dementia (HR, 0.89; 95% CI, 0.86 to 0.91), 7% for Alzheimer's disease (HR, 0.93; 95% CI, 0.88 to 0.98), and 12% for vascular dementia (HR, 0.88; 95% CI, 0.81 to 0.95).

CONCLUSION

Appropriately higher urate levels within the threshold of hyperuricemia can reduce the adverse health effects of excessively high urate levels and better protect the cognitive health of people with varying diabetes status.

摘要

目的

糖尿病与血清尿酸水平升高及痴呆风险增加相关。然而，目前关于血清尿酸与痴呆之间关联的证据存在争议。在糖尿病患者群体中如何有效控制尿酸水平的研究空白仍然存在。我们旨在研究糖尿病状态和血清尿酸与痴呆发病率之间的关联，以及不同糖尿病状态参与者在这种关联上的差异。

方法

从英国生物银行招募了总共321,896名参与者，并随访至2022年。根据美国糖尿病协会2023年指南，将糖尿病状态分为糖尿病、糖尿病前期和血糖正常。血清尿酸水平根据性别特异性浓度四分位数进行分层。使用国际疾病分类第10版（ICD - 10）确定全因性痴呆、阿尔茨海默病和血管性痴呆。采用Cox比例风险回归模型来研究血清尿酸、糖尿病状态与痴呆发病率之间的关联。

结果

在321,896名参与者（平均年龄57岁；43.5%为男性）中，有7,087名（2.20%）个体在随访期间被诊断为痴呆。糖尿病分别与全因性痴呆、阿尔茨海默病和血管性痴呆风险增加70%、58%和134%相关。无论糖尿病状态如何，血清尿酸水平升高与全因性和特定病因痴呆的较低风险相关。尿酸浓度每增加一个标准差，与全因性痴呆风险降低11%（风险比[HR]，0.89；95%置信区间[CI]，0.86至0.91）、阿尔茨海默病风险降低7%（HR，0.93；95% CI，0.88至0.98）以及血管性痴呆风险降低12%（HR，0.88；95% CI，0.81至0.95）相关。