ADA 2013：许樟荣发现中国2型糖尿病合并高尿酸血症的临床特点

2013年第73届美国糖尿病协会科学年会(ADA2013)于6月21日~25日在美国芝加哥隆重举办。在ADA2013年会上，解放军306医院许樟荣教授发表一篇会议摘要“中国2型糖尿病合并高尿酸血症的临床特点：不同年龄和性别所致的影响”发表在会议摘要上，研究指出中国2型糖尿病和高尿酸血症合并患者的胰岛素抵抗、血脂异常更明显，e-GFR更低。男性和女性患者中影响BUA水平的因素并不相同。
　　4099名中国2型糖尿病(T2DM)患者，根据正常或异常血尿酸(BUA)水平分为2组，A组为高尿酸血症(男性420 umol/l以上，女性357  umol/l以上)，B组为正常血尿酸水平，根据BUA水平从低到高分为5个亚组。同时，根据患者的年龄分为8组(从40到70岁，每5年为1组)。对各组的高尿酸血症患病率、BMI、WHR(腰围和臀围比)、血压(BP)和其他参数进行比较。
　　男性的BUA水平明显比女性高。男性和女性的BUA水平随着年龄的变化明显不同，男性的BUA水平随年龄增长逐渐下降，但超过65岁后随年龄增长逐渐升高。女性的BUA水平和年龄呈平行变化，尤其是从50岁往后。与高尿酸血症血症女性患者相比，男性患者的年龄要年轻6岁，糖尿病的病程更短(比女性短12个月)，且BMI和高密度脂蛋白(HDL-C)水平较低，WHR和甘油三酯(TG)水平较高。
　　高尿酸血症患者空腹和餐后血糖较低，糖尿病化血红蛋白(HbA1c)和肾小球滤过率(e-GFR)较低，空腹和餐后胰岛素水平较高，胰岛素抵抗更明显，血TG、尿素氮(BUN)  和肌酐水平更高。
　　在男性患者，与尿酸正常者相比，高尿酸血症患者的血压、脉压、总胆固醇(TC)以及尿白蛋白(Alb)/肌酐(Cr)尿比值显著升高。在女性患者中，有无高尿酸血症之间无此差别。Logistic回归分析提示在男性患者中，BUA水平和BMI、TG、Alb/Cr比值具有正相关性，和HbA1c  及e-GFR负相关。在女性患者中，BUA水平和BMI、TG和HDL-C具有正相关性，和e-GFR负相关。
　　糖尿病和高尿酸血症合并患者的胰岛素抵抗、血脂异常更明显，e-GFR更低。男性和女性患者中影响BUA水平的因素在某些方面是不同的。

【研究摘要】

Clinical Characteristics of Hyperuricemia in the Chinese Patients with Type 2  Diabetes_Impact of Different Age and Gender

Zhangrong Xu MD Diabetes Centre

4099 Chinese patients with T2DM were divided into 2 groups based on normal or  abnormal blood uric acid (BUA) level group A with hyperuricemia (above 420  umol/l for male or 357 umol/l for female) and group B with normal BUA level and  into 5 groups based on the BUA level from lowerest to highest. The patients were  also divided into 8 groups according to their age (5 yrs differences from 40 to  70). The prevalence of hyperuricemia BMI WHR(waist-to-hip ratio) blood pressure  (BP) and other parameters were compared. BUA was obviously higher in male than  female patients change of BUA with age was obviously different between male and  female. BUA decreased with age and then increased in the male when over 65 yrs.  BUA increased paralleled with aging particular from the age 50 yrs in female  patients. Comparing with female patients with hyperuricemia male patients were 6  yrs younger in age and 12 months shorter in diabetes duration with lower BMI and  HDL-C higher WHR and TG. Patients with hyperuricemia had lower fasting glucose  and post-prandial glucose level lower HbA1c and e-GFR higher fasting insulin and  post-prandial insulin level more severe insulin-resistance higher blood TG BUN  and creatinine level. Significant higher BP higher pulse pressure TC and urine  Alb/Cr ratio in male patients with hyperuricemia than the males with normal BUA.  No differences of these parameters between female patients with or without  hyperuricemia. Logistic regression analysis showed that BUA positively related  with BMI TG Alb/Cr and negatively related with HbA1c and e-GFR in the male  patients. BUA was positively associated with BMI TG HDL-C and negatively related  with e-GFR in females. Patients with diabetes and hyperuricemia had more severe  insulin resistance lipids disorder and lower e-GFR. The impacting factors to BUA  level were different in some way between male and female patients with  diabetes.