糖尿病前期患者血尿酸水平与餐后2 h血糖水平相关性分析

目的 探讨糖尿病前期（即糖调节受损，impaired glucose regulation，IGR）患者中血尿酸（serum uric acid, SUA）和餐后2 h血糖（2-h PG）水平的相关性。方法 纳入3 588例在我院门诊就诊患者为研究对象，检测SUA、肌酐、胱抑素C（Cystatin, Cys-C）、血脂和糖化血红蛋白（glycosylated hemoglobin A1c, HbA1c）水平，行糖耐量试验（oral glucose tolerance test, OGTT）和胰岛功能试验。根据空腹血糖（fasting plasma glucose, FPG）和HbA1c水平将研究对象分为糖调节正常（normal glucose regulation, NGT）组、IGR组和2型糖尿病（type 2 diabetes mellitus, T2DM）组。对各检测指标进行组间比较，分析各组检查者SUA 与OGTT 中2-h PG相关性，以及其它检测指标与2-h PG相关性，并计算IGR人群2-h PG增高的相对危险度（odds ratio, OR）及95%可信区间（confidence interval, CI）。结果 研究人群中，NGT 556例，IGR 1 019例， T2DM 2 013例。3组间血糖、血清胰岛素、甘油三酯、高密度脂蛋白胆固醇、HbA1c、SUA、肌酐、Cys-C水平比较差异均有统计学意义（ P均<0.05）。多元线性回归分析发现NGT和IGR组的SUA水平与2-h PG水平呈正相关（ P<0.05），T2DM中SUA水平与2-h PG无相关关系( P=0.156)。在整个研究人群中HbA1c和FPG水平与2-h PG水平呈正相关（ P<0.05）。在NGT中FPG水平与2-h PG水平呈正相关（ P=0.031）。在IGR和T2DM中，HbA1c水平与2-h PG水平呈正相关（ P<0.05）。HbA1c、FPG和SUA水平是IGR患者2-h PG的独立风险因素。结论 糖尿病前期SUA与2-h PG相关，并独立于FPG、HbA1c和其他已知的危险因素；SUA在糖尿病前期患者的病情演变过程中可能起重要作用，因此SUA检测可以作为监测糖尿病前期患者发展成T2DM的风险指标。
Objective To investigate whether serum uric acid (SUA) is associated with 2-hour postload glucose (2-h PG) in predibetic patients. Methods There were 3 588 subjects enrolled in this study from May 2014 to March 2015 in the department of physical examination center and outpatient clinic of West China Hospital of Sichuan University. All the subjects received a 75-g oral glucose tolerance test (OGTT) and measurements of serum uric acid (SUA), Creatinine, Cystatin (Cys-C), serum lipid and glycosylated hemoglobin (HbA1c). According to the results of glucose and HbA1c, the subjects were divided into three groups, including normal glucose regulation (NGT), impaired glucose regulation (IGR) and Type 2 Diabetes Mellitus (T2DM) group. The correlation between 2-h PG and serum uric acid in each group was analyzed. Results Based on the exam results, there were 556 cases of NGT, 1 019 cases of IGR, 2 013 cases of T2DM. There were statistically significant differences of glucose, serum insulin, triglycerides, high density lipoprotein, HbA1c, SUA, Creatinine, Cys-C levels among the three groups ( P<0.05). Multiple linear regression analysis showed that SUA level was positively correlated to 2-h PG level ( P<0.05) in NGT and IGR groups, but there was no correlation in T2DM group ( P=0.156). In the entire study population, levels of HbA1c and FPG were positive to 2-h PG correlated ( P<0.05). Positive correlation existed between FPG and 2-h PG in NGT group ( P=0.031). In IGR and T2DM group, HbA1c and 2-h PG were positively correlated ( P<0.05). HbA1c, FPG and SUA levels were independent