【摘要】 目的 研究2型糖尿病自然病程的不同阶段肾脏尿酸排泄的变化，识别影响尿酸排泄的相关因素，为2型糖尿病合并高尿酸血症个体化用药提供依据。方法 收集168例无糖尿病病史的志愿者，行75克口服葡萄糖实验(OGTT)，测定空腹尿白蛋白、尿肌酐、尿酸和血尿酸与肌酐，计算尿尿酸肌酐比(UUA/CRE)和尿酸排泄分数(FUE)。结果 尿酸排泄分数在正常糖耐量(NGT，n=61)、糖尿病前期(空腹血糖受损和/或糖耐量受损,n=55)和糖尿病( n=52)组间差异无统计学意义;男性(p=0.007)、腹型肥胖(p=0.001)及高尿酸血症者(p<0.0001)有相对低的尿酸排泄分数;腰围是尿酸排泄独立的相关因素(p<0.0001);在糖尿病和糖尿病前期合并高尿酸血症患者(n=16)中，仅有12.5%患者尿尿酸肌酐比低于正常人尿尿酸肌酐比1%分位( 根据16例男性和29例女性无高血压、无高血糖、无高尿酸计算)。 结论 尿酸排泄降低是高尿酸血症发生的重要机制。尿酸排泄在糖尿病发生不同阶段没有明显变化，大部分糖尿病和糖尿病前期合并高尿酸血症患者可能存在尿酸生成和排泄双重障碍，在治疗前和治疗期间测定UUA/CRE是必要的。

　　【关键词】 糖尿病 2型； 高尿酸血症 ；尿酸排泄

　　The Changes of renal excretion of uric acid in the subjects with different glucose tolerance conditions

　　Han Xue-yao Cui Ji-fang Ji li-nong，Peking University People’s Hospital, Peking Diabetes Center 100044

　　【Abstract】 Objectives To investigate the changes of renal uric acid excretion in different stages of type 2 diabetes, and identify its relating facts, providing the evidence for individualized treatment for hyperuricemia in patients with type 2 diabetes. Methods 168 participants without history of diabetes were included in this study. OGTTs were conducted, the concentrations of uric acid , creatinine and albumin in spot morning fasting urine , concurrently the concentrations of uric acid and creatinine of fasting serum samples were determined. The fraction of uric acid excretion (FUE) and ratio of uric acid/creatinine (UUA/CRE) were calculated. Results No significant difference among three groups with normal OGTT(n=61),pre-diabetes(impaired fasting glucose and /or impaired glucose tolerance, n=55) and diabetes(n=52) was observed; The subjects with male gender( p=0.007), central obesity(p=0.001) and hyperuricemia(p<0.0001) have relatively low FUE and UUA/CRE compared with female gender, no central obesity and normal serum uric acid levels; Waist circumference was an independent fact associated with UUA/CRE(p<0.0001).16 subjects with diabetes or pre-diabetes have hyperuricemia , of whom 12.5% subjects have lower than 1% percentile of UUA/CRE obtained from 16 men and 29 women without hyperglycemia, hypertension and hyperuricemia. Conclusion Reduced renal excretion of uric acid play an important role in pathogenesis of hyperuricemia, and most patients with hyperglycemia and hyperuricemia might have combined excess product and low excretion of uric acid. Therefore, it’s necessary to determine UUA/CRE before and after initiation of treatment for hyperuricemia in the patients with type 2 diabetes.

　　【Key Words】  Diabetes mellitus, type 2; Hyperuricemia; Excretion of uric acid