糖化血红蛋白与颈动脉内膜-中膜厚度的相关性研究

doi:10.11958/20220321

天津医药 ›› 2022, Vol. 50 ›› Issue (10): 1061-1065.doi: 10.11958/20220321

糖化血红蛋白与颈动脉内膜-中膜厚度的相关性研究

李雪敏(), 李卫东, 时文涛, 魏凤江()

天津医科大学基础医学院医学遗传学系（邮编300070）

收稿日期:2022-02-28 修回日期:2022-05-17 出版日期:2022-10-15 发布日期:2022-10-20
通讯作者: 魏凤江 E-mail:q2462798569@163.com;wfj166@tmu.edu.cn
作者简介:李雪敏（1995）,女,硕士在读,主要从事医学遗传学方面研究。E-mail： q2462798569@163.com
基金资助:
国家自然科学基金资助项目(92046014);京津冀基础研究合作专项项目(19JCZDJC64700)

Study on the correlation between glycosylated hemoglobin and carotid intima-media thickness

LI Xuemin(), LI Weidong, SHI Wentao, WEI Fengjiang()

Department of Medical Genetics, School of Basic Medical Science, Tianjin Medical University, Tianjin 300070, China

Received:2022-02-28 Revised:2022-05-17 Published:2022-10-15 Online:2022-10-20
Contact: WEI Fengjiang E-mail:q2462798569@163.com;wfj166@tmu.edu.cn

李雪敏, 李卫东, 时文涛, 魏凤江. 糖化血红蛋白与颈动脉内膜-中膜厚度的相关性研究[J]. 天津医药, 2022, 50(10): 1061-1065.

LI Xuemin, LI Weidong, SHI Wentao, WEI Fengjiang. Study on the correlation between glycosylated hemoglobin and carotid intima-media thickness[J]. Tianjin Medical Journal, 2022, 50(10): 1061-1065.

摘要/Abstract

摘要：

目的研究普通体检人群糖化血红蛋白（HbA1c）水平与颈动脉内膜-中膜厚度（CIMT）的相关性。方法选取9 881例普通体检人群为研究对象,其中男7 091例,女2 790例,采用血管彩色多普勒超声测量CIMT。根据是否有CIMT增厚,分为增厚组（4 513例）和正常组（5 368例）。收集2组的一般资料和实验室资料并进行比较。采用Logistic回归分析总人群及不同性别中CIMT增厚的危险因素。采用受试者工作特征（ROC）曲线评价HbA1c水平对CIMT增厚的预测效果。结果与正常组相比,增厚组的男性比例、年龄、体质量指数（BMI）、收缩压（SBP）、直接胆红素（DBIL）、球蛋白（GLB）、血尿素氮（BUN）、血肌酐（Scr）、血糖（GLU）、HbA1c、总胆固醇（TC）和低密度脂蛋白胆固醇（LDL-C）水平均升高,而估算肾小球滤过率（eGFR）、丙氨酸转氨酶（ALT）、白蛋白（ALB）、高密度脂蛋白胆固醇（HDL-C）降低（P<0.05）。多因素Logistic回归分析显示,在总人群中高龄,男性,ALB、GLU、LDL-C升高,HbA1c≥5.7%是CIMT增厚的危险因素,GLB、HDL-C升高是CIMT增厚的保护因素。男性人群中高龄,ALB、LDL-C升高,HbA1c≥5.7%是CIMT增厚的危险因素,ALT、GLB、HDL-C升高是CIMT增厚的保护因素;女性人群中SBP、TC升高,HbA1c≥5.6%是CIMT增厚的危险因素,BMI、eGFR、ALB、Scr、HDL-C升高是CIMT增厚的保护因素。ROC曲线结果分析显示,HbA1c在总人群、男性和女性中预测CIMT增厚的最佳截断值均为5.65%,女性中HbA1c对CIMT增厚的预测效能较优。结论在普通人群中HbA1c水平升高为CIMT增厚的危险因素,且在女性人群中,HbA1c对CIMT增厚的影响更大。

关键词: 血红蛋白A,糖基化, 颈动脉, 回归分析, 颈动脉内膜-中膜厚度, 普通人群

Abstract:

