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2型糖尿病肾脏疾病患者血尿酸水平与肾功能不全的相关性
The relationship of serum uric acid level and renal insufficiency in Chinese type 2 diabetic kidney disease patients

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DOI:
作者:
李青 潘洁敏 包玉倩 张磊 贾伟平
LI Qing, Pan Jieming, BAO Yuqian,ZHANG Lei,JIA Wei
作者单位:
上海交通大学附属第六人民医院内分泌代谢科 上海市糖尿病临床医学中心 上海市糖尿病重点实验室 上海市糖尿病研究所
Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital，Shanghai Clinical Center for Diabetes ，Shanghai Key Laboratory of Diabetes Mellitus，Shanghai Diabetes Institute.
关键词:
糖尿病肾脏疾病；尿酸；肾小球滤过率
Diabetic kidney disease, Serum uric acid, Glomerular filtration rat
摘要:
目的 通过分析住院2型糖尿病肾脏疾病（DKD）患者的血尿酸（UA）水平与肾功能不全的相关性，探讨血UA在防治DKD中的价值。方法 对2009年1月-2011年8月期间住院的2型糖尿病患者测定血肌酐、尿酸（UA）、24h尿白蛋白定量等。应用简化肾脏病膳食改良试验（MDRD）公式计算肾小球滤过率（eGFR）。eGFR <60 ml.min-1.1.73m-2被定义为“肾功能不全”。结果（1）按2007年美国国立肾脏病基金会（NKF）的糖尿病及慢性肾脏疾病的临床诊断治疗指南，共入选DKD患者364例，男性201例，女性163例；平均年龄为（63+12）岁。平均血UA为(350±99 )umol/L；eGFR 为（80±31）ml.min-1.1.73m-2。（2）本组研究人群“肾功能不全”的发生率26.9%。eGFR＜60 ml.min-1.1.73m-2组患者的血UA水平显著高于eGFR≥60 ml.min-1.1.73m-2组（P <0.01）。单相关分析显示血UA水平和eGFR呈负相关（r=-0.303，P <0.05）。（3）本组研究人群中微量白蛋白尿（MAU）的发生率为50.5%，大量白蛋白尿（CAU）的发生率为49.5%。CAU组的血UA水平显著高于MAU组（P <0.01）。单相关分析显示血UA水平和尿白蛋白量呈正相关（r=0.162，P <0.05）。（4）多因素Logistic回归分析结果显示年龄、尿白蛋白量、血UA是2型糖尿病DKD患者发生“肾功能不全”的独立危险因素。结论 为有效地延缓2型糖尿病肾脏病变的发展,临床工作中要积极控制血尿酸水平及尿白蛋白排泄量。
【Abstract】Objective To investigate the relationship of serum uric acid level and “renal insufficiency” in hospitalized type 2 diabetic kidney disease (DKD) and to assess the value of serum uric acid in DKD prevention and treatment. Methods Type 2 diabetes patients, hospitalized from January, 2009 to August, 2011, underwent serum creatinine, serum uric acid and 24-hour urinary albumin excretion (24h-UAE). Estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease (MDRD) equation. eGFR<60 ml.min-11.73m-2 was defined as “renal insufficiency”. Results (1) Totally 364 diabetic kidney disease patients including 201 males and 163 females, following with the clinical practice guidelines for diabetes and chronic kidney disease suggested by national kidney foundation (NFK 2007), were enrolled in the present study. The study population had mean age of (63±12) years, mean uric acid level of (350±99) umol/L, and mean eGFR of (80±31) ml.min-11.73m-2. (2) The prevalence of “renal insufficiency” was 26.9% in the study population. Serum uric acid level was significantly higher in eGFR<60 ml.min-11.73m-2 group than eGFR≥60 ml.min-11.73m-2 group（P <0.01）. Univariate correlation analysis demonstrated that serum UA level was negatively correlated with eGFR (r=-0.303，P <0.05). （3）The prevalence of microalbuminuria、macroalbuminuria was 50.5%,49.5% respectively in the study population. Serum uric acid level was significantly higher in macroalbuminuric group than microalbuminuric group（P <0.01）. Univariate correlation analysis demonstrated that serum uric acid level was positively correlated with 24h-UAE （r=0.162，P <0.05）. (4) Multivariate Logistic regression analysis indicated that age, 24h-UAE, serum uric acid were independent factors of DKD patients developing renal dysfunction. Conclusions Reduction of serum uric acid level and urinary albumin excretion rate plays an important role in delay of type 2 diabetic kidney disease development

 

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