尿酸與糖尿病之相關性探討—臺灣北部某區域醫院成人健檢資料分析

Gender Difference in the Association between Serum Uric Acid and Diabetes Mellitus

目的：目前已知尿酸和胰島素阻抗及新陳代謝症候群有關，但針對尿酸和糖尿病的相關性及其在不同性別差異性進行探討的研究仍不多見。本研究透過分析統計全民健保成人預防保健資料，探討尿酸與糖尿病的相關性。
方法：本研究使用2006至2011年北部某區域醫院所承作的健保成人健檢資料樣本共7,568人進行統計分析，依其過去病史、健康行為、身高、體重、血壓及實驗室檢查的數據，將受檢者血中尿酸濃度由低至高分成四組分析尿酸與糖尿病相關性，更進一步探討在不同性別中尿酸與糖尿病的關係。
結果：經校正年齡、性別、吸菸、飲酒、BMI、高血壓、高血脂、GPT、肌酸酐、膽固醇和三酸甘油酯等多因子後，從資料統計中發現尿酸越高，糖尿病的風險有越低的趨勢。尿酸最高組和尿酸最低組糖尿病的風險比 (OR) 為 0.53 (p for trend<0.0001)。以性別進行分組發現，男性組在統計上呈現顯著關係 (OR=0.38, p for trend<0.0001)；進一步檢視不同性別中尿酸與不同程度血糖調節異常的相關性，發現在多因子校正分析後，男性組中新發現糖尿病 (OR=0.34, p for trend<0.0001) 及已知糖尿病 (OR=0.43, p for trend <0.0001) 和血中尿酸濃度呈顯著負相關，空腹血糖調節異常 (impaired fasting glucose, IFG) 則未見顯著趨勢；女性組別均未發現有統計上顯著的相關性。
結論：尿酸較高的族群糖尿病的風險較低，其趨勢在男性更為顯著；尿酸與血糖相關異常的負相關性在男性且血糖異常程度較高的族群裡較為顯著，推測尿酸和血糖相關異常的關係可能有性別差異，且在較嚴重的血糖異常時血糖與尿酸之間的互動更為顯著。

Background and Objectives: The research assessed the association between serum uric acid (SUA) and diabetes mellitus by analyzing data from adult health screening under the National Health Insurance Plan.
Methods: The study sample consisted of 7,568 persons undergoing health check-ups from 2006 to 2011 at a regional hospital in northern Taiwan. Logistic regression was used to assess the association between SUA levels and diabetes mellitus and gender differences in the relationship.
Results: In multivariate logistic regression models, we found that higher SUA levels were inversely associated with diabetes mellitus. Compared with the lowest quartile, the highest quartile of SUA had an odds ratio of 0.53 ( p trend < 0.0001). In subgroup analysis by gender, the results were consistent among men (OR= 0.38, p for trend < 0.0001). After multivariate adjustment, gender-specific analysis on the association between SUA and stages of impaired glucose regulation (IGR) found a significant inverse association in newly diagnosed diabetes mellitus (OR=0.34, p for trend < 0.0001) and known diabetes mellitus (OR=0.43, p for trend < 0.0001) groups but not in the group of impaired fasting glucose, in male subjects.
Conclusion: Higher SUA levels were found to be inversely associated with diabetes mellitus, especially among men. There was stronger inverse association between SUA and IGR in men with more advanced stages of IGR. The findings suggested a gender difference in the relationship of SUA with IGR and the interaction between SUA and glucose regulation seemed to be more significant in advanced stages of IGR.