脂质蓄积指数和糖尿病家族史交互作用与糖尿病关系的研究

The interactive effect of lipid accumulation product with family history on the risk of diabetes

目的探讨脂质蓄积指数(lipid accumulation product,LAP)和糖尿病家族史交互作用对糖尿病患病风险的影响。方法利用logistic回归和受试者工作特征(receiver operating characteristics,ROC)曲线研究LAP与糖尿病的关系,并用交互作用引起的相对超额风险(the relative excess risk due to interaction,RERI),相互作用比例(attributable proportion due to interaction,AP)和协同指数(synergy index,SI)评价LAP和糖尿病家族史对糖尿病的交互作用。研究对象来源于2015年在安徽省蚌埠市某区进行的"创建省级慢性病管理示范区"项目,通过多阶段随机抽样方法在该区7个社区/街道进行抽样调查,共计纳入1777名研究对象。结果多因素logistics回归分析显示,LAP升高(OR=3.93,95%CI:2.47~6.27)是糖尿病发病的重要危险因素。男性中LAP预测糖尿病风险的能力优于BMI(Z=2.37,P=0.02),但与腰围(waist circumference,WC)比较差异无统计学意义(Z=1.23,P=0.22);女性中LAP的AUC与BMI(Z=2.57,P=0.01)和WC(Z=2.33,P=0.02)差异均有统计学意义。LAP和糖尿病家族史对糖尿病风险有交互作用(RERI:2.93,95%CI:0.33~5.52;AP:0.46,95%CI:0.21~0.72;SI:2.24,95%CI:1.21~4.15)。结论LAP增加与糖尿病发病风险密切相关,且其与糖尿病家族史对糖尿病发病存在交互作用。

Objective To explore the interactive effect of lipid accumulation product(LAP)with family history on the risk of diabetes.Methods Logistic regression model and receiver operating characteristics(ROC)curves were applied to analyze the association between LAP and diabetes risk.The interactive effect of LAP with family history on the risk of diabetes was assessed by using the relative excess risk due to interaction(RERI),attributable proportion due to interaction(AP)and synergy index(SI).The study subjects were randomly recruited from 7 communities in Bengbo where the project of"Creating provincial demonstration zone for chronic disease management"was conducted in 2015 using multi-stage sampling method and a total of 1777 participants were included.Results The prevalence of diabetes among participants was 17.73%.Multivariate logistic regression analysis showed that elevated LAP(OR=3.93,95%CI:2.47-6.27)was a significant risk factor for diabetes.In males,LAP worked better than BMI(Z=2.37,P=0.02)but did similarly as WC(Z=1.23,P=0.22)in predicting diabetes risk.However,in female,the performance of AUC of LAP in predicting diabetes risk was statistically different from that of BMI(Z=2.57,P=0.01)and WC(Z=2.33,P=0.02).There was a significant interactive effect between LAP and family history of diabetes(RERI:2.93,95%CI:0.33-5.52;AP:0.46,95%CI:0.21-0.72;SI:2.24,95%CI:1.21-4.15)on diabetes risk.Conclusions the elevated level of LAP is closely related with an increased risk of diabetes,which interacts with disease family history further increases the risk.