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目的探讨高尿酸血症对2型糖尿病肾病发生、发展中的作用及意义。方法将115例糖尿病肾病患者(尿白蛋白MA30-500mg/24h)据血尿酸水平,分为高尿酸组60例、正常尿酸组55例,分别测定各组血清胰岛素、血糖、血肌酐、血脂、尿微量白蛋白水平,并计算人体质量指数、肾小球滤过率、稳态模型胰岛素抵抗指数(HOMA-IR)和胰岛B细胞功能指数(HOMA-IS)。结果高尿酸组患者胰岛素水平、胰岛素抵抗指数、尿白蛋白和血肌酐值较正常尿酸组升高(P<0.05);胰岛β细胞功能和肾小球滤过率较正常尿酸组下降明显(P<0.001),并且体质量指数(BMI)和甘油三酯也较正常尿酸组升高(P<0.05)。Spearman等级相关分析显示,高尿酸组血尿酸与SCR、HOMA-β呈显著正相关(г=0.538,г=0.424,均P<0.01);与FINS、HOMA-IR、MA、体质量指数呈正相关(г=0.396,г=0.334,г=0.325,г=0.324,均P<0.05);与肾小球滤过率呈显著负相关(г=-0.487,P<0.01)。结论糖尿病肾病患者高尿酸血症与肾脏损害及胰岛素抵抗密切相关,对2型糖尿病肾病发生、发展起促进作用。
Objective To investigate the role and significance of hyperuricemia in the occurrence and development of type 2 diabetic nephropathy. Methods According to the level of serum uric acid in urine of diabetic nephropathy patients (urine albumin MA30-500mg / 24h), 60 cases were divided into hyperuricemia group and 55 cases of normal uric acid group. Serum insulin, blood glucose, serum creatinine, blood lipid, Urinary microalbuminuria was measured and body mass index, glomerular filtration rate, homeostasis model insulin resistance index (HOMA-IR) and islet B cell function index (HOMA-IS) were calculated. Results The level of insulin, insulin resistance index, urinary albumin and serum creatinine in hyperuricemia group were significantly higher than those in normal uric acid group (P <0.05). The function of islet β-cell and the glomerular filtration rate were significantly lower than those in normal uric acid group <0.001), and body mass index (BMI) and triglyceride also increased compared with normal uric acid group (P <0.05). Spearman rank correlation analysis showed that serum uric acid was positively correlated with SCR and HOMA-β in hyperuricemia group (г = 0.538, г = 0.424, all P <0.01), and positively correlated with FINS, HOMA-IR and MA (г = 0.396, г = 0.334, г = 0.325, г = 0.324, all P <0.05), and had a significant negative correlation with glomerular filtration rate (χ = -0.487, P <0.01). Conclusion Hyperuricemia in patients with diabetic nephropathy is closely related to renal damage and insulin resistance, and plays an important role in the occurrence and development of type 2 diabetic nephropathy.