传统及联合脂质代谢指标与糖尿病发病关系的巢式病例对照研究

A nested case-control study on relationship of traditional and combined lipid metabolism indexes with incidence of diabetes

目的探讨脂质参数与糖尿病发病的关系,并将传统脂质参数与联合脂质参数进行比较,以期探讨、识别和预测糖尿病患者的最佳替代指标。方法以金昌队列为基础,采用巢式病例对照研究方法,排除恶性肿瘤和相关内分泌、循环系统疾病后抽取随访期内新发糖尿病者1025例作为病例组,然后按照年龄±2岁、性别进行1∶1匹配获得对照组1025例,进而研究脂质参数与糖尿病的关系。结果传统脂质参数中,TG、TC和LDL-C水平的第四分位数组的糖尿病发病风险较高,分别是第一分位数组的14.00倍(95%CI:9.73~20.15)、2.15倍(95%CI:1.65~2.79)和1.66倍(95%CI:1.29~2.14),HDL-C水平的第四分位数组的糖尿病发病风险是第一分位数组的0.21倍(95%CI:0.15~0.28)。联合脂质参数中,TG/HDL-C、TC/HDL-C、LDL-C/HDL-C和非HDL-C水平的第四分位数组的糖尿病发病风险较高,分别是第一分位数组的14.86倍(95%CI:10.35~21.34)、8.12倍(95%CI:5.94~11.01)、5.85倍(95%CI:4.34~7.88)和5.20倍(95%CI:3.85~7.03)。TG、TC、HDL-C、LDL-C、TG/HDL-C、TC/HDL-C、LDL-C/HDL-C、非HDL-C的受试者工作特征曲线下面积分别为0.76(95%CI:0.74~0.78)、0.59(95%CI:0.57~0.61)、0.67(95%CI:0.65~0.69)、0.57(95%CI:0.55~0.59)、0.77(95%CI:0.75~0.78)、0.73(95%CI:0.71~0.75)、0.69(95%CI:0.67~0.71)、0.66(95%CI:0.64~0.68);预测糖尿病的最佳切点分别为1.40、4.70、1.28、3.25、1.17、3.43、2.46、3.58 mmol/L。结论脂质代谢紊乱是糖尿病的危险因素。TG和TG/HDL-C是较好的糖尿病预测指标。

Objective To explore the relationship between lipid indicators and the incidence of diabetes,and to compare the diabetes prediction and identification power of traditional lipid combined lipid indicators,in order to explore the best alternative indicators for identifying and predicting diabetes.Methods Based on the Jinchang cohort,a nested case-control study was conducted in 1025 new cases of diabetes after excluding patients with malignant tumor and related endocrine,circulatory system disease,then an age(±2 years),gender matched 1∶1 control group of 1025 cases was set to analyze the relationship between the incidence of diabetes and lipid parameters.Results Among the traditional lipid parameters,the fourth quartile of TG,TC,and LDL-C indicated higher risks of developing diabetes,which was 14.00 times(95%CI:9.73-20.15),2.15 times(95%CI:1.65-2.79)and 1.66 times(95%CI:1.29-2.14)than that of the first quartile,respectively.The risk of developing diabetes indicated by the fourth quartile of HDL-C was 0.21 times than that indicated by the first quartile(95%CI:0.15-0.28).In the combined lipid parameters,the fourth quartile of TG/HDL-C,TC/HDL-C,LDL-C/HDL-C and non-HDL-C indicated higher risks of developing diabetes,which was 14.86 times(95%CI:10.35-21.34),8.12 times(95%CI:5.94-11.01),5.85 times(95%CI:4.34-7.88)and 5.20 times(95%CI:3.85-7.03)than that indicated by the first quartile,respectively.The areas under the ROC curve of TG,TC,HDL-C,LDL-C,TG/HDL-C,TC/HDL-C,LDL-C/HDL-C and non-HDL-C were 0.76(95%CI:0.74-0.78),0.59(95%CI:0.57-0.61),0.67(95%CI:0.65-0.69),0.57(95%CI:0.55-0.59),0.77(95%CI:0.75-0.78),0.73(95%CI:0.71-0.75),0.69(95%CI:0.67-0.71)and 0.66(95%CI:0.64-0.68),respectively.The optimal diabetes predicting point cuts of TG,TC,HDL-C,LDL-C,TG/HDL-C,TC/HDL-C,LDL-C/HDL-C and non-HDL-C were 1.40,4.70,1.28,3.25,1.17,3.43,2.46,and 3.58 mmol/L,respectively.Conclusions Lipid metabolic disorder is a risk factor for diabetes.TG and TG/HDL-C are the good lipid metabolism indicators for the prediction of diabetic.