简易胰岛素抵抗指标与698例2型糖尿病患者发生高尿酸血症风险的关联

Association of 4 simple insulin resistance indicators with the risk of hyperuricemia in 698 patients with type 2 diabetes mellitus

目的 旨在探讨甘油三酯葡萄糖(TyG)指数、甘油三酯葡萄糖体质量(TyG-BMI)指数、甘油三酯/高密度脂蛋白胆固醇(TG/HDL-C)比值和胰岛素抵抗代谢(METS-IR)指数对中老年男性2型糖尿病(T2DM)患者发生高尿酸血症(HUA)风险的影响。方法 选取2016年1月至2019年12月山东省立医院内分泌科住院的中老年男性2型糖尿病患者698例。根据血尿酸值(SUA)将698例中老年男性T2DM患者分为非高尿酸血症组(SUA<420μmol/L,NUA组)和HUA组(SUA≥420μmol/L)。采用多因素Logistics回归评估简易胰岛素抵抗指标及其四分位数对中老年男性T2DM患者发生HUA的影响。采用ROC曲线评估4种简易胰岛素抵抗(IR)指标对中老年男性T2DM患者发生HUA的预测价值。结果 HUA组的TyG指数、TyG-BMI指数、TG/HDL-C比值、METS-IR指数较NUA组升高,差异有统计学意义(P<0.05)。以T2DM患者是否发生HUA(赋值:0=否,1=是)为因变量,以单因素回归分析中有统计学意义的指标为自变量进行多因素二分类Logistic回归分析,结果显示,血清肌酐(Scr)、维生素A结合蛋白(RBP)、TyG指数、TyG-BMI、TG/HDL-C和METS-IR是中老年男性T2DM患者发生HUA的独立影响因素(P<0.05)。ROC曲线显示,TyG指数对T2DM患者发生HUA的参考价值最高,AUC为0.73(95%CI:0.68~0.77),灵敏度为76.6%,特异度为57.8%,约登指数为0.34;其次是TyG-BMI、TG/HDL-C、METS-IR。结论 TyG指数、TyG-BMI、TG/HDL-C和METS-IR对中老年男性2型糖尿病患者发生HUA具有参考意义。

Objective To investigate the effects of triglyceride-glucose(TyG), triglyceride-glucose body mass index(TyG-BMI), triglyceride/high-density lipoprotein cholesterol ratio(TG/HDL-C) and metabolic score for insulin resistance(METS-IR) on the risk of hyperuricemia(HUA) in 698 patients with type 2 diabetes mellitus(T2 DM). Methods A total of 698 patients with T2 DM hospitalized in the Department of Endocrinology of Shandong Provincial Hospital during Jan. 2016 and Dec. 2019 were selected. According to the serum uric acid value(SUA), the patients were divided into the non-hyperuricemia group(SUA<420 μmol/L, NUA group) and HUA group(SUA≥420 μmol/L, HUA group). The reference value of TyG, TyG-BMI, TG/HDL-C and METS-IR for HUA was analyzed with multivariate Logistic regression and receiver operator characteristic(ROC) curve. Results TyG, TyG-BMI, TG/HDL-C and METS-IR were higher in HUA group than in NUA group(P<0.05). With the occurrence of HUA(assignment: 0=no, 1=yes) as the dependent variable, and the indicators with statistical significance in the univariate regression analysis as the independent variables, the multivariate binary Logistic regression analysis showed that, serum creatinine(Scr), retinol binging protein(RBP), TyG, TyG-BMI, TG/HDL-C and METS-IR were independent influencing factors of HUA in T2 DM patients(P<0.05). The ROC curve showed that TyG had the highest reference value on the occurrence of HUA, with the area under the curve(AUC) of 0.73(95%CI: 0.68-0.77), sensitivity of 76.6%, specificity of 57.8 %, and Youden index of 0.34, followed by TyG-BMI, TG/HDL-C and METS-IR. Conclusion TyG, TyG-BMI, TG/HDL-C and METS-IR have reference significance for the occurrence of HUA in middle-aged and elderly male patients with T2 DM.