Objective To study the correlation between glycosylated hemoglobin (HbA1c) level and carotid intima-media thickness (CIMT) thickening in general physical examination population. Methods A total of 9 881 cases with general physical examination were selected as the research object, including 7 091 males and 2 790 females. CIMT was measured by vascular color Doppler ultrasound. According to whether there was CIMT thickening, the cases were divided into the thickening group (4 513 cases) and the normal group (5 368 cases). The general data and laboratory data of the two groups were collected and compared. Logistic regression was used to analyze the risk factors of CIMT thickening in the general population and different genders. Receiver operating characteristic curve (ROC) was used to evaluate the predictive effect of the HbA1c level on CIMT thickening. Results Compared to the normal group, male proportion, age, body mass index (BMI), systolic blood pressure (SBP), direct bilirubin (DBIL), globulin (GLB), blood urea nitrogen (BUN), blood creatinine (Scr), blood glucose (GLU), HbA1c, total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) levels were increased in the thickening group. The glomerular filtration rate (eGFR), alanine aminotransferase (ALT), albumin (ALB) and high density lipoprotein cholesterol (HDL-C) were decreased (P<0.05). Logistic regression analysis showed that in the total population, advanced age, male, ALB, GLU and LDL-C increased, and HbA1c≥5.7% was risk factors for CIMT thickening, while increased GLB and HDL-C were protective factors for CIMT thickening. In males, advanced age, increased ALB and LDL-C, and HbA1c≥5.7% were risk factors for CIMT thickening, while increased ALT, GLB and HDL-C were protective factors for CIMT thickening. In females, increased SBP and TC and HbA1c≥5.6% were risk factors for CIMT thickening, while increased BMI, eGFR, ALB, Scr and HDL-C were protective factors for CIMT thickening. ROC curve analysis showed that the optimal cut-off value of HbA1c in predicting CIMT thickening was 5.65% in the total population, males and females, and HbA1c has better predictive efficiency for CIMT thickening in females. Conclusion The elevated HbA1c levels are a risk factor for CIMT thickening in the general population, and HbA1c has a greater effect on CIMT thickening in the females.

Key words: hemoglobin A, glycosylated, carotid arteries, regression analysis, carotid artery intima-media thickness, general population

中图分类号:

R543.4

图/表 6

参考文献 22

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组别	n			性别（男/女）			年龄（岁）	BMI（kg/m²）			eGFR[mL/（min·1.73 m²）]				SBP（mmHg）			DBP（mmHg）			SUA（μmol/L）
正常组	5 368			3 571/1 797			51.00±13.51	24.68±3.27			108.64±21.11				127.84±17.59			75.18±11.72			357.24±90.90
增厚组	4 513			3 520/993			69.19±12.22	24.99±3.12			95.92±21.06				139.29±19.38			74.92±11.66			359.30±83.70
χ²、t或Z				159.267^＊＊			69.046^＊＊	4.725^＊＊			29.886^＊＊				30.688^＊＊			1.093			1.159
组别			ALT（U/L）			TBIL（μmol/L）			DBIL（μmol/L）			TP（g/L）		ALB（g/L）			GLB（g/L）			BUN（mmol/L）
正常组			25.23±18.50			13.91±5.68			3.45±1.52			74.83±4.49		45.35±2.84			29.47±3.82			4.84±1.20
增厚组			22.15±12.60			13.97±5.21			3.65±1.54			74.83±4.63		44.61±2.77			30.22±4.19			5.51±1.69
χ²、t或Z			9.496^＊＊			0.524			6.070^＊＊			0.088		13.101^＊＊			9.318^＊＊			23.040^＊＊
组别		Scr（μmol/L）			GLU（mmol/L）			HbA1c（%）		TC（mmol/L）			TG（mmol/L）			HDL-C（mmol/L）			LDL-C（mmol/L）
正常组		67.66±14.63			5.21±1.09			5.69±0.67		5.21±0.97			1.50（1.05,2.09）			1.39±0.34			3.00±0.81
增厚组		74.33±23.68			5.71±1.46			6.02±0.87		5.32±1.08			1.52（1.13,2.08）			1.31±0.33			3.18±0.94
χ²、t或Z		17.125^＊＊			19.644^＊＊			21.599^＊＊		5.515^＊＊			1.510			11.858^＊＊			9.896^＊＊

