本文選題：高尿酸血癥 + 糖尿病��； 參考：《上海交通大學(xué)》2015年碩士論文

【摘要】：研究目的隨著我國(guó)人民生活水平的不斷提高,高尿酸血癥的患病率呈逐年上升趨勢(shì)。高尿酸血癥和糖尿病一樣,是危害人類健康的一種嚴(yán)重的代謝性疾病。同為代謝性疾病的糖尿病和高尿酸血癥,兩種疾病之間存在何種聯(lián)系?目前缺乏對(duì)糖尿病合并高尿酸血癥的系統(tǒng)流行病學(xué)研究。尿酸排泄是影響血尿酸水平的重要因素。既往大多以24 h尿尿酸定量測(cè)定來(lái)簡(jiǎn)單區(qū)分尿酸生成過(guò)多或腎臟排泄減少,但此種方法受飲食、飲水、尿量及血尿酸的影響,現(xiàn)在采用尿酸排泄分?jǐn)?shù)(fraction excertion of uric acid,FEUA)代替24 h尿尿酸定量法,該指標(biāo)消除了血尿酸波動(dòng)、尿量等混雜因素的影響,更為準(zhǔn)確可靠。糖尿病患者中尿酸排泄與高尿酸血癥、腎功能之間存在何種關(guān)系,目前尚未見研究報(bào)道。計(jì)算排泄分?jǐn)?shù)通常收集24 h尿,但由于收集24 h尿標(biāo)本較為困難,對(duì)正常人更是受到一定限制。FEUA與血尿酸、血肌酐、任意點(diǎn)尿尿酸及尿肌酐之間的對(duì)應(yīng)關(guān)系目前尚無(wú)定論。是否可以用點(diǎn)尿酸的結(jié)果替代目前未見有研究報(bào)道。此外,在臨床工作中血尿酸的檢測(cè)通常都選擇空腹,進(jìn)食對(duì)血尿酸水平究竟有多大的影響?因此本研究的目的為:1、分析糖尿病合并高尿酸血癥的流行情況、易患因素及與腎功能的關(guān)系;2、分析糖尿病合并高尿酸血癥患者的尿酸排泄情況、影響因素及與腎功能的關(guān)系;3、分析進(jìn)餐前后血尿酸水平的變化、24h尿酸排泄與點(diǎn)尿酸之間的相關(guān)關(guān)系。研究方法受試者均為2011年7月到2014年9月之間來(lái)自于上海糖尿病臨床中心,另招募了80名健康志愿者作為正常糖耐量無(wú)高尿酸血癥的對(duì)照。向病人采集病史及測(cè)量血壓、身高、體重,檢測(cè)肝腎功能、電解質(zhì)、血脂、尿微量白蛋白和肌酐比值、HbA1c、24h尿尿酸及尿肌酐、點(diǎn)尿尿酸及尿肌酐等臨床指標(biāo)。不同組患者的特征以ANOVA作比較、協(xié)方差作分析,對(duì)照組和患者組之間連續(xù)變量比較使用t檢驗(yàn),分類變量使用卡方檢驗(yàn)。相關(guān)分析采用Pearson相關(guān)檢驗(yàn)、多元線性回歸分析和偏相關(guān)分析。pearson相關(guān)分析顯示與尿酸呈顯著相關(guān)(p0.05)的變量進(jìn)入逐步線性回歸分析。多元logistic回歸分析尿酸與糖尿病患者腎功能不全及異常蛋白尿發(fā)生之間的關(guān)系。gfr評(píng)估公式與mgfr的一致性用bland-altman作圖法分析,各公式對(duì)超濾過(guò)及腎功能下降的診斷效能采用受試者工作特征曲線(receiver-operatingcharacteristiccurve,roc曲線)分析。研究結(jié)果1、糖尿病合并高尿酸血癥的流行情況、易患因素及與腎功能關(guān)系本研究表明在中國(guó)糖尿病患者中,高尿酸血癥的患病率為15.87%,在男性中為14.52%,在女性中為17.80%,gfr、空腹c肽、性別、尿微量白蛋白、年齡糖化白蛋白及bmi與血尿酸獨(dú)立相關(guān)。我們的研究顯示,49歲以后女性糖尿病患者高尿酸血癥患病率顯著高于男性,而且女性糖尿病患者隨年齡的增加,高尿酸血癥的患病率逐漸增加;隨著bmi、空腹c肽及使用c肽計(jì)算的homa-ir增加,糖尿病患者高尿酸血癥的患病率逐漸增加,血尿酸水平與空腹c肽及homa-ir呈顯著正相關(guān);隨著ga增加,無(wú)論男性還是女性,高尿酸血癥的患病率逐漸降低;隨著gfr水平的下降及尿微量白蛋白水平的增加,高尿酸血癥的患病率逐漸增加。糖尿病合并高尿酸血癥患者腎功能不全及異常蛋白尿發(fā)生的危險(xiǎn)度顯著增加,超濾過(guò)發(fā)生危險(xiǎn)度顯著降低,該相關(guān)獨(dú)立于年齡、性別、bmi、糖尿病病程、hba1c、sbp、dbp、ldl及hdl等其他相關(guān)因素。在合并高尿酸血癥的糖尿病患者中,血尿酸水平每增加1sd(94μmol/l),腎功能不全發(fā)生危險(xiǎn)度增加0.8%,異常蛋白尿發(fā)生危險(xiǎn)度增加0.3%,超濾過(guò)發(fā)生危險(xiǎn)度降低0.5%(model2)。2、糖尿病合并高尿酸血癥患者的尿酸排泄情況、影響因素及與腎功能的關(guān)系無(wú)論1型還是2型糖尿病,未合并高尿酸血癥時(shí)均已存在尿酸排泄減少及尿酸生成增多的情況,以尿酸生成增多為主;合并高尿酸血癥時(shí),以尿酸排泄降低為主。在gfr60ml/min/1.73m2人群,1型糖尿病合并高尿酸血癥患者尿酸排泄以尿酸生成增多為主,2型糖尿病以尿酸排泄減少為主,尿酸排泄(feua)與hdl、bmi、年齡、ga、性別、ldl、lnacr及tg獨(dú)立相關(guān)。研究表明,隨著年齡的增加,女性尿酸排泄水平無(wú)顯著變化,男性57歲以上人群feua水顯著高于57歲以下人群;在每一年齡組,女性患者的feua水平均顯著高于男性的feua水平。隨著bmi、ga及蛋白尿水平的增加,feua水平顯著增加。糖尿病不伴蛋白尿患者,隨著尿酸排泄的增加gfr顯著升高;合并蛋白尿患者者不論是高尿酸人群還是非高尿酸人群,隨著尿酸排出的增加,尿蛋白逐漸增加的同時(shí)gfr逐漸下降。在總體糖尿病人群中,feua每升高1sd(2.64%),腎功能不全發(fā)生的危險(xiǎn)度增加24.7%,異常蛋白尿發(fā)生的危險(xiǎn)度增加13.9%(model2);尿酸生成增加人群腎功能不全及蛋白尿發(fā)生的危險(xiǎn)度顯著增加,or值分別為5.187(3.594-7.488,p0.001)和1.875(1.465-2.401,p0.001)。3、進(jìn)餐前后血尿酸水平的變化、尿酸排泄水平及糖尿病腎功能的評(píng)估正常人群、糖耐量異常及糖尿病人群空腹及進(jìn)餐2小時(shí)血尿酸水平無(wú)統(tǒng)計(jì)學(xué)差異。feua與血尿酸、血肌酐及任意點(diǎn)尿尿酸、尿肌酐顯著相關(guān),與血尿酸及任意點(diǎn)尿尿酸獨(dú)立相關(guān),其線性回歸方程為:feua=14.02-0.02×sua-0.002×uua(mg/l),r=0.617。