Association Study Of Serum Uric Acid And Lower Extremity Arterial Disease In Patients With Type 2 Diabetes

Objective: Lower extremity arterial disease(LEAD) was one of the main complications in type 2 diabetes mellitus(T2DM), which caused serious consequences, such as diabetic foot and amputation. Purine metabolism led to the production of uric acid. Recent studies indicated that increased uric acid impaired the function of endothelial cells and led to the development of vascular diseases. However, there was still less evidence about the relationship between uric acid and vascular complications in T2 DM patients. In this study, we collected the clinical data of T2 DM inpatients in Hebei General Hospital, analyzed the potential risk factors of LEAD and explored the association between uric acid and LEAD in T2 DM patients.Methods: 431 inpatients with T2 DM were recruited in this study from September 2013 to July 2014 in Hebei General Hospital. There were 238 males and 193 females, aged from 41~83, with course of disease from 1~25 years. Based on LEAD or without LEAD,all patients were divided into two groups. Clinical data of each patient was collected, including age, course of T2 DM, height, systolic blood pressure(SBP), diastolic blood pressure(DBP), fasting plasma glucose(FPG), 2h plasma glucose(2h PG), Hb A1 c, total cholesterol(TC), triglyceride(TG), low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C), apolipoprotein A1(Apo A1), apolipoprotein B(Apo B), serum uric acid(SUA), creatinine(Cr), blood urea nitrogen(BUN), alanine aminotransferase(ALT), aspartate aminotransferase(AST) and gamma- glutamyl transpeptidase(γ-GT). Ankle brachial index(ABI) was determined by blood pressure and pulse check. Lower extremity arteriosclerosis or occlusion was evaluated by ultrasonic Doppler. All statistical tests were performed using SPSS software.Results:1 There were 99 males and 83 females in the LEAD group, with average age 64.38±12.44. There were 139 males and 110 females in the Non-LEAD group, with average age 62.67±11.86. There were significant differences in SBP and course of disease between two groups(P<0.05). Age, BMI and DBP showed no significant difference between LEAD and Non-LEAD groups.2 FPG, Hb A1 c, TG, LDL-C, SUA and Apo B were significant higher in patients with LEAD than those in patients without LEAD; while HDL-C and Apo A1 showed the opposite results(P<0.05). There were no significant differences in TC, 2h PG, Cr, BUN, ALT, AST and γ-GT between LEAD group and Non-LEAD group.3 We used logistic regression to analyze the risk factors of LEAD in T2 DM patients. The result showed that seven factors entered the regression equation, including SBP(OR:1.02, 95%CI:1.00-1.03, P=0.029), FPG(OR:1.20, 95%CI:1.11-1.30, P<0.001), Hb A1c(OR:1.17, 95%CI:1.06-1.30, P=0.002), HDL-C(OR:0.28, 95%CI:0.14-0.55, P<0.001)、SUA(OR:1.01, 95%CI: 1.00-1.01, P<0.001), Apo A1(OR:0.04, 95%CI:0.01-0.16, P<0.001), Apo B(OR:8.99, 95%CI:2.91-27.77, P<0.001).4 Based on the quartile of serum uric acid, all patients were divided into four groups: Q1≤252umol/L(108), Q2:253-323umol/L(108), Q3:324-430umol/L(107) and Q4≥431umo/L(108). The prevalence of LEAD was 22.2% in Q1, 26.9% in Q2, 49.5% in Q3 and 70.4% in Q4, respectively. There was no significant difference in LEAD prevalence between Q1 and Q2(P=0.429). Compared with Q1, the LEAD incidence was significantly higher in Q3 and Q4(P<0.05). The prevalences of coronary heart disease(CHD), diabetic nephropathy(DN), diabetic peripheral neuropathy(DPN) and diabetic retinopathy(DR), were significant lower in Q1 than those in Q3 and Q4(P=0.003 and P<0.001 for CHD, P=0.039 and P<0.001 for DN, P<0.001 and P<0.001 for DPN, P=0.001 and P<0.001 for DN). There were no significant differences in the prevalence of cerebral vascular disease and diabetic foot among Q1, Q2, Q3 and Q4(P>0.05).5 Logistic regression analysis showed the prevalence of LEAD was significant higher in Q3(OR:3.44, 95%CI:1.90-6.20, P<0.001) and Q4(OR:8.31, 95%CI:4.50-15.35, P<0.001) than that in Q1. After adjusting course of disease, BMI and blood pressure, the LEAD prevalence was still higher in Q3(OR:2.99, 95%CI:1.62-5.52, P<0.001) and Q4(OR:9.45, 95%CI:4.74-18.86, P<0.001) when compared with Q1. Further adjusting with FPG, Hb A1 C, TC, TG, LDL-C, HDL-C, Cr, BUN, γ-GT, Apo A1 and Apo B, the results above were still existed, with the OR and 95%CI as follows:(OR:2.31, 95%CI:1.08-4.92, P<0.001) for Q3 and(OR:6.44, 95%CI:2.76-15.01, P<0.001) for Q4.Conclusions:1 Elevated serum uric acid was associated with T2 DM complications. The prevalence of LEAD in T2 DM patients increased accompanied with the rise of serum uric acid. High serum uric acid was a risk factor of LEAD in T2 DM patients.2 Increase of Course of disease, TG, LDL-C, blood glucose, SBP and decrease of HDL-C were associated with LEAD in T2 DM patients.