| Background and objectThe prevalence of hyperuricemia in type 2 diabetes is increasing year by year.At present,the relationship between hyperuricemia and type 2 diabetes is still controversial.Although some studies had suggested that there was no causal relationship between hyperuricemia and the development of type 2 diabetes,most studies suggested that hyperuricemia was an independent risk factor for type 2diabetes and its cardiovascular complications which are closely related to the pro-thrombotic environment.The purpose of this study is to assess the state of coagulation in patients with type 2 diabetes at different levels of serum uric acid by thromboelastography and to explore the effect of hyperuricemia to the coagulation state of type 2 diabetics.MethodsAccording to the inclusion criteria and exclusion criteria,557 adult type 2 diabetic patients undergoing thromboelastography testing at the Second Affiliated Hospital of Nanjing Medical University from January 2016 to February 2018 were included and divided into two groups:the normal uric acid group(n=442),and the hyperuricemia group(HUA group,n=115),and other 117 physical examine subjects in the hospital were selected as normal control group(NC group).General clinical data and coagulation function status were compared between the three groups.Results1.The basic condition of type 2 diabetes:The average age of patients with type 2diabetes was(61.38±12.07)years and the overall prevalence of hyperuricemia was20.6%(15.1%for men and 27.9%for women).The mean ages of HUA group and normal serum uric acid group were(63.39±12.60)and(60.86±11.89)years respectively,and the difference was statistically significant(t=2.01,P=0.045).The HbA1c level in the HUA group was significantly lower than that in the normal serum uric acid group(8.34±1.88 vs 8.97±2.15)%,while the fasting C-peptide and 2-hour postprandial C-peptide were significantly higher than the normal serum uric acid group which were(2.69±1.56 vs 1.87+1.15),(5.83±3.68 vs 4.43±2.84)ng/mL,respectively,the differences were statistically significant(t=-2.42,4.24,3.01,P=0.016,<0.001,=0.003).The BMI of HUA group was higher than that of normal serum uric acid group(26.05±3.52 vs 25.21±3.42)kg/m~2,and the difference was statistically significant(t=2.01,P=0.045).The prevalence of diabetic nephropathy,hypertension,and coronary heart disease in the HUA group was significantly higher than that in the normal serum uric acid group(c~2=7.57,12.42,4.14,P=0.006,<0.001,=0.042).2.Comparison of clinical blood and biochemical tests between type 2 diabetes and the control:Compared with the control group,platelet count and high-density lipoprotein cholesterol were significantly decreased in the normal serum uric acid group and HUA group(F=6.08,16.51,P=0.002,<0.001),Triglycerides increased(F=11.87,P<0.001);serum creatinine levels in HUA group were higher than that in normal serum uric acid group(P<0.05).Patients with type 2 diabetes were divided into four groups according to the uric acid by quartile.The results showed,that,With the increase of serum uric acid level,BMI,systolic blood pressure,fasting C-peptide,post-prandial C-peptide,serum creatinine,and triglyceride levels in patients with type2 diabetes gradually increased,and HbA1c and high-density lipoprotein cholesterol gradually decreased,the differences between groups were statistically significant(P<0.05).3.Conventional coagulation test:There was a significant difference in activated partial thromboplastin time(APTT),D-dimer(DD),and fibrinogen(FIB)between the three groups(F=5.11,5.84,8.17,P=0.006,0.003,<0.001).Compared with the control group and the normal serum uric acid group,the APTT of the HUA group decreased,and the D-dimer increased(both P<0.05).The fibrinogen in the control group,the normal serum uric acid group,and the HUA group were(2.67±0.75,2.85±0.85,3.12±0.84)(g/L),respectively,and there were statistically significant differences between groups.4.Thrombelastography test:Compared with the control group,the normal serum uric acid group and HUA group showed a trend of hypercoagulable state,manifested as R value,K value decreased,angle and MA value increased(F=10.90,6.89,9.40,and9.61,all P<0.01);Compared with the normal serum uric acid group,the K value of the HUA group decreased,and the angle and MA value increased(P<0.05).Furthermore,the results of grouping the patients according to gender and hyperuricemia revealed that the male hyperuricemia group and the female hyperuricemia group showed a tendency of hypercoagulation.5.While hyperuricemia as the dependent variable,multivariate logistic regression analysis showed that women(OR:4.281,95%CI:1.988-9.222),high BMI(OR:2.182,95%CI:1.086-4.384),high triglycerides(OR:2.989,95%CI:1.434-6.232),high serum creatinine levels(OR:3.274,95%CI:1.568-6.835),high fibrinogen(OR:1.943,95%CI:1.011-3.735)were independent risk factors for hyperuricemia of type2 diabetics,while high-density lipoprotein cholesterol was negatively associated with hyperuricemia of type 2 diabetics(OR: 0.441,95% CI: 0.211-0.925).6.When thromboelastographys R,K,angle,and MA as dependent variables,multivariate logistic regression analysis revealed that hyperuricemia was negatively correlated with K(OR: 0.534,95% CI: 0.288-0.990),and was positively correlated with angle(OR: 2.009,95% CI: 1.085-3.718);fibrinogen was negatively correlated with R and K,OR and 95% CI were 0.630(0.398-0.997),0.182(0.110-0.299),respectively,and inversely,fibrinogen was positively correlated with angle,MA,OR and 95% CI were 3.264(2.000-5.327)and 4.892(2.898-8.258),respectively.There was a positive correlation between platelet count and MA(OR : 1.791,95% CI : 1.109-2.894).Conclusions Type 2 diabetics have hypercoagulable state,and hypercoagulability tends to be more pronounced in type 2 diabetics with hyperuricemia.Hyperuricemia may be an independent risk factor for hypercoagulability in patients with type 2 diabetes.The detection of the thromboelastogram can help to understand the patient's blood coagulation profile,and has guiding significance for the development of individualized clinical treatment measures to some extent. |
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