血尿酸与糖尿病主要并发症关系的研究

发布时间：2018-06-04 12:13

本文选题：2型糖尿病 + 血尿酸　；参考：《天津医科大学》2017年博士论文

【摘要】：目的随着2型糖尿病(T2DM)及其并发症患病率的不断上升,T2DM尤其糖尿病的并发症给糖尿病患者的生活质量以及生命健康造成了严重的影响。伴随饮食结构的变化,高尿酸血症的患病率也逐年增加且呈现年龄提前的趋势。2型糖尿病患者由于胰岛素抵抗存在或者胰岛素分泌不足,存在血脂、血糖、蛋白质以及血尿酸的代谢紊乱。本文着重探讨血尿酸和糖尿病主要并发症之间的联系以及血尿酸与其他因素的交互作用对糖尿病主要并发症的影响。方法为了解2型糖尿病患者管理情况,中国医院协会从2013年5月到8月在我国27个城市81所三甲医院开展横断面调查。6800例2型糖尿病住院患者应邀请参与了本次研究。依据研究对象入选和排除标准,最终6713例患者的资料用于分析。本次研究中糖尿病主要并发症包括急性病并发症(低血糖),慢性心血管并发症和小血管并发症。本次研究中低血糖定义为血糖浓度≤3.9μmol/L并在住院前1个月无任何症状,住院前的一个月内有一次或多次症状性低血糖发作;或者住院前的三个月内有一次或多次的需要他人帮助的症状性低血糖发作。慢性心血管并发症(CVD)定义为先前的冠心病、脑卒中和外周血管病。糖尿病小血管并发症(MVD)定义为糖尿病肾病和糖尿病视网膜病。通过限制性立方样条分析血尿酸和糖尿病主要并发症的联系方式,采用Logistic回归分析血尿酸和糖尿病主要并发症危险性的比值比(OR)及其95%可信区间(95%CI),通过相加交互作用指标(RERI、AP)及其95%CI进行定性和定量分析血尿酸和其他因素的对糖尿病主要并发症的相加交互作用。RERI0和AP0表示因素间具有显著交互作用。结果最终纳入分析的6713例2型糖尿病患者的平均年龄为56.38±10.55岁,患糖尿病病程的中位数为3.00年(下四分位数:0.41;上四分位数:6.05),研究对象中女性患者比例为43.44%。所有研究对象中,409(6.09%)发生低血糖症状,其中无症状性、中度和重度低血糖的人数及比例分别为25(0.37%)、304(4.53%)和80(1.19%);561(8.36%)患有CVD,其中冠心病、脑卒中和外周动脉病的人数及比例分别为357(5.32%)、106(1.58%)和216(3.21%);408(6.08%)患有MVD,其中糖尿病肾病和糖尿病视网膜病人数及比例分别为220(3.28%)和281(4.19%)。血尿酸和糖尿病主要并发症的联系如下:1.血尿酸和低血糖呈非线性联系;多因素模型中高血尿酸水平(≥283μmol/L)和低血糖发生的OR为1.98(95%CI:1.58-2.48);高血尿酸水平和轻度肾小球滤过率降低(60e GFR≤90 m L/min/1.73 m2)两因素同时存在对低血糖的危险性有相加交互作用,多因素模型中RERI(95%CI)和AP(95%CI)分别为2.11(0.42-3.81)和0.54(0.25-0.82)。2.血尿酸和心血管并发症大致呈线性联系,血尿酸每增加1μmol/L,心血管病危险性增加0.1%;多因素分析模型中高血尿酸水平(SUA≥283μmol/L)和糖尿病心血管并发症发生的OR为1.49(95%CI:1.25-1.78);高血尿酸水平和轻度肾小球滤过率降低(60e GFR≤90 m L/min/1.73 m2)两因素同时存在对心血管并发症的危险性有相加交互作用,多因素模型中RERI(95%CI)和AP(95%CI)分别为1.15(0.05-2.26)和0.48(0.15-0.81);高尿酸水平和低胆红素水平(11.5μmol/L)两因素同时存在对心血管并发症的危险性有相加交互作,多因素模型中RERI(95%CI)和AP(95%CI)分别为4.40(3.25-5.54)和0.84(0.77-0.90)。3.无论单因素还是多因素模型中,血尿酸和小血管并发症呈非线性联系;多因素分析模型中高血尿酸水平(SUA≥283μmol/L)和糖尿病小血管并发症发生的OR为1.35(95%CI:1.04-1.75);高血尿酸水平和轻度肾小球滤过率降低(60e GFR≤90 m L/min/1.73 m2)两因素同时存在对小血管并发症的危险性有相加交互作用,多因素模型中RERI(95%CI)和AP(95%CI)分别为0.87(0.10-1.65)和0.66(0.32-0.99);高尿酸水平和低胆红素水平(11.5μmol/L)两因素同时存在对小血管并发症的危险性有相加交互作,RERI(95%CI)和AP(95%CI)分别为1.06(0.40-1.73)和0.58(0.32-0.84)。讨论血尿酸和糖尿病主要并发症危险性有关联,血尿酸和低血糖、小血管并发症的联系呈非线性,与心血管并发症的联系大致呈现线性;高血尿酸水平和肾小球肾功能轻度下降对糖尿病主要并发症的危险性有相加交互作用;高血尿酸水平和低血胆红素对糖尿病心血管并发症和小血管并发症的危险性有相加的交互作用。本次研究结果有待于在其他人群,尤其2型糖尿病非住院人群中证实,且因素和并发症间联系的相关机制,以及血尿酸被纳入糖尿病病人血管并发症的危险评分模型后的预测效果也有待于进一步研究。
[Abstract]:Objective with the increasing prevalence of type 2 diabetes (T2DM) and its complications, the complications of T2DM especially diabetes have a serious impact on the quality of life and life and health of diabetic patients. With the change of diet structure, the prevalence of hyperuricemia also increases year by year and presents the trend of age.2 diabetes. The relationship between blood uric acid and the major complications of diabetes and the interaction of blood uric acid and other factors on the main complications of diabetes are discussed in this paper. The method is to understand the type 2 diabetic patients. The Chinese Hospital Association, from May 2013 to August, conducted a cross-sectional survey of 81 three A hospitals in 27 cities in 27 cities in China. The hospitalized patients with type 2 diabetes mellitus should be invited to this study. According to the selection and exclusion criteria of the subjects, the data of the final 6713 patients were used for analysis. The main complications of diabetes in this study were the major complications of diabetes. It includes acute complications (hypoglycemia), chronic cardiovascular complications, and small vascular complications. This study was defined as blood glucose levels less than 3.9 UU mol/L and no symptoms for 1 months before hospitalization, one or more episodes of symptomatic hypoglycemia in one month before hospitalization, or one or more needs within three months before hospitalization. Symptomatic hypoglycemia attacks by others. Chronic cardiovascular complications (CVD) are defined as previous coronary heart disease, stroke, and peripheral vascular disease. Diabetic small vascular complications (MVD) are defined as diabetic nephropathy and diabetic retinopathy. The ratio Ratio (OR) and 95% confidence interval (95%CI) of the risk of major complications of blood uric acid and diabetes were analyzed by Logistic regression. The additive interaction index (RERI, AP) and its 95%CI were used to qualitatively and