组别	n			性别（男/女）			年龄（岁）	BMI（kg/m²）			eGFR[mL/（min·1.73 m²）]				SBP（mmHg）			DBP（mmHg）			SUA（μmol/L）
正常组	5 368			3 571/1 797			51.00±13.51	24.68±3.27			108.64±21.11				127.84±17.59			75.18±11.72			357.24±90.90
增厚组	4 513			3 520/993			69.19±12.22	24.99±3.12			95.92±21.06				139.29±19.38			74.92±11.66			359.30±83.70
χ²、t或Z				159.267^＊＊			69.046^＊＊	4.725^＊＊			29.886^＊＊				30.688^＊＊			1.093			1.159
组别			ALT（U/L）			TBIL（μmol/L）			DBIL（μmol/L）			TP（g/L）		ALB（g/L）			GLB（g/L）			BUN（mmol/L）
正常组			25.23±18.50			13.91±5.68			3.45±1.52			74.83±4.49		45.35±2.84			29.47±3.82			4.84±1.20
增厚组			22.15±12.60			13.97±5.21			3.65±1.54			74.83±4.63		44.61±2.77			30.22±4.19			5.51±1.69
χ²、t或Z			9.496^＊＊			0.524			6.070^＊＊			0.088		13.101^＊＊			9.318^＊＊			23.040^＊＊
组别		Scr（μmol/L）			GLU（mmol/L）			HbA1c（%）		TC（mmol/L）			TG（mmol/L）			HDL-C（mmol/L）			LDL-C（mmol/L）
正常组		67.66±14.63			5.21±1.09			5.69±0.67		5.21±0.97			1.50（1.05,2.09）			1.39±0.34			3.00±0.81
增厚组		74.33±23.68			5.71±1.46			6.02±0.87		5.32±1.08			1.52（1.13,2.08）			1.31±0.33			3.18±0.94
χ²、t或Z		17.125^＊＊			19.644^＊＊			21.599^＊＊		5.515^＊＊			1.510			11.858^＊＊			9.896^＊＊

变量	β	SE	Wald χ²	P	OR	OR 95%CI
性别	0.305	0.068	19.937	<0.001	1.357	1.115~1.518
年龄	0.108	0.003	1 646.525	<0.001	1.114	1.108~1.119
ALB	0.044	0.011	16.262	<0.001	1.045	1.023~1.068
GLB	-0.020	0.007	7.729	0.005	0.980	0.966~0.994
GLU	0.063	0.031	4.222	0.040	1.065	1.003~1.132
HDL-C	-0.696	0.093	56.383	<0.001	0.498	0.416~0.598
LDL-C	0.240	0.032	55.419	<0.001	1.272	1.194~1.355
HbA1c	-	-	9.440	0.004	-	-
5.4%~<5.7%	0.151	0.085	0.207	0.080	1.163	0.982~1.378
5.7%~<6.0%	0.235	0.083	6.944	0.008	1.265	1.062~1.570
≥6.0%	0.322	0.106	16.609	<0.001	1.380	1.154~1.650
常量	-7.846	0.623	158.393	<0.001	0.000	-

变量	β	SE	Wald χ²	P	OR	OR 95%CI
性别	0.305	0.068	19.937	<0.001	1.357	1.115~1.518
年龄	0.108	0.003	1 646.525	<0.001	1.114	1.108~1.119
ALB	0.044	0.011	16.262	<0.001	1.045	1.023~1.068
GLB	-0.020	0.007	7.729	0.005	0.980	0.966~0.994
GLU	0.063	0.031	4.222	0.040	1.065	1.003~1.132
HDL-C	-0.696	0.093	56.383	<0.001	0.498	0.416~0.598
LDL-C	0.240	0.032	55.419	<0.001	1.272	1.194~1.355
HbA1c	-	-	9.440	0.004	-	-
5.4%~<5.7%	0.151	0.085	0.207	0.080	1.163	0.982~1.378
5.7%~<6.0%	0.235	0.083	6.944	0.008	1.265	1.062~1.570
≥6.0%	0.322	0.106	16.609	<0.001	1.380	1.154~1.650
常量	-7.846	0.623	158.393	<0.001	0.000	-

变量	β	SE	Wald χ²	P	OR	OR 95%CI
年龄	0.102	0.003	1 073.859	<0.001	1.108	1.101~1.115
ALT	-0.006	0.002	8.452	0.004	0.994	0.989~0.998
ALB	0.044	0.013	11.901	0.001	1.045	1.019~1.071
GLB	-0.020	0.008	5.302	0.021	0.981	0.964~0.997
HDL-C	-0.815	0.115	50.522	<0.001	0.443	0.354~0.554
LDL-C	0.283	0.038	56.143	<0.001	1.328	1.233~1.430
HbA1c	-	-	9.908	0.003	-	-
5.4%~<5.7%	0.191	0.100	0.013	0.050	1.210	1.000~1.464
5.7%~<6.0%	0.270	0.094	10.560	0.008	1.310	1.074~1.599
≥6.0%	0.370	0.093	16.187	<0.001	1.448	1.187~1.768
常量	-7.399	0.707	109.439	<0.001	0.001	-

糖化血红蛋白与颈动脉内膜-中膜厚度的相关性研究

Study on the correlation between glycosylated hemoglobin and carotid intima-media thickness

