不同血糖代谢状态下老年人血脂与胰岛素抵抗的关系研究

Association of lipid parameters with insulin resistance in different glycemic among the elderly population

目的分析老年人在不同血糖代谢状态下血脂与胰岛素抵抗之间的关系.方法选取2015年中国成人慢性病与营养监测中60岁及以上人群且完成问卷调查、体格检查、血生化及血清胰岛素检测的调查对象,最终纳入15535名研究对象.根据2010年美国糖尿病学会标准,将研究对象划分为正常血糖、糖尿病前期、新发糖尿病、已诊糖尿病,采用多因素logistic回归模型分析老年人在不同血糖代谢状态下血脂与胰岛素抵抗之间的关系.结果正常血糖、糖尿病前期、新发糖尿病、已诊糖尿病者分别占50.46％（7839名）、22.19％（3448例）、12.46％（1937例）和14.88％（2311例）.在血糖正常组中,胰岛素抵抗的发生风险随甘油三酯、非高密度脂蛋白胆固醇（Non-HDL-C）/HDL-C及甘油三酯/HDL-C四分位水平的增加而增加,其调整OR（95％CI）值分别为1.48（1.35～1.62）、1.23（1.12～1.35）和1.50（1.36～1.65）;随HDL-C四分位水平的增加而降低,其调整OR（95％CI）值为0.83（0.76～0.90）.在糖尿病前期组中,胰岛素抵抗的发生风险随甘油三酯和甘油三酯/HDL-C四分位水平的增加而增加,其调整OR（95％CI）值分别为1.26（1.14～1.39）和1.38（1.24～1.54）;随HDL-C四分位水平的增加而降低,其调整OR（95％CI）值为0.79（0.71～0.87）.在新发糖尿病组,胰岛素抵抗的发生风险随甘油三酯/HDL-C四分位水平的增加而增加,其调整的OR（95％CI）值为1.29（1.12～1.48）.在已诊糖尿病组中,胰岛素抵抗的发生风险随甘油三酯、Non-HDL/HDL-C及甘油三酯/HDL-C四分位水平的增加而增加,其调整的OR（95％CI）值分别为1.28（1.16～1.41）、1.37（1.21～1.55）和1.51（1.33～1.72）,而HDL-C每增加1个四分位水平,胰岛素抵抗的发生风险下降,其调整OR（95％CI）值为0.77（0.67～0.87）.结论不同的血糖代谢状态下血脂与胰岛素抵抗之间的关系不同.对于血糖正常及患有糖尿病的老年人需要重点关注甘油三酯/HDL-C、甘油三酯、HDL-C及Non-HDL/HDL-C的水平变化,对于糖尿病前期的老年人则需重点关注甘油三酯/HDL-C、甘油三酯及HDL-C水平的变化.

Objective This study was to analyze the association of lipid parameters with insulin resistance of Chinese elderly population in different glycemic status. Methods Data were from China National Chronic Diseases and Nutrition Survey （2015）. A total of 15535 participants aged 60 and above who had completed survey questionnaire, physical examination, fasting blood biochemistry and insulin measurements were included in this study. According to the American Diabetes Association （2010） criteria, the participants were divided into normal glucose regulation, pre-diabetes, newly-diagnosed diabetes and previously-diagnosed diabetes. Multivariable logistic regression was preformed to assess the effects of lipid parameters on insulin resistance in different glycemic among the elderly population. Results The proportion of normal glucose regulation, pre-diabetes, newly-diagnosed diabetes and previously-diagnosed diabetes was 50.46%（n=7839）, 22.19%（n=3448）, 12.46%（n=1937） and 14.88%（n=2311）, respectively. The risk of insulin resistance increased with the elevated per quartile of triglycerides （TG） （OR=1.48,95%CI： 1.35-1.62）, non-high-density lipoprotein cholesterol （Non-HDL）/HDL-C （OR=1.23, 95%CI： 1.12-1.35） and TG/HDL-C （OR=1.50, 95%CI：1.36-1.65） and decreased with the elevated per quartile of HDL-C （OR=0.83, 95%CI： 0.76-0.90） after multivariate adjustment among normal glucose regulation participants. As for pre-diabetes participants, the risk of insulin resistance increased with the elevated per quartile of TG （OR=1.26, 95%CI： 1.14-1.39） and TG/HDL-C （OR=1.38, 95%CI： 1.24-1.54） and decreased with the elevated per quartile of HDL-C （OR=0.79, 95%CI：0.71-0.87）. The risk of insulin resistance increased with the elevated per quartiles of TG/HDL-C （OR=1.29, 95%CI：1.12-1.48） among newly-diagnosed diabetes. As for previously-diagnosed diabetes, the risk of insulin resistance increased with the elevated per quartile of TG, Non-HDL/HDL-C and TG/HDL-C with adjusted OR（95%CI） about 1.28 （1.16-1.41）, 1.37（1.21-1.55） and 1.51 （1.33-1.72） repsectivley and decreased with the elevated per quartile of HDL-C （OR=0.77, 95%CI：0.67-0.87）. Conclusion The relationship between lipid parameters and insulin resistance presented diversely in different glycemic status. The elderly with normal glucose regulation and previously-diagnosed diabetes should pay close attention to the change of TG/HDL-C, TG, HDL-C and Non-HDL/HDL-C. As for prediabetes participants, the TG/HDL-C, TG and HDL-C level change should be focused.