脂质相关指数与糖尿病肾病相关性研究

doi:10.11958/20241059

摘要/Abstract

摘要：

目的通过观察脂质相关指数在不同分期糖尿病肾病（DKD）的表达来探讨其与DKD的相关性。方法将265例2型糖尿病（T2DM）患者分为T2DM组106例和DKD组159例。根据估算肾小球滤过率（eGFR）水平将DKD组分DKD-G2组（59例）DKD-G3组（59例）、DKD-G4组（41例）。收集患者甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白（Apo）A、Apo B、尿白蛋白/尿肌酐比值（UACR）等，计算eGFR，计算甘油三酯-葡萄糖指数（TyG）、内脏脂肪指数（VAI）、血浆致动脉粥样硬化指数（AIP）、分析TyG、VAI、AIP不同组间差异及与eGFR、UACR的相关性；多重线性回归分析DKD肾损伤的影响因素，绘制受试者工作特征（ROC）曲线评估TyG、VAI、AIP预测效能。结果不同分期DKD组患者TyG、VAI、AIP高于T2DM组，随病程进展，各指数呈升高趋势（P<0.05）。DKD患者的TyG、VAI、AIP与eGFR呈负相关（r分别为-0.396、-0.425、-0.519，P<0.01），与UACR呈正相关（r分别为0.482、0.479、0.583，P<0.01）。多重线性回归结果显示VAI、AIP为eGFR的影响因素，TG、HDL-C、LDL-C、Apo B、VAI、AIP为UACR的影响因素（P<0.01）。ROC曲线显示TyG、VAI、AIP曲线下面积为0.902（0.866~0.937）、0.969（0.953~0.986）、0.958（0.937~0.979）。结论 TyG、VAI、AIP与DKD进展相关，对DKD有一定预测价值，可作为DKD发生发展评估的生物学指标。

关键词: 糖尿病肾病, 甘油三酯类, 葡萄糖, 腹内脂肪, 动脉粥样硬化, 危险因素

Abstract:

Objective To investigate the correlation between lipid-related index and diabetic kidney disease (DKD) by observing the expression levels of lipid-related index in different stages of DKD. Methods A total of 265 patients with type 2 diabetes mellitus (T2DM) were divided into the T2DM group (n=106) and the DKD group (n=159). According to estimated glomerular filtration rate (eGFR) level, the DKD group was sub-divided into the DKD-G2 group (n=59), the DKD-G3 group (n=59) and the DKD-G4 group (n=41). Data of triglycerides (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), apolipoprotein A (Apo A), Apo B and urinary albumin/urinary creatinine ratio (UACR) were collected. Gomerular filtration rate (eGFR), triglyceride-glucose index (TyG), visceral adiposity index (VAI) and atherogenic index of plasma (AIP) were calculated. The differences of TyG, VAI and AIP between different groups and their correlation with eGFR and UACR were analyzed. Multiple linear regression analysis of DKD renal injury factors was conducted. Receiver operating characteristic (ROC) curves were drawn to evaluate the predictive efficiency of TyG, VAI, and AIP. Results The levels of TyG, VAI and AIP were significantly higher in the DKD group compared to the T2DM group, and these indices exhibited an increasing trend with disease progression (P<0.05). Furthermore, there was a negative correlation between TyG, VAI, AIP and eGFR (r=-0.396, -0.425, -0.519, P<0.01), and a positive correlation between UACR and eGFR (r=0.482, 0.479 and 0.583, P<0.01) in DKD patients. Multiple linear regression results showed that VAI and AIP were independent risk factors for eGFR, and TG, HDL-C, LDL-C, Apo B and VAI were influencing factors of UACR (P<0.05). The ROC curve analysis revealed that the areas under the curves for TyG, VAI and AIP were 0.902 (0.866-0.937), 0.969 (0.953-0.986) and 0.958 (0.937-0.979) respectively. Conclusion The levels of TyG, VAI and AIP are correlated with the progression of DKD, and have predictive value for the occurrence and development of DKD. These biomarkers can be used as a biological indicator to evaluate the occurrence and development of DKD.

Key words: diabetic kidney diseases, triglycerides, glucose, intra-abdominal fat, atherosclerosis, risk factors

中图分类号:

R587.1

图/表 7

参考文献 27

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组别	n	性别（男/女）	年龄/ 岁	BMI/（kg/m²）	WC/cm	病程/年	TC/ （mmol/L）	TG/ （mmol/L）	HDL-C/ （mmol/L）	LDL-C/ （mmol/L）
T2DM组	106	60/46	53.79±12.51	26.94±3.18	90.00±9.92	5.58±2.72	4.63±0.99	1.68±0.37	1.23±0.22	2.73±0.85
DKD-G2组	59	34/25	56.14±11.46	26.04±2.85	88.12±7.14	8.49±4.11^a	4.85±0.95	2.70±0.86^a	1.03±0.24^a	2.76±0.97
DKD-G3组	59	28/31	60.39±12.87^a	26.71±4.30	91.49±11.55	14.64±7.01^ab	5.57±1.64^ab	3.76±1.43^ab	1.04±0.32^a	3.13±1.29^a
DKD-G4组	41	25/16	62.05±11.10^ab	26.94±3.23	93.85±9.22^ab	19.80±7.21^abc	5.60±1.68^ab	4.52±1.36^abc	0.84±0.35^abc	3.10±1.17
χ²或F		1.977	6.443^＊＊	0.993	3.137^＊	95.903^＊＊	9.996^＊＊	108.083^＊＊	23.136^＊＊	2.748^＊
组别		FBG/ （mmol/L）		HbA1c/ %	ApoA/ （g/L）	ApoB/ （g/L）	BUN/ （mmol/L）	SCr/ （μmol/L）		UACR/ （mg/g）
T2DM组		8.84±2.45		8.13±1.64	1.30±0.28	1.07±0.33	6.20±5.38	59.39±8.28		22.34±5.41
DKD-G2组		9.60±2.63		8.56±1.69	1.23±0.30	1.26±0.31^a	5.28±2.96	90.04±13.94^a		80.36±31.35^a
DKD-G3组		9.02±2.49		8.13±1.62	1.04±0.28^ab	1.44±0.57^a	11.52±8.18^ab	138.51±24.37^ab		248.97±102.30^ab
DKD-G4组		9.60±3.33		8.43±1.99	0.87±0.34^abc	1.80±1.00^abc	16.96±5.19^abc	244.73±37.20^abc		590.59±154.92^abc
F		1.507		1.102	26.210^＊＊	19.629^＊＊	47.234^＊＊	872.427^＊＊		556.260^＊＊

组别	n	性别（男/女）	年龄/ 岁	BMI/（kg/m²）	WC/cm	病程/年	TC/ （mmol/L）	TG/ （mmol/L）	HDL-C/ （mmol/L）	LDL-C/ （mmol/L）
T2DM组	106	60/46	53.79±12.51	26.94±3.18	90.00±9.92	5.58±2.72	4.63±0.99	1.68±0.37	1.23±0.22	2.73±0.85
DKD-G2组	59	34/25	56.14±11.46	26.04±2.85	88.12±7.14	8.49±4.11^a	4.85±0.95	2.70±0.86^a	1.03±0.24^a	2.76±0.97
DKD-G3组	59	28/31	60.39±12.87^a	26.71±4.30	91.49±11.55	14.64±7.01^ab	5.57±1.64^ab	3.76±1.43^ab	1.04±0.32^a	3.13±1.29^a
DKD-G4组	41	25/16	62.05±11.10^ab	26.94±3.23	93.85±9.22^ab	19.80±7.21^abc	5.60±1.68^ab	4.52±1.36^abc	0.84±0.35^abc	3.10±1.17
χ²或F		1.977	6.443^＊＊	0.993	3.137^＊	95.903^＊＊	9.996^＊＊	108.083^＊＊	23.136^＊＊	2.748^＊
组别		FBG/ （mmol/L）		HbA1c/ %	ApoA/ （g/L）	ApoB/ （g/L）	BUN/ （mmol/L）	SCr/ （μmol/L）		UACR/ （mg/g）
T2DM组		8.84±2.45		8.13±1.64	1.30±0.28	1.07±0.33	6.20±5.38	59.39±8.28		22.34±5.41
DKD-G2组		9.60±2.63		8.56±1.69	1.23±0.30	1.26±0.31^a	5.28±2.96	90.04±13.94^a		80.36±31.35^a
DKD-G3组		9.02±2.49		8.13±1.62	1.04±0.28^ab	1.44±0.57^a	11.52±8.18^ab	138.51±24.37^ab		248.97±102.30^ab
DKD-G4组		9.60±3.33		8.43±1.99	0.87±0.34^abc	1.80±1.00^abc	16.96±5.19^abc	244.73±37.20^abc		590.59±154.92^abc
F		1.507		1.102	26.210^＊＊	19.629^＊＊	47.234^＊＊	872.427^＊＊		556.260^＊＊

组别	n	TyG	VAI	AIP
T2DM组	106	9.32±0.37	1.85±0.71	0.13±0.12
DKD-G2组	59	9.85±0.37^a	4.46±2.42^a	0.41±0.18^a
DKD-G3组	59	10.11±0.44^ab	6.26±2.94^ab	0.55±0.19^ab
DKD-G4组	41	10.35±0.45^abc	11.26±9.98^abc	0.76±0.25^abc
F		88.450^＊＊	49.257^＊＊	160.275^＊＊

组别	n	TyG	VAI	AIP
T2DM组	106	9.32±0.37	1.85±0.71	0.13±0.12
DKD-G2组	59	9.85±0.37^a	4.46±2.42^a	0.41±0.18^a
DKD-G3组	59	10.11±0.44^ab	6.26±2.94^ab	0.55±0.19^ab
DKD-G4组	41	10.35±0.45^abc	11.26±9.98^abc	0.76±0.25^abc
F		88.450^＊＊	49.257^＊＊	160.275^＊＊

	B	SE	β	t	P
模型1
VAI	0.612	0.269	0.099	2.272	0.024
AIP	-42.226	15.003	-0.369	-2.815	0.005
常数项	183.104	33.641		5.443	<0.001
模型2
HDL-C	-42.397	9.910	-0.391	-4.278	<0.001
LDL-C	-5.723	2.711	-0.181	-2.111	0.036
Apo A	13.370	5.056	0.134	2.644	0.009
AIP	-130.197	19.699	-1.137	-6.609	<0.001
常数项	150.076	35.664		4.210	<0.001