Relationship Between Atherosclerosis, Adiponectin And C-reactive Protein Of Type 2 Diabetes Mellitus With High Uric Acid Level

Objective Prevalence of diabetes, hyperuricemia or gout increased significantly. Atherosclerosis is the major pathological basis of diabetic macro- vascular complications, which occurs early and develops rapidly, without specificity in histopathology. Macro-vascular complications suffered by patients with type 2 diabetes mellitus are the main causes of death for type 2 diabetic patients. Cardio and cerebral vascular diseases induced by Diabetic vascular disease-atherosclerosis (AS) are the leading causes of disability in patients with type 2 diabetes mellitus (T2DM). T2DM is known to be associated with hyperuricemia, patients with T2DM have obvious metabolic disorders, including lipid metabolism disorders, uric acid metabolism disorders, which may cause macro-vascular and micro-vascular complications. A number of studies have shown hyperuricemia is an independent risk factor contributing to atherosclerotic cardiovascular disease, and represent a link with metabolic syndrome (MS) components as obesity, dyslipidemia, hypertension, coronary heart disease and atherosclerosis disease. Diabetes and hyperuricemia are both the independent risk factors for atherosclerosis. They effect on each other and lead to aggravation of diabetic macro-vascular complications. Adiponectin is associated with insulin resistance, diabetes and its macro-angiopathy complication, while C-reactive protein is associated with increased risk of cardiovascular disease. Carotid intima-media thickness (C-IMT) measured noninvasively by ultra-sonography is now widely used as a surrogate marker for atherosclerotic diseases and is directly associated with increased risks of cardiovascular disease. IMT is used to represent the level of arteriosclerosis. To investigate the relationship between the intima-media thickness (IMT), adiponectin (APN) and C-reactive protein (CRP) of type 2 diabetes mellitus (T2DM) with high uric acid level and to evaluate the effect of APN and CRP on atherosclerosis (AS) of these groups.Methods 85 cases with T2DM were divided into two groups: normal serum uric acid group (NUADM, n=42) and hyperuricemia group (HUADM, n=43). The serum levels of uric acid (UA), fasting plasma glucose (FPG), fasting insulin (FINS), APN, CRP, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG), glycosylated hemoglobin A1c (HbA₁c), two hour plasma glucose (2hPG), two hour insulin (2hINS), and IMT were detected. Body mass index (BMI), waist-hip-ratio (WHR) and homeostasis model assessment of insulin resistance (HOMA-IR) were calculated. A multiple stepwise regression analysis was used on IMT as the dependent variable, and the levels of APN, CRP, FINS, HDL-C, LDL-C, TC, TG, HbA₁c, BMI, WHR, and HOMA-IR as the independent variables in HUADM group. The protocol was approved by the ethics committee of the National Public Heath Institute. All participants gave written informed consent.Results 1. There was no difference in age, sexuality, diastolic blood pressure (DBP) between two groups. BP,BMI and WHR in HUADM group were higher than those in NUADM in statistics (P<0.05).2. Compare serum lipids in two groups: The level of TG in HUADM group was higher than control group P<0.05; the level of HDL-C was lower than control group P<0.05. There were no significant differences between HUADM and NUADM in TC and LDL-C. The levels of HbA1c,FPG, 2hPG,FINS, 2hINS and HOMA-IR were higher than control group P<0.05 or P<0.01.3. To compare C-IMT,CRP and adiponectin in two groups, we can see that C-IMT were higher in HUADM groups compared to the control cases, the concentration of serum CRP increased in HUADM group compared with that in NUADM group and the plasma adiponectin levels in HUADM group is significantly lower than the other group in statistics (P<0.01).4. A linear correlation analysis was used on IMT, age, course, SBP,DBP,BMI,WHR,HbA1C,FPG,2hPG,FINS,2hINS,HOMA-IR,TC,TG,HDL-C,LDL-C,UA,APN and CRP in HUADM group. IMT levels were positively correlated with SBP,BMI,WHR,HbA1C,FPG,FINS,HOMA-IR,TC,TG,LDL-C,UA,CRP, P<0.05 or P<0.01, but negatively correlated with APN, HDL-C, P<0.05 or P<0.01.5. A multiple stepwise regression analysis was used on IMT as the dependent variable, and the levels of age, SBP,DBP,BMI,WHR,HbA1C,FPG,2hPG,FINS,2hINS,HOMA-IR,TC,TG,LDL-C,HDL-C,UA,APN,CRP as the independent variables in HUADM group. It revealed that HOMA-IR,TG,APN,LDL-C and CRP entered regression equation in HUADM group. HOMA-IR,TG,LDL-C and CRP was positively correlated with IMT levels, but negatively correlated with APN.Conclusions 1.Type 2 diabetes individuals with high uric acid level are characterized by both metabolic disorder and insulin resistant more than control group.2.Type 2 diabetes individuals with high uric acid level are more prone to atherosclerosis disease.3.HOMA-IR,TG,APN,LDL-C and CRP were the most influential factors that affected IMT levels in type 2 diabetes individuals with high uric acid, so we deduced that with the increase of insulin resistant, lipid disorder, high level of CRP, and decrease in APN were all participated in the formation and progress of atherosclerosis.