1型糖尿病患者中糖尿病肾病风险增加时血清尿酸阈值的确定。

Identification of the serum uric acid threshold with increasing risk for diabetic nephropathy in type 1 diabetes.

作者信息

Huang Mei, Wei Qianying, Chen Xin, Qin Yao, Dai Liuyan, Li Yuxiao, Gu Yong, Chen Yang, Yang Tao, Zhang Mei

机构信息

Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, China.

出版信息

Hormones (Athens). 2025 Jul 8. doi: 10.1007/s42000-025-00690-y.

DOI:10.1007/s42000-025-00690-y

PMID:40627329

Abstract

PURPOSE

To investigate the correlation between serum uric acid (SUA) levels and the risk for diabetic nephropathy (DN) in Chinese patients with type 1 diabetes mellitus (T1DM) and determine the potential optimal SUA threshold.

METHODS

In this case-control study, 913 T1DM patients were matched 1:1 with healthy controls by age and sex. Multivariable adjusted logistic regression analysis was used to investigate the association between SUA levels and the risk of developing DN. Restricted cubic spline (RCS) was applied to investigate the optimal threshold for SUA. Additionally, longitudinal analysis of 94 patients with at least three visits accessed SUA variability correlations with estimated glomerular filtration rate (eGFR) and urinary albumin creatinine ratio (UACR) changes using Spearman's correlation analysis. A linear mixed-effects model was performed to access the correlations in SUA, eGFR, and UACR over time.

RESULTS

T1DM patients exhibited significantly lower median SUA levels (4.24 vs. 4.93 mg/dL, P < 0.001) than controls. The incidence of DN was 12% in T1DM patients. After adjusting for confounding factors, the SUA level was inversely significantly correlated with the risk for DN as a continuous variable (OR: 1.47; 1.25-1.74) and in quartile 4 (OR: 3.01; 1.44-6.50), respectively. The RCS plot revealed an identified threshold of SUA as being 4.30 mg/dL with increasing risk for DN. Correlation analysis showed the SUA variability significantly correlate with eGFR variability (r = 0.206, P = 0.046) and UACR variability (r = 0.405, P = 0.025). The linear mixed-effects model revealed a significant negative relationship between SUA and eGFR over time (R = 0.035, P < 0.001), as well as a significant positive relationship between SUA and UACR (R = 0.041, P < 0.001).

CONCLUSIONS

Our study revealed that decreased SUA level is common in T1DM and identified the threshold as being 4.30 mg/dL for increased DN risk.

摘要

目的

探讨中国1型糖尿病（T1DM）患者血清尿酸（SUA）水平与糖尿病肾病（DN）风险之间的相关性，并确定潜在的最佳SUA阈值。

方法

在这项病例对照研究中，913例T1DM患者按年龄和性别与健康对照进行1:1匹配。采用多变量调整逻辑回归分析来研究SUA水平与发生DN风险之间的关联。应用受限立方样条（RCS）来研究SUA的最佳阈值。此外，对94例至少有三次就诊记录的患者进行纵向分析，使用Spearman相关分析评估SUA变异性与估计肾小球滤过率（eGFR）和尿白蛋白肌酐比值（UACR）变化之间的相关性。采用线性混合效应模型来评估SUA、eGFR和UACR随时间的相关性。

结果

T1DM患者的SUA中位数水平显著低于对照组（4.24对4.93mg/dL，P<0.001）。T1DM患者中DN的发生率为12%。在调整混杂因素后，SUA水平作为连续变量与DN风险呈显著负相关（OR：1.47；1.25 - 1.74），在四分位数4中也呈负相关（OR：3.01；1.44 - 6.50）。RCS图显示，SUA的确定阈值为4.30mg/dL，DN风险随之增加。相关分析表明，SUA变异性与eGFR变异性显著相关（r = 0.206，P = 0.046）以及与UACR变异性显著相关（r = 0.405，P = 0.025）。线性混合效应模型显示，随着时间推移，SUA与eGFR之间存在显著负相关（R = 0.035，P<0.001），以及SUA与UACR之间存在显著正相关（R = 0.041，P<0.001）。