本文選題：2型糖尿病 + 血尿酸��； 參考：《天津醫(yī)科大學(xué)》2017年博士論文

【摘要】：目的 隨著2型糖尿病(T2DM)及其并發(fā)癥患病率的不斷上升,T2DM尤其糖尿病的并發(fā)癥給糖尿病患者的生活質(zhì)量以及生命健康造成了嚴(yán)重的影響。伴隨飲食結(jié)構(gòu)的變化,高尿酸血癥的患病率也逐年增加且呈現(xiàn)年齡提前的趨勢。2型糖尿病患者由于胰島素抵抗存在或者胰島素分泌不足,存在血脂、血糖、蛋白質(zhì)以及血尿酸的代謝紊亂。本文著重探討血尿酸和糖尿病主要并發(fā)癥之間的聯(lián)系以及血尿酸與其他因素的交互作用對糖尿病主要并發(fā)癥的影響。方法 為了解2型糖尿病患者管理情況,中國醫(yī)院協(xié)會(huì)從2013年5月到8月在我國27個(gè)城市81所三甲醫(yī)院開展橫斷面調(diào)查。6800例2型糖尿病住院患者應(yīng)邀請參與了本次研究。依據(jù)研究對象入選和排除標(biāo)準(zhǔn),最終6713例患者的資料用于分析。本次研究中糖尿病主要并發(fā)癥包括急性病并發(fā)癥(低血糖),慢性心血管并發(fā)癥和小血管并發(fā)癥。本次研究中低血糖定義為血糖濃度≤3.9μmol/L并在住院前1個(gè)月無任何癥狀,住院前的一個(gè)月內(nèi)有一次或多次癥狀性低血糖發(fā)作;或者住院前的三個(gè)月內(nèi)有一次或多次的需要他人幫助的癥狀性低血糖發(fā)作。慢性心血管并發(fā)癥(CVD)定義為先前的冠心病、腦卒中和外周血管病。糖尿病小血管并發(fā)癥(MVD)定義為糖尿病腎病和糖尿病視網(wǎng)膜病。通過限制性立方樣條分析血尿酸和糖尿病主要并發(fā)癥的聯(lián)系方式,采用Logistic回歸分析血尿酸和糖尿病主要并發(fā)癥危險(xiǎn)性的比值比(OR)及其95%可信區(qū)間(95%CI),通過相加交互作用指標(biāo)(RERI、AP)及其95%CI進(jìn)行定性和定量分析血尿酸和其他因素的對糖尿病主要并發(fā)癥的相加交互作用。RERI0和AP0表示因素間具有顯著交互作用。結(jié)果 最終納入分析的6713例2型糖尿病患者的平均年齡為56.38±10.55歲,患糖尿病病程的中位數(shù)為3.00年(下四分位數(shù):0.41;上四分位數(shù):6.05),研究對象中女性患者比例為43.44%。所有研究對象中,409(6.09%)發(fā)生低血糖癥狀,其中無癥狀性、中度和重度低血糖的人數(shù)及比例分別為25(0.37%)、304(4.53%)和80(1.19%);561(8.36%)患有CVD,其中冠心病、腦卒中和外周動(dòng)脈病的人數(shù)及比例分別為357(5.32%)、106(1.58%)和216(3.21%);408(6.08%)患有MVD,其中糖尿病腎病和糖尿病視網(wǎng)膜病人數(shù)及比例分別為220(3.28%)和281(4.19%)。血尿酸和糖尿病主要并發(fā)癥的聯(lián)系如下:1.血尿酸和低血糖呈非線性聯(lián)系;多因素模型中高血尿酸水平(≥283μmol/L)和低血糖發(fā)生的OR為1.98(95%CI:1.58-2.48);高血尿酸水平和輕度腎小球?yàn)V過率降低(60e GFR≤90 m L/min/1.73 m2)兩因素同時(shí)存在對低血糖的危險(xiǎn)性有相加交互作用,多因素模型中RERI(95%CI)和AP(95%CI)分別為2.11(0.42-3.81)和0.54(0.25-0.82)。2.血尿酸和心血管并發(fā)癥大致呈線性聯(lián)系,血尿酸每增加1μmol/L,心血管病危險(xiǎn)性增加0.1%;多因素分析模型中高血尿酸水平(SUA≥283μmol/L)和糖尿病心血管并發(fā)癥發(fā)生的OR為1.49(95%CI:1.25-1.78);高血尿酸水平和輕度腎小球?yàn)V過率降低(60e GFR≤90 m L/min/1.73 m2)兩因素同時(shí)存在對心血管并發(fā)癥的危險(xiǎn)性有相加交互作用,多因素模型中RERI(95%CI)和AP(95%CI)分別為1.15(0.05-2.26)和0.48(0.15-0.81);高尿酸水平和低膽紅素水平(11.5μmol/L)兩因素同時(shí)存在對心血管并發(fā)癥的危險(xiǎn)性有相加交互作,多因素模型中RERI(95%CI)和AP(95%CI)分別為4.40(3.25-5.54)和0.84(0.77-0.90)。3.無論單因素還是多因素模型中,血尿酸和小血管并發(fā)癥呈非線性聯(lián)系;多因素分析模型中高血尿酸水平(SUA≥283μmol/L)和糖尿病小血管并發(fā)癥發(fā)生的OR為1.35(95%CI:1.04-1.75);高血尿酸水平和輕度腎小球?yàn)V過率降低(60e GFR≤90 m L/min/1.73 m2)兩因素同時(shí)存在對小血管并發(fā)癥的危險(xiǎn)性有相加交互作用,多因素模型中RERI(95%CI)和AP(95%CI)分別為0.87(0.10-1.65)和0.66(0.32-0.99);高尿酸水平和低膽紅素水平(11.5μmol/L)兩因素同時(shí)存在對小血管并發(fā)癥的危險(xiǎn)性有相加交互作,RERI(95%CI)和AP(95%CI)分別為1.06(0.40-1.73)和0.58(0.32-0.84)。討論 血尿酸和糖尿病主要并發(fā)癥危險(xiǎn)性有關(guān)聯(lián),血尿酸和低血糖、小血管并發(fā)癥的聯(lián)系呈非線性,與心血管并發(fā)癥的聯(lián)系大致呈現(xiàn)線性;高血尿酸水平和腎小球腎功能輕度下降對糖尿病主要并發(fā)癥的危險(xiǎn)性有相加交互作用;高血尿酸水平和低血膽紅素對糖尿病心血管并發(fā)癥和小血管并發(fā)癥的危險(xiǎn)性有相加的交互作用。本次研究結(jié)果有待于在其他人群,尤其2型糖尿病非住院人群中證實(shí),且因素和并發(fā)癥間聯(lián)系的相關(guān)機(jī)制,以及血尿酸被納入糖尿病病人血管并發(fā)癥的危險(xiǎn)評分模型后的預(yù)測效果也有待于進(jìn)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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R587.2;R589.7

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