對(duì)以肌酐為基礎(chǔ)的gfr評(píng)估公式(cg、mdrd及ckd-epi公式)的比較顯示,ckd-epi公式的偏倚最小,15%、30%及50%準(zhǔn)確性最高。對(duì)mdrd公式、胱抑素c公式及肌酐-胱抑素c公式的比較顯示,肌酐-胱抑素c公式的偏倚最小,精確度及15%、30%、50%準(zhǔn)確性最好,胱抑素c公式適用性最差。研究結(jié)論1、在中國(guó)糖尿病患者中,高尿酸血癥的患病率為15.87%,在男性中為14.52%,在女性中為17.80%,49歲以后女性糖尿病患者高尿酸血癥患病率顯著高于男性,而且女性糖尿病患者隨年齡的增加,高尿酸血癥的患病率逐漸增加;隨著bmi、空腹c肽、使用c肽計(jì)算的homa-ir及蛋白尿水平的增加及gfr水平的下降,高尿酸血癥的患病率逐漸增加;隨著ga水平的增加,高尿酸血癥的患病率逐漸降低。2、糖尿病合并高尿酸血癥患者腎功能不全及蛋白尿發(fā)生的危險(xiǎn)度顯著增加,超濾過(guò)發(fā)生危險(xiǎn)度顯著降低。3、無(wú)論1型還是2型糖尿病,未合并高尿酸血癥時(shí)已存在尿酸排泄減少及尿酸生成增多的情況,以尿酸生成增多為主;合并高尿酸血癥時(shí),以尿酸排泄降低為主。在腎功能正常(gfr60ml/min/1.73m2)的糖尿病患者中,1型糖尿病合并高尿酸血癥患者尿酸排泄以尿酸生成增多為主,2型糖尿病以尿酸排泄減少為主。4、糖尿病不伴蛋白尿患者,隨著尿酸排泄的增加gfr顯著升高;合并蛋白尿患者者不論是高尿酸人群還是非高尿酸人群,隨著尿酸排出的增加,尿蛋白逐漸增加的同時(shí)gfr逐漸下降。5、在糖尿病患者中,無(wú)論是否合并高尿酸血癥,尿酸生成增加人群腎功能不全及蛋白尿發(fā)生的危險(xiǎn)度顯著增加。6、正常人群、糖耐量異常及糖尿病人群空腹及進(jìn)餐2小時(shí)血尿酸水平無(wú)統(tǒng)計(jì)學(xué)差異。7、feua與血尿酸及任意點(diǎn)尿尿酸獨(dú)立相關(guān),其線性回歸方程為:feua=14.02-0.02×SUA-0.002×UUA(mg/L),R=0.617。8、以肌酐為基礎(chǔ)的GFR評(píng)估公式中,CKD-EPI公式在中國(guó)糖尿病人群中的適用性最好;與MDRD公式及胱抑素C公式相比,肌酐-胱抑素C公式在中國(guó)糖尿病人群中的適用性更好,該結(jié)論同樣適用于不同血糖水平的患者。
[Abstract]:With the continuous improvement of the living standard of our people, the prevalence of hyperuricemia is increasing year by year. Like hyperuricemia and diabetes, it is a serious metabolic disease that endangers human health. What is the connection between the two diseases and diabetes and hyperuricemia? A systematic epidemiological study of diabetes with hyperuricemia. Uric acid excretion is an important factor affecting the level of blood uric acid. Most of the past 24 h urine uric acid quantitative determination is used to simply distinguish uric acid formation or renal excretion, but this method is affected by diet, drinking water, urine volume and blood uric acid, and uric acid excretion score is now used. Fraction excertion of uric acid, FEUA) instead of 24 h urine uric acid quantitative method, which eliminates the influence of mixed factors such as uric acid fluctuation and urine volume, is more accurate and reliable. The relationship between uric acid excretion and hyperuricemia and renal function in diabetic patients has not yet been reported. The calculation of excretory score usually collects 24 h urine, However, as it is difficult to collect 24 h urine specimens, there is no definite relationship between the normal people and the relationship between.FEUA and blood uric acid, blood creatinine, urinic urinic acid at any point and urine creatinine. The purpose of this study is to analyze the effect of eating on the level of uric acid? 1, the purpose of this study is to analyze the prevalence of diabetes with hyperuricemia, the risk factors and the relationship with renal function; 2, analyze the relationship between uric acid excretion, influence factors and renal function in diabetic patients with hyperuricemia; 3. The changes in the level of uric acid in the post blood, the relationship between 24h uric acid excretion and