甘油三酯和高密度脂蛋白比值与糖尿病肾病的相关性

Correlation of triglyceride and high density lipoprotein cholesterol ratio to diabetic kidney disease in type 2 diabetic mellitus patients

目的探讨2型糖尿病(T2DM)患者甘油三酯(TG)和高密度脂蛋白胆固醇(HDL-C)比值(TG/HDL-C)与微量白蛋白尿及尿α_1微球蛋白(α_1-MG)的关系。方法选择2014年6月至2015年12月在第四军医大学附属西京医院内分泌科住院的837例T2DM患者为研究对象,查阅出院病历,收集患者年龄、性别、病程、治疗情况等一般信息和空腹血糖(FPG)、总胆固醇(TC)、甘油三酯(TG)、HDL-C、尿白蛋白/肌酐比(ACR)、α_1-MG等实验室检测结果。根据2013年肾脏病生存质量指导指南(KDIQO)标准,ACR<3 mg/mmol为非蛋白尿组,ACR≥3 mg/mmol为蛋白尿组;尿α_1-MG<12 mg/L为正常组,尿α_1-MG≥12 mg/L为尿α_1-MG组。采用SPSS 19.0软件进行t检验、非参数检验和χ~2检验,用logistic回归分析TG/HDL-C与ACR及尿α_1-MG之间的关系。结果 837例患者中,606例患者(72.4%)是男性。蛋白尿组患者共202例,非蛋白尿组患者共635例,蛋白尿组患者的TG/HDL-C水平[1.69(1.70)]明显高于非蛋白尿组[1.43(1.49)],差异有统计学意义(P<0.01)。尿α_1-MG组患者287例,正常组550例,尿α_1-MG组TG/HDL-C水平[1.66(1.79)]明显高于正常组[1.43(2.00)],差异有统计学意义(P<0.01)。多因素logistic回归分析结果显示,校正了年龄、性别、病程、饮酒率、高血压患者比例等因素后,与TG/HDL-C水平最低组(<0.94)比较,TG/HDL-C水平最高组(≥2.53)ACR异常风险OR值为1.856(95%CI:1.069~3.221),有统计学意义(P<0.05);与TG/HDL-C水平最低组(<0.94)比较,α_1-MG升高风险OR值为1.769(95%CI:1.129~2.770),有统计学意义(P<0.05)。结论 TG/HDL-C与ACR和尿α_1-MG均存在独立关系。

Objective To explore the correlation of triglyceride （TG） and high density lipoprotein cholesterol （HDL-C） ratio （TG/HDL-C） to albumin-to-creatinine rate （ACR） and urine α1-microglobulin （α1-MG） in type 2 diabetic mellitus （T2DM） patients.Methods The clinical data of 837 T2DM patients during June of 2014 and December of 2015 were retrospectively analyzed,which included the data of age,gender,diabetic duration,diabetic medications,fasting plasma glucose （FPG）,total cholesterol （TC）,TG,HDL-C,ACR and α1-MG.According to the 2013 KDOQI guidelines,the subjects were divided into non-proteinuria group （ACR〈3 mg/mmol）,proteinuria group （ACR≥3 mg/mmol）,normal urinary α1-MG group （α1-MG〈12 mg/L） and urinary α1-MG group （α1-MG≥ 12 mg/L）.Statistical analyses were performed using independent two-sample t-tests,Mann-Whitney U-test and x2 tests with SPSS 19.0 statistics software.Logistic regression analysis was used to assess the correlation of TG/HDL-C to ACR and urinary α1-MG.Results Among 837 cases,males were 606 cases （72.4%）.The non-proteinuria group and proteinuria group included 202 and 635 cases.The TG/HDL-C level [1.66 （1.70）] in the proteinuria group was significantly higher than that [1.43（1.49）] in the normal group （P〈0.01）.The normal urinary α1-MG group and urinary α1-MG group included 550 and 287 cases.The TG/HDL-C level [1.66 （1.79）] in α1-MG group was significantly higher than that [1.43 （2.00）] in the normal group （P〈0.01）.Multivariable logistic regression analysis showed that after adjusting age,gender,disease duration,drinking rate and hypertension ration,as compared with the lowest TG/HDL-C group （〈0.94）,OR value for ACR risk in the highest TG/HDL-C group （〉2.53） was 1.856 （95%CI：1.069-3.221） （P〈0.05）;as compared with the lowest TG/HDL-C group （〈0.94）,OR value for ACR risk in α1-MG group was 1.769 （95%CI：1.129-2.770） （P〈0.05）.Conclusion TG/HDL-C is independently associated with ACR and urine α1-MG.