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参考文献 22

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变量	β	SE	Wald χ²	P	OR	OR 95%CI
BMI	-0.049	0.018	7.073	0.008	0.952	0.918~0.987
eGFR	-0.066	0.007	92.737	<0.001	0.936	0.923~0.949
SBP	0.032	0.003	114.897	<0.001	1.032	1.026~1.038
ALB	-0.045	0.019	5.469	0.019	0.956	0.920~0.993
Scr	-0.081	0.013	40.805	<0.001	0.922	0.900~0.946
TC	0.174	0.052	11.174	0.001	1.190	1.075~1.318
HDL-C	-0.460	0.153	9.013	0.003	0.631	0.467~0.852
HbA1c	-	-	8.258	0.006	-	-
5.4%~<5.6%	0.217	0.142	3.691	0.234	1.242	0.869~1.775
5.6%~<5.9%	0.365	0.140	7.800	0.036	1.440	1.025~2.024
≥5.9%	0.723	0.158	12.365	0.001	2.061	1.354~3.136
常量	0.917	1.793	28.032	<0.001	2.501	-

组别	AUC（95%CI）	截断值	敏感度	特异度	约登指数
总人群	0.664（0.653~0.674）	5.65%	0.655	0.600	0.255
男性	0.646（0.634~0.659）	5.65%	0.649	0.579	0.228
女性	0.703（0.683~0.723）	5.65%	0.676	0.676	0.352

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[2]	张文静, 温德惠, 郑英娟, 李朝喜, 牛亚军, 苗青. QAS联合QIMT技术对正常高值血压患者颈动脉硬化的研究[J]. 天津医药, 2023, 51(6): 662-667.
[3]	朱云林, 殷广莉, 戴平涛. 颈动脉超声及血清HbA1c、FIB对急性前循环脑梗死的评估价值分析[J]. 天津医药, 2022, 50(9): 948-952.
[4]	郭丹丹, 曹丽, 张凯, 周贵明. 中老年女性颈动脉斑块发生及稳定性相关危险因素分析[J]. 天津医药, 2021, 49(7): 719-722.
[5]	杨虹, 刘轩, 刘雯, 岳松. 血尿酸及颈动脉病变情况与H型高血压合并2型糖尿病的关系[J]. 天津医药, 2018, 46(6): 639-643.
[6]	高培龙，胡群亮，李建伟，田竺，苏娅，郝占坡. 超早期支架辅助弹簧圈治疗颅内破裂宽颈动脉瘤的疗效观察[J]. 天津医药, 2017, 45(8): 868-871.
[7]	边志颖，胡艳云，王君，孙倩，郄海静，赵新翠，肖艳新，尹超. 2 型糖尿病患者血小板反应蛋白-1 与颈动脉粥样硬化的关系[J]. 天津医药, 2017, 45(12): 1316-1319.
[8]	张冬，张继明. 血清同型半胱氨酸与2型糖尿病患者脑梗死相关性研究[J]. 天津医药, 2016, 44(7): 902-905.
[9]	王成蒙，王赞鑫，魏民新. OPCAB 患者合并颈动脉狭窄临床危险因素与预后的相关性研究[J]. 天津医药, 2016, 44(6): 720-723.
[10]	谢朝云 1,2，熊芸 1，孙静 1，胡阳 2，李耀福 1. 慢性阻塞性肺疾病多重耐药菌感染的危险因素分析[J]. 天津医药, 2016, 44(6): 744-747.
[11]	许继波1,赵华灵2,李春慧2,宋路2,吴云涛3△，王增英4. 卧位高血压与颈动脉内膜中层厚度的关联性研究[J]. 天津医药, 2016, 44(12): 1447-1452.
[12]	江金垚徐西子. 香叶醇对大鼠颈动脉球囊损伤后血管内膜增生的抑制作用[J]. 天津医药, 2016, 44(10): 1221-1224.
[13]	谢婷,何学恕，杨锡恒，戴日新，莫新玲. H型高血压患者血清Hcy、Cyst-C、UA水平与颈动脉粥样硬化的关系[J]. 天津医药, 2015, 43(6): 620-623.
[14]	吴振华 1， 2，郭志刚 2，林云佳 2，李培军 2. 颈动脉评估与非体外循环冠脉旁路移植术后患者认知障碍的相关性[J]. 天津医药, 2015, 43(6): 631-634.
[15]	刘雯，刘轩，岳松. 天津市公安民警颈动脉内中膜厚度与代谢综合征的关系[J]. 天津医药, 2015, 43(3): 315-318.