point uric acid. The subjects were recruited from July 2011 to September 2014 from the clinical center of diabetes in Shanghai and recruited 80 healthy volunteers as normal glucose tolerance and non hyperuricemia. Weight, detection of liver and kidney function, electrolyte, blood lipid, urine microalbumin and creatinine ratio, HbA1c, 24h uric acid and urine creatinine, urine creatinine, urine creatinine and other clinical indicators. The characteristics of different groups were compared with ANOVA, covariance was analyzed, t test was used for the continuous variables between the control group and the patient group, and the classified variables were checked by chi square test. Correlation analysis used Pearson correlation test, multivariate linear regression analysis and partial correlation analysis.Pearson correlation analysis showed that the variables associated with uric acid (P0.05) entered the stepwise linear regression analysis. Multivariate logistic regression analysis of the relationship between uric acid and diabetic patients with renal dysfunction and ISO albuminuria was.Gfr evaluation formula The consistency of mgfr was analyzed by Bland-Altman mapping. The efficacy of each formula in the diagnosis of ultrafiltration and renal dysfunction was analyzed by the subjects' working characteristic curve (receiver-operatingcharacteristiccurve, ROC curve). Results 1, the flow of diabetes with hyperuricemia, the risk factors and the relationship with the renal function Among Chinese diabetic patients, the prevalence of hyperuricemia was 15.87%, 14.52% in men and 17.80% in women, GFR, fasting C peptide, sex, urine microalbumin, age glycated albumin and BMI were independent of blood uric acid. Our study showed that the incidence of hyperuricemia in women with 49 years old was significantly higher than that of men. Sex, and with the increase of age, the prevalence of hyperuricemia increased gradually. With the increase of BMI, fasting C peptide and the increase of HOMA-IR using C peptide, the prevalence of hyperuricemia in diabetic patients increased gradually. The serum uric acid level was positively correlated with the C peptide and HOMA-IR in the empty stomach; with the increase of GA, both male and female, The prevalence of hyperuricemia gradually decreased, with the decrease of GFR level and the increase of microalbuminuria, the prevalence of hyperuricemia increased gradually. The risk of renal dysfunction and abnormal proteinuria in patients with hyperuricemia was significantly increased, the risk of ultrafiltration decreased significantly, and the correlation was independent of the year. Age, sex, BMI, the course of diabetes, HbA1c, SBP, DBP, LDL and HDL, and other related factors. In patients with hyperuricemia, the level of uric acid increased by each 1sd (94 mu mol/l), the risk of renal dysfunction increased by 0.8%, the risk of abnormal proteinuria increased by 0.3%, the risk of