糖化血红蛋白变异指数对2型糖尿病患者发生高尿酸血症的预测价值研究

背景糖化血红蛋白变异指数（HGI）是一种衡量血红蛋白糖化程度的简易指标，与糖尿病微血管和大血管病变等多种慢性并发症密切相关，但目前国内外关于HGI与2型糖尿病（T2DM）患者高尿酸血症（HUA）发生情况的关系研究较少。目的探讨HGI对T2DM患者发生HUA的预测价值。方法选取2017年1月至2021年1月于西南医科大学附属医院内分泌科就诊并建立档案的符合研究标准的1 194例T2DM患者为研究对象。记录患者基本信息、体格检查指标、实验室检查指标，计算HGI。根据HGI三分位数法将研究对象分为低HGI组（HGI<-0.94%）、中HGI组（-0.94%≤HGI<0.27%）和高HGI组（HGI≥0.27%）。采用多因素Logistic回归分析探究T2DM患者发生HUA的影响因素。绘制HGI联合临床指标预测T2DM患者发生HUA的受试者工作特征（ROC）曲线。结果低HGI组、中HGI组和高HGI组T2DM患者HUA的发生率分别为17.09%（68/398）、27.14%（108/398）和31.66%（126/398）。中HGI组和高HGI组患者HUA发生率均高于低HGI组（χ2值分别为11.672、22.928，P<0.01）。多因素Logistic回归分析结果显示，年龄〔OR=1.048，95%CI（1.029，1.067）〕、皮下脂肪面积（SFA）〔OR=1.006，95%CI（1.001，1.010）〕、三酰甘油（TG）〔OR=1.096，95%CI（1.034，1.161）〕、高密度脂蛋白胆固醇（HDL-C）〔OR=0.560，95%CI（0.326，0.961）〕、HGI〔OR=1.360，95%CI（1.208，1.531）〕是T2DM患者发生HUA的独立影响因素（P<0.05）。校正年龄、SFA、TG、HDL-C影响因素后的多因素Logistic回归分析结果显示，中HGI组患者发生HUA的风险是低HGI组的1.855倍〔95%CI（1.283，2.681），P<0.001〕，高HGI组患者发生HUA的风险是低HGI组的2.192倍〔95%CI（1.530，3.141），P<0.001〕。HGI联合临床指标〔 Logit（P）=-4.549+0.618×中HGI组+0.785×高HGI组+0.039×年龄+0.008×SFA+0.088×TG-0.750×HDL-C〕诊断T2DM患者发生HUA的ROC曲线下面积（AUC）为0.71〔95%CI（0.68，0.75）〕，最佳截断值为0.208，灵敏度为78.7%，特异度为53.5%，约登指数为0.322。结论HGI升高的T2DM患者更易发生HUA，且HGI可作为预测T2DM患者发生HUA的临床指标。

Predictive Value of Hemoglobin Glycation Index for Hyperuricemia in Type 2 Diabetes

Background Hemoglobin glycation index(HGI)is a simple marker of hemoglobin glycation,which is closely related to various chronic complications,such as diabetic microvasculopathy and macroavasculopathy.However,there are few studies on the relationship between HGI and hyperuricemia(HUA)in type 2 diabetes mellitus(T2DM).Objective To investigate the predictive value of HGI for HUA in T2DM.Methods Eligible participants were T2DM patients(n=1194)who received treatment and personal health record creation services from Department of Endocrinology,the Affiliated Hospital of Southwest Medical University between January 2017 and January 2021.Demographics,physical examination information,laboratory test markers and calculated HGI were collected.HUA prevalence was compared across tertile groups of HGI〔low HGI(<-0.94%),moderate HGI(-0.94%≤HGI<0.27%),and high HGI(HGI≥0.27%)〕.Multivariate Logistic regression analysis was used to explore the factors affecting the development of HUA in T2DM.The receiver operating characteristic(ROC)curve was plotted for HGI with clinical markers in predicting HUA in T2DM.Results Low HGI group had much lower prevalence of HUA than did moderate HGI group〔17.09%(68/398)vs 27.14%(108/398),χ²=11.672,P<0.01〕and high HGI group〔17.09%(68/398)vs 31.66%(126/398),χ²=22.928,P<0.01〕.Multivariate Logistic regression analysis found that age〔OR=1.048,95%CI(1.029,1.067)〕,subcutaneous fat area(SFA)〔OR=1.006,95%CI(1.001,1.010)〕,triglyceride(TG)〔OR=1.096,95%CI(1.034,1.161)〕,high density lipid-cholesterol(HDL-C)〔OR=0.560,95%CI(0.326,0.961)〕,and HGI〔OR=1.360,95%CI(1.208,1.531)〕independently influenced the development of HUA in T2DM(P<0.05).After adjusting for age,SFA,TG,and HDL-C,it was found that the risk of HUA was 1.855 times higher in moderate HGI group〔95%CI(1.283,2.681),P<0.001〕,and 2.192 times higher in high HGI group〔95%CI(1.530,3.141),P<0.001〕compared to that of low HGI group.The AUC for HGI with clinical markers〔Logit(P)=-4.549+0.618×moderate HGI+0.785×high HGI+0.039×age+0.008×SFA+0.088×TG-0.750×HDL-C〕to diagnose HUA in T2DM was 0.71〔95%CI(0.68,0.75)〕,with sensitivity of 78.7%,specificity of 53.5%,Youden index of 0.322,and optimal cut-off value of 0.208.Conclusion T2DM patients with elevated HGI may be more prone to HUA.HGI could be used as a clinical predictor of HUA in T2DM.