| Background:With the improvement of living standards and lifestyle changes,the incidence of diabetes mellitus increased a lot.The world's largest diabetes mellitus epidemic is in China.It is well known that diabetes mellitus is harmful mainly because of its complications.Diabetic retinopathy(DR)is one of the most common microvascular complications of diabetes mellitus and is a leading cause of vision loss in working people.According to the data published by the World Health Organization(WHO),the blindness caused by DR accounts for 4.8%of the 37 million cases of blindness worldwide.A large number of epidemiological data show that duration of diabetes,poor control of glucose and blood pressure are the main factors that contribute to the occurrence and progression of DR.However,we observed that although diabetic patients had intensive control of blood glucose and blood pressure,the efficacy was still unsatisfactory,and the incidence of microvascular lesions in diabetic patients was still high.Therefore,it is speculated that there might be other important risk factors associated with the DR.Uric acid is the end product of purine metabolism.With more and more studies on uric acid,it has been found that serum uric acid has biological activity and has both positive and negative effects of antioxidation and promoting oxidative stress.In addition,uric acid can stimulate endothelial dysfunction,inflammation and vasoconstriction.Previous study have shown that serum uric acid(SUA)is an independent risk factor for cardiovascular disease,which is closely related to the components of metabolic syndrome,including obesity,hyperglycemia,dyslipidemia and insulin resistance.Recent studies have found that serum uric acid is associated with the occurrence and development of diabetic nephropathy,and uric acid-lowering therapy can reduce urinary albumin.However,the association between uric acid concentration and diabetic retinopathy is completely unclear.Objective:To analyze the association between serum uric acid levels and diabetic retinopathy and related metabolic factors in patients with type 2 diabetes mellitus.Methods:With a retrospective study,the selected population was 389 patients with type 2 diabetes who received in the department of Endocrinology,Shandong Provincial Hospital affiliated to Shandong University from March to September 2017 was recruited.Clinical history,biochemical indexes and fundus photographic results of these patients were collected.Firstly,the 389 cases are classified into two groups,the patients with DR(DR group)and the patients without DR(NDR group),and a comparison will be made in terms of prevalence rate of hyperuricemia and clinical variables.Multivariate logistic regression analysis was performed to estimate the odds ratio(OR)and 95%confidence intervals(Cls)for risk factors of DR.Then,the patients were divided into 4 quartile groups Q1,Q2,Q3 and Q4 according to SUA levels,so as to further discuss the relationship between uric acid and type 2 diabetic retinopathy.Correlation analysis were applied to analyze the relationship between uric acid and related metabolic factors.All data were analyzed with IBM SPSS software version 23.0.Results:(1)Compared with NDR group,age,duration of diabetes,ratio of HbAlc>7%,SUA and UACR in DR group increased significantly,and eGFR decreased significantly(P<0.05).The prevalence of hyperuricemia in DR group was 20.25%,and that in NDR group was 8.41%.The difference was statistically significant(P<0.05).(2)The prevalence of DR varies with the level of SUA.A positive trend was observed between the prevalence of DR and the level of SUA concentration in quartiles(?2= 20.76,P<0.001).There was a significant difference between the four groups.The prevalence of DR in Q1,Q2,Q3 and Q4 groups was 26.32%,36.00%,49.48%and 55.67%,respectively(?2= 20.76,P<0.001).We further compared the differences between the groups.We found that the prevalence of DR was significant higher in the third quartile and the fourth quartile than the first quartile.And compared with the second quartile,the fourth quartile were also significant higher in prevalence of DR(P<0.05).(3)Stepwise Logistic regression analysis showed that duration of diabetes,HbAlc Scr,and UACR were risk factors for DR.Different levels of SUA had different effects on DR.The higher range of SUA(Q3 and Q4)showed a higher risk for DR than the lower level(Q1)(OR 3.056,1.506-6.198,OR 3.417,95%Cl:1.635-7.139,respectively).(4)The correlation analysis showed that SUA was positively correlated with DBP,BMI,TG,Scr,and UACR(P<0.05),negatively correlated with age,HDL-C and eGFR(P<0.05).Conclusion:(1)Elevated SUA levels is associated with diabetic retinopathy.Besides actively adjusting blood pressure and blood sugar,we should put emphasis on uric acid in the diagnosis and treatment of type 2 diabetes.(2)The uric acid is closely related with DBP,BMI,TQ Scr,UACR and eGFR,which may be contribute to the diabetic retinopathy. |
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