ultrafiltration was reduced by 0.5% (model2).2, diabetes mellitus, and diabetes mellitus. Uric acid excretion in patients with hyperuricemia, the influence factors and the relationship with renal function in type 1 or type 2 diabetes mellitus, the decrease of uric acid excretion and the increase of uric acid production in the absence of hyperuricemia, the increase of uric acid production, and the decrease of uric acid excretion in the case of hyperuricemia in gfr60ml/min/ 1.73m2 population, uric acid excretion in patients with type 1 diabetes combined with hyperuricemia was mainly increased by uric acid production, and type 2 diabetes was mainly induced by uric acid excretion, and uric acid excretion (feua) was independent of HDL, BMI, age, GA, sex, LDL, lnacr and TG. The study showed that the level of uric acid excretion was not significantly changed with the age of age, and the male was over 57 years old. The population of feua was significantly higher than those under 57 years of age. In each age group, the feua level of the female patients was significantly higher than that of the male feua. With the increase of BMI, GA and proteinuria, the level of feua increased significantly. The patients with diabetes without proteinuria increased significantly with the increase of uric acid excretion; the patients with proteinuria were high urine. In the acid population or in the non high uric acid population, with the increase of uric acid excretion, the urinary protein gradually increased and the GFR decreased gradually. In the population of general diabetes, the risk of renal dysfunction increased by 24.7%, the risk of abnormal proteinuria increased by 13.9% (model2) per 1sd (2.64%), and the formation of uric acid increased renal insufficiency in the population. The risk of proteinuria and proteinuria increased significantly. The or values were 5.187 (3.594-7.488, p0.001) and 1.875 (1.465-2.401, p0.001).3, the changes in the level of uric acid before and after the meal, the level of uric acid excretion and the assessment of the renal function in the normal population. There was no statistical difference between the abnormal glucose tolerance and the blood uric acid level of the diabetic group and the 2 hour meal. .feua was significantly related to blood uric acid, serum creatinine and urine creatinine at any point and urine creatinine. It was independent of blood uric acid and urinate at any point. The linear regression equation was feua=14.02-0.02 x sua-0.002 x UUA (mg/l), r=0.617. for GFR evaluation formula based on creatinine (CG, MDRD and CKD-EPI formula), the bias of CKD-EPI formula was the smallest, 15 The accuracy of%, 30% and 50% was the highest. The comparison of the MDRD formula, the cystatin C formula and the creatinine C formula showed that the bias of the creatinine C formula was the least, the accuracy and the accuracy of 15%, 30%, and 50% were the best, and the applicability of