quantitatively analyze the additive interaction of serum uric acid and other factors on the main complications of diabetes,.RERI0 and AP0. The average age of 6713 patients with type 2 diabetes was 56.38 + 10.55 years old. The median of the course of diabetes was 3 years (the lower four digits, 0.41, the upper four digits 6.05). Among the subjects of the study, the proportion of women in the study was 43.44%., 409 (6.09%) of hypoglycemia symptoms, of which no The number and proportion of symptomatic, moderate and severe hypoglycemia were 25 (0.37%), 304 (4.53%) and 80 (1.19%); 561 (8.36%) had CVD. The number and proportion of coronary heart disease, stroke and peripheral artery disease were 357 (5.32%), 106 (1.58%) and 216 (3.21%), respectively, and the number and proportion of diabetic nephropathy and diabetic retina patients. 220 (3.28%) and 281 (4.19%) respectively. The relationship between blood uric acid and the main complications of diabetes was as follows: 1. the blood uric acid and hypoglycemia showed a nonlinear relationship; the high blood uric acid level (> 283 mol/L) and the occurrence of hypoglycemia in the multifactor model were 1.98 (95%CI:1.58-2.48); the high blood uric acid level and the mild glomerular filtration rate decreased (60E GFR < 90 m L/min/). 1.73 m2) two factors simultaneously had an additive interaction for the risk of hypoglycemia. In the multifactor model, RERI (95%CI) and AP (95%CI) were 2.11 (0.42-3.81) and 0.54 (0.25-0.82).2., respectively, with a linear relationship between blood uric acid and cardiovascular complications. The increase of blood uric acid was 1 micron, and the risk of cardiovascular disease increased by 0.1%; the multifactor analysis model was high. The levels of blood uric acid (SUA > 283 / mol/L) and diabetic cardiovascular complications were 1.49 (95%CI:1.25-1.78); high blood uric acid level and mild glomerular filtration rate (60E GFR < 90 m L/min/1.73 m2) two factors simultaneously had a combined effect on the risk of cardiovascular complications, and RERI (95%CI) and AP (AP) in the multifactor model. 1.15 (0.05-2.26) and 0.48 (0.15-0.81), high uric acid level and low bilirubin level (11.5 micron mol/L) two factors were simultaneously interacted with the risk of cardiovascular complications. RERI (95%CI) and AP (95%CI) in multifactor models were 4.40 (3.25-5.54) and 0.84 (0.77-0.90).3. respectively in single factor or multifactor model, hematuria There was a nonlinear relationship between acid and small vascular complications; the level of high blood uric acid (SUA > 283 mol/L) and OR of diabetic small vascular complications were 1.35 (95%CI:1.04-1.75) in the multifactor analysis model, and two factors of the high blood uric acid level and mild glomerular filtration rate (60E GFR < 90 m L/min /1.73 m2) were at the same time for the risk of small vascular complications. In the multifactor model, RERI (95%CI) and AP (95%CI) were 0.87 (0.10-1.65) and 0.66 (0.32-0.99) in the multifactor model, and the two factors of high uric acid level and low bilirubin level (11.5 mu mol/L) were simultaneously interacted with the risk of small vascular complications, and RERI (95%CI) and AP (95%CI) were 1.06 (0.40-1.73) and 0.58 (0.58), respectively. This is associated with the risk of major complications of blood uric acid and diabetes, blood uric acid and hypoglycemia, a nonlinear relationship between small vascular complications and a linear relationship with cardiovascular complications; high blood uric acid levels and a mild decline in glomerular renal function have a combined effect on the risk of major diabetic complications; high blood uric acid Levels and low blood bilirubin have a combined effect on the risk of cardiovascular complications and small vascular complications in diabetes. This study remains to be confirmed in other populations, especially in non hospitalized people with type 2 diabetes, and the associated mechanisms of factors and complications, and the inclusion of blood uric acid in diabetic vascular complications. The prediction effect after the risk score model still needs further study.
【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R587.2;R589.7

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