Mei Huang, Qianying Wei, Xin Chen, Yao Qin, Liuyan Dai, Yuxiao Li, Yong Gu, Yang Chen, Tao Yang, Mei Zhang
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引用次数: 0
Abstract
Purpose: To investigate the correlation between serum uric acid (SUA) levels and the risk for diabetic nephropathy (DN) in Chinese patients with type 1 diabetes mellitus (T1DM) and determine the potential optimal SUA threshold.
Methods: In this case-control study, 913 T1DM patients were matched 1:1 with healthy controls by age and sex. Multivariable adjusted logistic regression analysis was used to investigate the association between SUA levels and the risk of developing DN. Restricted cubic spline (RCS) was applied to investigate the optimal threshold for SUA. Additionally, longitudinal analysis of 94 patients with at least three visits accessed SUA variability correlations with estimated glomerular filtration rate (eGFR) and urinary albumin creatinine ratio (UACR) changes using Spearman's correlation analysis. A linear mixed-effects model was performed to access the correlations in SUA, eGFR, and UACR over time.
Results: T1DM patients exhibited significantly lower median SUA levels (4.24 vs. 4.93 mg/dL, P < 0.001) than controls. The incidence of DN was 12% in T1DM patients. After adjusting for confounding factors, the SUA level was inversely significantly correlated with the risk for DN as a continuous variable (OR: 1.47; 1.25-1.74) and in quartile 4 (OR: 3.01; 1.44-6.50), respectively. The RCS plot revealed an identified threshold of SUA as being 4.30 mg/dL with increasing risk for DN. Correlation analysis showed the SUA variability significantly correlate with eGFR variability (r = 0.206, P = 0.046) and UACR variability (r = 0.405, P = 0.025). The linear mixed-effects model revealed a significant negative relationship between SUA and eGFR over time (R2 = 0.035, P < 0.001), as well as a significant positive relationship between SUA and UACR (R2 = 0.041, P < 0.001).
Conclusions: Our study revealed that decreased SUA level is common in T1DM and identified the threshold as being 4.30 mg/dL for increased DN risk.
目的：探讨中国1型糖尿病（T1DM）患者血清尿酸（SUA）水平与糖尿病肾病（DN）风险的相关性，并确定SUA的潜在最佳阈值。方法：913例T1DM患者按年龄、性别与健康对照者1:1配对。采用多变量调整logistic回归分析探讨SUA水平与DN发生风险之间的关系。采用限制三次样条（RCS）法对SUA的最佳阈值进行了研究。此外，对94例至少就诊三次的患者进行纵向分析，使用Spearman相关分析获得SUA变异性与肾小球滤过率（eGFR）和尿白蛋白肌酐比（UACR）变化的相关性。采用线性混合效应模型来获取SUA、eGFR和UACR随时间的相关性。结果：T1DM患者的中位SUA水平显著降低（4.24 vs 4.93 mg/dL, P 2 = 0.035, P 2 = 0.041， P）。结论：我们的研究显示，SUA水平降低在T1DM患者中很常见，并确定了4.30 mg/dL为DN风险增加的阈值。
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