男性2型糖尿病血尿酸水平与胰岛β细胞功能的相关性

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摘要目的：探讨男性2型糖尿病患者血尿酸水平与胰岛β细胞功能的相关性。方法：选取2014年12月至2016年4月于南京医科大学第一附属医院内分泌科住院的510例男性2型糖尿病患者作为研究对象，根据血尿酸水平分为高尿酸组（50例）和正常尿酸组（460例），测定人体参数、血尿酸、生化指标、胰岛自身抗体，并行馒头餐试验评估患者胰岛β细胞功能及胰岛素抵抗。结果：线性相关分析发现血尿酸与△C30/△G30（r=0.122，P=0.006）、iCpAUC180/iGAUC180（r=0.304，P＜0.001）、胰岛素分泌功能指数（HOMA2-%β）（r=0.267，P＜0.001）、CpAUC180（r=0.328，P＜0.001）及胰岛素抵抗指数（HOMA2-IR）（r=0.248，P＜0.001）均呈正相关。高尿酸组（50例）与正常尿酸组（460例）的血尿酸水平分别为（480.63±57.39）µmol/L、（304.22±59.38）µmol/L。高尿酸组与正常尿酸组相比，HOMA2-IR（1.76±0.80 vs. 1.34±0.71，P＜0.001）、HOMA2-%β（89.15±47.64 vs. 67.18±30.88，P＜0.001）、△C30/△G30（146.43±166.05 vs. 75.00±184.45，P=0.009）、CpAUC180（5 991.02±2 549.86 vs. 4 577.51± 1 970.00，P＜0.001）和iCpAUC180/iGAUC180（222.29±175.86 vs. 140.79±104.81，P＜0.001）更高；校正组间差异后，差异仍有统计学意义（均P＜0.05）。对胰岛自身抗体阴性患者进行分析，高尿酸组的HOMA2-IR、HOMA2-%β、△C30/△G30、CpAUC180和iCpAUC180/iGAUC180更高（均P＜0.05）。在校正组间差异后，高尿酸组与正常尿酸组相比HOMA2-%β、CpAUC180和iCpAUC180/iGAUC180仍高，而HOMA2-IR（F=2.141，P=0.144）和△C30/△G30（F=3.655，P=0.057）差异无统计学意义。结论：男性2型糖尿病血尿酸与馒头餐负荷的胰岛β细胞功能及胰岛素抵抗正相关；代谢综合征及胰岛自身抗体可能影响男性2型糖尿病血尿酸与胰岛β细胞功能的相关性。

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关键词 ：血尿酸；2型糖尿病；&beta, 细胞功能；胰岛自身抗体

Abstract：Objective: To investigate the correlation of serum uric acid and β-cell function in male type 2 diabetes. Methods: A total of 510 male patients who were clinically diagnosed as type 2 diabetes and received treatment at the First Affiliated Hospital of Nanjing Medical University between December 2014 and April 2016 were enrolled in this study. They were divided into hyperuricemia group (n=50) and normal uric acid group (n=460) based on the levels of serum uric acid. The body parameters, blood uric acid, biochemical indexes and islet autoantibodies were measured. The function of islet β-cell and insulin resistance was evaluated in parallel with mixed-meal tolerance test. Results: The linear correlation analysis between the two groups showed that the serum uric acid was positively correlated with ΔC30/ΔG30(r=0.122, P=0.006), iCpAUC180/iGAUC180 (r=0.304, P<0.001), HOMA2-% β(r=0.267, P<0.001), CpAUC180(r=0.328, P<0.001) and HOMA2-IR(r=0.248, P<0.001). The serum uric acid levels of the hyperuricemia and the normal uric acid groups were (480.63±57.39) and (304.22± 59.38) µmol/L respectively. Compared with the normal uric acid group, the hyperuricemia group showed significant higher HOMA2-IR (1.76±0.80 vs. 1.34±0.71, P<0.001), HOMA2-%β (89.15±47.64 vs. 67.18±30.88, P<0.001), ΔC30/ΔG30 (146.43±166.05 vs. 75.00±184.45, P=0.009), CpAUC180 (5 991.02±2 549.86 vs. 4 577.51±1 970.00,
P<0.001) and iCpAUC180/iGAUC180 (222.29±175.86 vs. 140.79±104.81, P<0.001). After adjusting the unbalanced factors between two groups, all calculated parameters of β-cell function and insulin resistance were also different between two groups. In the islet autoantibody negative patients, the hyperuricemia group had higher HOMA2-IR, HOMA2-%β, ΔC30/ΔG30, CpAUC180 and iCpAUC180/iGAUC180 (all P<0.05) compared to the normal uric acid group. After adjusting the unbalanced factors between two groups, HOMA2-%β, CpAUC180 and iCpAUC180/iGAUC180 were also significantly higher in the hyperuricemia group than those in the control group. But there were no statistical differences in HOMA2-IR (F=2.141, P=0.144) and ΔC30/ΔG30 (F=3.655, P=0.057) between two groups. Conclusion: The serum level of uric acid was positively correlated to islet β-cell function and insulin resistance evaluated in parallel with mixed-meal tolerance test. Metabolic syndrome and islet autoantibodies might affect the relationship between serum uric acid and islet β-cell function in male patients with type 2 diabetes.

Key words： serum uric acid diabetes mellitus, type 2 beta cell function islet autoantibodies

收稿日期: 2018-09-29

基金资助:国家自然科学基金资助项目（81270897，81530026）。

通讯作者: 杨涛，教授，Email：yangt@njmu.edu.cn。

作者简介: 何银辉（1982-），男，江西新干人，副主任医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2019/V49/I3/162

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