摘要
目的 探讨中国成人2型糖尿病(T2DM)患者血清同型半胱氨酸(Hcy)与高尿酸血症(HUA)发生风险的相关性。方法 427例成人T2DM患者,均进行身体指标、血压及血清生物学标记物检测。分析患者的临床资料,血清Hcy与HUA发生风险的相关性,不同分层中血清Hcy与尿酸(UA)的相关性,Hcy与体质量指数(BMI)对HUA发生风险的联合作用。结果 427例患者的平均UA水平为295.2μmol/L,其中52例(12.2%)患者为HUA。根据血清Hcy水平从低到高分为三分位(T1、T2、T3),结果显示HUA发生风险随着Hcy水平的升高而增加,在进一步校正基线时的血压、吸烟史、饮酒史、空腹血糖(FBG)、总胆固醇、甘油三酯、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血清胱抑素C、血清γ-谷氨酰转肽酶(γ-GGT)、尿微量白蛋白排泄率、C肽、肾小球滤过率(eGFR)以及糖尿病病程、HUA家族史、服用二甲双胍和胰岛素史后,HUA发生风险在Hcy水平逐渐增加的三分位上的比值比95%置信区间[OR(95%CI)]分别为1.00、1.387(0.605,3.181)和2.397(1.055,5.448)(趋势P=0.037<0.05)。在性别分层分析中,血清Hcy和UA在男性中仍然显著相关(趋势P=0.032<0.05),但在女性中无相关(趋势P=0.134>0.05)。将年龄分为<60岁和≥60岁两组,结果发现在两个年龄组中,血清Hcy与UA均无相关性(趋势P=0.189、0.140>0.05)。根据血压水平分为高血压和非高血压两组,根据BMI分为非肥胖(BMI<28 kg/m2)和肥胖(BMI≥28 kg/m2)两组,研究发现血清Hcy与UA在高血压(趋势P=0.001<0.05)和肥胖(趋势P=0.014<0.05)患者中的相关性比非高血压(趋势P=0.628>0.05)和非肥胖(趋势P=0.065>0.05)患者更明显。而且对于患HUA风险,Hcy与BMI之间存在显著的交互作用(交互作用P=0.005<0.05),但与血压的交互作用不显著(交互作用P=0.219>0.05)。Hcy和BMI这两个标志物在HUA发生风险方面显示出叠加效应。结论 在中国成人T2DM男性患者中,血清Hcy水平与HUA发生风险呈正相关,且与其他代谢因素无关,此外,BMI和血压可放大Hcy水平对HUA的影响。
Objective To discuss the correlation between serum homocysteine(Hcy)and risk of hyperuricemia(HUA)in adults with type 2 diabetes mellitus(T2DM).Methods 427 adult patients with T2DM were tested for physical indices,blood pressure and serum biological markers.Clinical data of patients were analyzed,including the correlation between serum Hcy and the risk of HUA,the correlation between serum Hcy and uric acid(UA)in different stratification,and the combined effect of Hcy and body mass index(BMI)on the risk of HUA.Results The mean UA level of 427 patients was 295.2μmol/L,of which 52 patients(12.2%)had HUA.Serum Hcy level was divided into three parts(T1,T2,T3)from low to high,and the results showed that the risk of HUA increased with the increase of Hcy level.After further correction for blood pressure at baseline,history of smoking,history of alcohol consumption,fasting blood glucose(FBG),total cholesterol,triglycerides,highdensity lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),serum cystatin C,serumγ-glutamyl transpeptidase(γ-GGT),urinary microalbumin excretion rate,C-peptide,estimated glomerular filtration rate(eGFR),and duration of diabetes,family history of HUA,insulin administration and history of metformin,95%confidence intervals[OR(95%CI)]for the ratio of the risk of HUA occurrence in the tertile of progressively increasing Hcy levels were 1.00,1.387(0.605,3.181),and 2.397(1.055,5.448)(P for trend=0.037<0.05).In gender-stratified analysis,serum Hcy and UA remained significantly correlated in men(P for trend=0.032<0.05)but not in women(P for trend=0.134>0.05).According to age,patients were divided into age group<60 years old and age group≥60 years old,and serum Hcy was found to be uncorrelated with UA in both age groups(P for trend=0.189,0.140>0.05).Patients were divided into hypertensive group and non-hypertensive group according to blood pressure level,and non-obese(BMI<28 kg/m2)group and obese(BMI≥28 kg/m2)group according to BMI.The study found that serum Hcy was more correlated with UA in hypertensive patients(P=0.001<0.05)and obese patients(P=0.014<0.05)than in non-hypertensive patients(P=0.628>0.05)and non-obese patients(P=0.065>0.05).Moreover,for the risk of HUA,there was a significant interaction between Hcy and BMI(P for interaction=0.005<0.05),but not with blood pressure(P for interaction=0.219>0.05).The two markers of Hcy and BMI showed a superimposed effect on the risk of HUA.Conclusion In Chinese adult male patients with T2DM,serum Hcy level is positively correlated with the risk of HUA,independent of other metabolic factors.Furthermore,BMI and Bp may amplify the effects of Hcy levels on HUA.
作者
朱艳
刘学奎
隋淼
贾静静
陈军
丁凯
ZHU Yan;LIU Xue-kui;SUI Miao(Department of Endocrinology,Xuzhou Hospital of Traditional Chinese Medicine,Xuzhou 221009,China)
出处
《中国实用医药》
2023年第12期64-68,共5页
China Practical Medicine
基金
徐州市科学技术基金资助(项目编号:KC190401)。
关键词
2型糖尿病
同型半胱氨酸
尿酸
性别
体质量指数
血压
Type 2 diabetes mellitus
Homocysteine
Uric acid
Gender
Body mass index
Blood pressure
