目的    探讨2型糖尿病（2型DM）患者血尿酸（SUA）水平与尿蛋白量及肾小球滤过率之间的相关关系，评估SUA预测糖尿病肾病（DN）预后的价值。 方法    回顾性分析武汉大学人民医院2012年5月至2013年5月住院且资料完整的2型DM患者220 例，按照尿白蛋白排泄率（UAER）和（或）24 h尿蛋白量将入选病例分为：（1）尿蛋白量正常组（NAU）；（2）微量蛋白尿组（MAU）；（3）大量蛋白尿组（MAAU）。前两组按照SUA＞420 μmol/L与否（女性 SUA＞357 μmol/L）分为血尿酸正常和高尿酸血症两个亚组；按照eGFR＞90 ml/min与否分为肾功能正常和肾功能下降两亚组。分析各组间患者血尿酸水平与临床表现、生化检查及eGFR之间的关系。采用Pearson和多元线性回归法分析血尿酸水平与尿蛋白、eGFR的相关性；Binary logistic回归法分析微量蛋白尿和轻度肾功能下降的危险因素。 结果    NAU、MAU和MAAU两两组间在收缩压、糖尿病病程（DD）、Scr、SUA方面的差异有统计学意义（均P＜0.05），Scr、SUA在MAAU组最高，NAU组最低（均P＜0.01）；eGFR在MAAU组最低，NAU组最高（均P＜0.05）。与NAU组比较，MAAU组和MAU组患者总胆固醇（Tch）、三酰甘油（TG）及糖化血红蛋白比率（HbA1C%）明显升高（均P＜0.05）。MAAU组和MAU组患者的高尿酸血症发生率明显高于NAU组（分别为56.9%比17.5%，51.2%比17.5%，均P＜0.05）。MAU组中的正常血尿酸和高血尿酸亚组间UAER差异明显大于NAU组。亚组分析结果提示：高血尿酸组较正常血尿酸组UAER高。线性回归分析结果显示年龄、血尿酸水平与eGFR呈负相关。logistic多因素回归分析结果提示血尿酸是预测蛋白尿的独立危险因素。 结论    2型糖尿病患者血尿酸和微量白蛋白尿水平与肾功能下降独立相关。

Objective    To investigate association between serum uric acid (SUA), albuminuria and glomerular filtration rates (eGFR) in type 2 diabetic patients.    Methods    A total of 220 patients were enrolled in this cross-sectional study. According to urinary albumin excretion rates, patients were divided into 3 groups: normoalbuminuria (NAU) group, microalbuminuria (MAU) group, and macroalbumnuria group (MAAU). The first two groups were subdivided at SUA＞420 μmol/L (＞357 μmol/L, female) into normouricemia group and hyperuricemia group, at eGFR＞90 ml/min into high and low renal function groups. General information, blood biochemical results were collected to analyze the association between serum uric acid, eGFR, UAER and urine albumin quantification among different groups.    Results    The difference of SBP, duration of diabetes (DD), Scr, SUA and eGFR between every two groups were significant (P＜0.05). SBP, DD, Scr and SUA were highest in subjects with macroalbumnuria, second in microalbuminuria group, and lowest in normoalbuminuria group, while eGFR was lowest in macroalbumnuria group and highest in normoalbuminuria group. Prevalence of hyperuricemia in macroalbumnuria group (56.9%) and microalbuminuria group (51.2%) were also significantly higher than that in normoalbuminuria group (17.5%) (all P＜0.01). The difference of UAER in the subgroups of normouricemia and hyperuricemia was more significant in microalbuminuria   group than in normoalbuminuria group. eGFR was significantly lower in hyperuricemia subgroups (P＜0.01). Age and SUA were significantlg higher in subjects with low renal function compared with high eGFR (P＜0.05). Linear regression analysis indicated SUA was negatively correlated with eGFR after adjusted age, DD and UAER (β＝-0.430, P＜0.01). Binary logistic regression analysis found that increased age, DD and SUA were risk factors of microalbuminuria [β＝1.092, 95％CI(1.025, 1.163), P＜0.01; β＝1.005, 95%CI(1.001, 1.009), P＜0.05; β＝1.407, 95％CI(1.052, 1.881), P＜0.05)] and SUA, age were risk factors of early renal function decline [β＝1.015, 95％CI(1.00, 1.023), P＜0.01; β＝1.098, 95％CI(1.006, 1.199), P＜0.05].    Conclusion    SUA is independently associated with albumnuria and renal function decline in type 2 DM patients.