高尿酸血症与初诊2型糖尿病患者hs-CRP和心率变异性的关系及干预研究

摘要

目的 探讨高尿酸血症对初诊2型糖尿病(type 2 diabete mellitus,T2DM)患者高敏C反应蛋白(high-sensitive-CRP,hs-CRP)和心率变异性的影响及苯溴马隆干预研究.方法 选取2010年1月-2016年6月保定市第一医院内分泌科新诊断T2DM患者60例(DM组)及新诊断T2DM合并高尿酸血症患者126例参加研究,将合并高尿酸血症患者随机分为治疗组和对照组各63例,对照组和DM组给予低盐低脂低嘌呤饮食及二甲双胍治疗;治疗组在对照组的基础上加用苯溴马隆50 mg/d口服,共12周.治疗前及治疗后12周检测血糖(fasting plasma glucose,FPG)、糖化血红蛋白(hemoglobin A 1C,HbA1c)、血脂、血尿酸(serum uric acid,SUA)、高敏C反应蛋白(hs-CRP)及肝肾功能;分别行24 h动态心电图监测,分析HRV时域和频域指标,对各组HRV指标进行比较.结果 合并高尿酸血症的T2DM患者SUA、hs-CRP水平明显升高,SDNN、rMSSD、PNN50、LF、HF及LF/HF比值降低,差异有统计学意义(P＜0.05).经苯溴马隆干预后与干预前及对照组治疗前后相比患者血SUA、hs-CRP水平明显降低,SDNN、rMSSD、PNN50、LF、HF及LF/HF比值升高(均P＜0.05).结论 高尿酸血症可影响初诊T2DM患者的心率变异性,降低尿酸水平,可以改善心率变异指标,其疗效可能与炎症改善有关.%Objective To investigate the effects of hyperuriccmia on the high-sensitivity C-reaction protein (hs-CRP)and heart rate variability (HRV) in paticnt with type 2 diabetes (T2DM) initially diagnosed and the intervention effects of benzbromarone.Methods A total of 60 T2DM patients and 126 T2DM patients with hyperuricemia were enrolled in the study.The T2DM patients with hyperuricemia were randomly divided into a treatment group and a control group (n=63).Both groups were given low salt,low fat and low purine diet and netformin.Meanwhile,the treatment group was also additionally orally treated with 50 mg benzbromarone once per day for 12 weeks.Betore and atter 12 weeks of treatment,their levels of the fasting plasma glucose (FPG),glycosylated hemoglobin (HbA 1c),blood lipids,serum uric acid (SUA),hs-CRP,liver and kidney function were examined.Furthermore,both groups were subject to 24 h dynamic electrocardiogram and compared for HRV.Results T2Dm patients with hyperuricenia showed remarkable increases in the levels of SUA and hs-CRP but decreases in the standard diviation of NN intervals (SDNN),the differeuce of mean square root (rMSSD),Edinburgh index (PNN50),low frequency (LF),high frequency(HF) and LF/ HF radio (P＜ 0.05).After benzbromarone intervention,the patients produced markedly lower amounts of SUA and hs-CRP but higher amounts of SDNN,rMSSD,PNN50,LF,HF and LF/HF ratio compared with those before intervention and in the control group (all P＜ 0.05).Conclusion Hyperuricemia is an important risk factor in T2dM patients with heart rate variability.Lower levels of uric acid can inhibit the inflammation stress and inprove the function of HRV in T2DM patients.