the cystatin C formula was the worst. Conclusion 1 in Chinese diabetic patients, the prevalence rate of hyperuricemia was 15.87% in men. The prevalence of hyperuricemia in women with diabetes was significantly higher than that of 14.52% in women and 17.80% in women. The prevalence rate of hyperuricemia in women with diabetes mellitus increased with age, with BMI, C peptide, HOMA-IR and proteinuria, and the decrease of GFR level, and hyperuria. The prevalence of acidemia increased gradually, with the increase of GA level, the prevalence of hyperuricemia gradually decreased.2. The risk of renal dysfunction and proteinuria increased significantly in patients with hyperuricemia, and the risk of ultrafiltration significantly decreased.3, no matter type 1 or type 2 diabetes, there was no hyperuricemia. The decrease of uric acid excretion and the increase of uric acid production are mainly in the increase of uric acid production; in patients with hyperuricemia, uric acid excretion is mainly reduced. In diabetic patients with normal renal function (gfr60ml/min/1.73m2), uric acid excretion is mainly increased in patients with type 1 diabetes and hyperuricemia, and type 2 diabetes mellitus is excreted with uric acid. The decrease in.4 and diabetes without proteinuria increased significantly with the increase of uric acid excretion; in the patients with proteinuria, both high uric acid and non high uric acid population, with the increase of uric acid excretion, the urinary protein gradually increased and GFR gradually decreased.5, in diabetic patients, whether or not hyperuricemia and urine were combined. The risk of renal dysfunction and proteinuria increased significantly by.6. There was no significant difference between normal population, abnormal glucose tolerance and diabetes and 2 hours of diabetes,.7, feua was independent of blood uric acid and urinate at any point. The linear regression equation was feua=14.02-0.02 * SUA-0.002 * UUA (mg/L), R =0.617.8, in the GFR assessment formula based on creatinine, the CKD-EPI formula is the best in the Chinese diabetic population. Compared with the MDRD formula and the cystatin C formula, the creatinine C formula is better in the Chinese diabetic population. This conclusion is also applicable to patients with different blood glucose levels.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R587.1;R589.7

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李黎;高尿酸血癥97例臨床分析[J];中國(guó)誤診學(xué)雜志;2005年14期

2 李曉君;;原發(fā)性擴(kuò)張型心肌病伴高尿酸血癥1例[J];現(xiàn)代中西醫(yī)結(jié)合雜志;2006年02期

3 楊玉霞;劉勇;;高尿酸血癥綜合系統(tǒng)管理分析[J];臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志;2006年06期

4 李玉珍;張曉華;;89例中老年人高尿酸血癥臨床分析[J];河北醫(yī)藥;2006年12期

5 呂才模;彭潔敏;劉曉燕;翟蓓;丁春艷;;烏魯木齊市漢族健康體檢者高尿酸血癥調(diào)查分析[J];內(nèi)科;2009年06期

6 陳素芬;;高尿酸血癥患者疾病相關(guān)知識(shí)調(diào)查分析[J];護(hù)理管理雜志;2009年08期

7 楊聰;黃謙;馮國(guó)君;劉云祥;;西藏某地區(qū)體檢人群高尿酸血癥分析[J];西南國(guó)防醫(yī)藥;2010年02期

8 袁自宏;g，

本文編號(hào)：2103567