Correlation Analysis Of Uric Acid To High-density Lipoprotein Cholesterol Ratio And Type 2 Diabetic Kidney Disease

BackgroundWith the development of social economy and the change of people’s living and eating habits,the prevalence of overweight and obesity in China is increasing.The current incidence rate of diabetes mellitus is so high that it is a huge economic burden for patients and the society.One of diabetic microvascular complications,diabetic kidney disease(DKD)is still an important cause of chronic kidney disease and end-stage renal disease,with a prevalence rate of 20%-40%in adult type 2 diabetic patients in China.The disadvantages of DKD are its insidious onset,and the serious kidney damage in the later stage.Therefore,the early diagnosis,prevention and postponement of the occurrence and development of DKD are of great significance to diabetic patients and society.Insulin resistance is an important feature of type 2 diabetes mellitus(T2DM),which plays an important role in renal function impairment.Uric acid is the end product of purine metabolism,most of which is excreted by the kidney.Physiological concentration of uric acid has antioxidant effect,while high concentration of uric acid can induce oxidative stress and inflammation,which is an important mechanism of the development of DKD.Multiple studies have confirmed that high uric acid is an independent risk factor for type 2 DKD.Highdensity lipoprotein cholesterol(HDL)also plays an important role in the development of DKD.An association between uric acid and HDL has also been reported.HDL has antioxidant and anti-inflammatory effects.High uric acid and low HDL may play a synergistic role in the occurrence and development of DKD.The ratio of uric acid to high-density lipoprotein cholesterol(UHR)is calculated from uric acid and HDL,combined with uric acid and lipids.In recent years,studies have found that UHR is associated with the level of blood glucose control in T2DM,metabolic syndrome in T2DM,and non-alcoholic fatty liver disease.However,there are no studies conducted on the relationship between UHR and insulin resistance and DKD all over the world.Because renal failure can lead to an increase in serum uric acid,a large number of studies have introduced the uric acid to creatinine ratio(UA/Cr)to normalize renal function with uric acid value.Studies have confirmed that UA/Cr is a risk factor for DKD.ObjectiveTo explore the correlation between UHR,insulin resistance and DKD in patients with type 2 diabetes,and to compare the diagnostic value of UHR,UA/Cr,UA and HDL in DKD.MethodsA total of 378 adult patients with T2DM who were admitted to the Department of Endocrinology of the First Affiliated Hospital of Zhengzhou University from October 2017 to January 2021 and met the inclusion and exclusion criteria of this study,were selected as the study subjects(group T2DM).210 healthy subjects who were admitted to our hospital during the same period for routine physical examination were selected as the healthy control group(group HC).Medical history and clinical data of the subjects were collected.According to DKD risk stages,the group T2DM was divided into group simple diabetes mellitus(SDM)/low risk,group medium risk,group high risk and group very high risk,according to the stages of albuminuria and glomerular filtration rate.Differences in various indicators between the study groups were observed.The correlation between each index and UHR,UACR and eGFR was analyzed,and multivariate ordered Logistic regression was used for multivariate analysis.The receiver operating curve(ROC)was plotted to assess the diagnostic value.Results1.There are no statistically significant differences in gender,age and HDL between the group HC and the group T2DM(P>0.05).BMI,SBP,DBP,Urea,UA,Cr,FBG,HbAlc,TC,TG,LDL,UA/Cr and UHR in group T2DM are higher than those in group HC(P<0.05),and eGFR is lower than that in group HC(P<0.05).2.There are no significant differences in gender,DBP,TC and LDL among the four T2DM groups(P>0.05),but there are significant differences in age,DM course,BMI,SBP,FBG,HbAlc,Urea,Cr,UA,eGFR,TG,HDL,UACR,UHR,HOMA2-IR,UA/Cr among the four T2DM groups(P<0.05).3.UHR is positively correlated with BMI,SBP,DBP,UACR,Cr,Urea,UA,TG and HOMA2-IR(r=0.384,0.234,0.152,0.328,0.419,0.334,0.807,0.495,0.346,respectively,P<0.05).UHR is negatively correlated with age,HbAlc,eGFR,HDL and LDL(r=-0.135,-0.112,-0.326,-0.698 and-0.202,respectively,P<0.05).There is no correlation between UHR with the duration of DM,FBG,TC,UA/Cr(P>0.05).4.UACR is positively correlated with age,BMI,DM course,SBP,Urea,UA,Cr,TC,TG,UHR and HOMA2-IR(r=0.121,0.129,0.226,0.176,0.385,0.326,0.502,0.190,0.353,0.328,0.139,respectively,P<0.05).UACR is negatively correlated with eGFR,HDL and UA/Cr(r=-0.524,-0.119 and-0.186,respectively,P<0.05).There is no correlation between UACR with DBP,FBG,HbA1c,LDL(P>0.05).5.eGFR is negatively correlated with age,BMI,DM course,SBP,Cr,UA,Urea,UHR,UACR(r=-0.656,-0.134,-0.357,-0.789,-0.428,-0.747,-0.326,-0.524,respectively,P<0.05).eGFR is positively correlated with LDL and UA/Cr(r=0.130 and 0.391,P<0.05).There is no correlation between eGFR with DBP,FBG,HbA1c,TC,HDL,TG,HOMA2-IR(P>0.05).6.Multiple ordered Logistic regression was performed with the stages of low risk,medium risk,high risk and very high risk of DKD as dependent variables.Univariate analysis showes that age(OR:1.031,95%CI:1.014,1.050),duration of DM(OR:1.092,95%CI:1.062,1.122),SBP(OR:1.057,95%CI:1.042,1.071),UACR(OR:1.013,95%CI:1.011,1.015),HOMA2-IR(OR:1.737,95%CI:1.334,2.261),UHR(OR:1.107,95%CI:1.067,1.149)are risk factors for higher risk grade of DKD(P<0.05),and eGFR(OR:0.937,95%CI:0.927,0.947),UA/Cr(OR:0.773,95%CI:0.697,0.861)are the protective factors of DKD risk grade(P<0.05).Multi-factor analysis was used when parallel lines in the diagnosis of P<0.05.After adjustment of confounding factors,the results indicate the age(OR:1.033,95%CI:1.004,1.063),SBP(OR:1.033,95%CI:1.014,1.051),UACR(OR:1.013,95%CI:1.010,1.016),HOMA2-IR(OR:1.697,95%CI:1.186,2.428)are independent risk factors for the development of higher DKD risk(P<0.05),eGFR(OR:0.946,95%CI:0.929,0.965)is an independent protective factor for higher risk grade of DKD(P<0.05).7.Receiver operating curve analysis was performed for DKD.UHR,UA/Cr,UA,HDL and Cr were included as test indexes,and DKD was the diagnostic criteria.The results showes that the area under the curve of UHR is the highest(AUC:0.674;95%CI:0.624,0.721,P<0.05).The diagnostic value of UHR is higher than that of UA/Cr(AUC:0.572;P<0.05),HDL(AUC:0.630;P<0.05).When the value of UHR is 11.35%,the sensitivity and specificity of diagnosis are the highest,which is 61.8%and 68.1%respectively.Conclusions1.UHR increases with the increase of the risk grade of type 2 diabetic kidney disease,and is a risk factor for the increase of the risk grade of type 2 diabetic kidney disease.2.Compared with UA/Cr and HDL,UHR has a higher diagnostic value for type 2 diabetic kidney disease.