血清三酰甘油/高密度脂蛋白胆固醇比值在2型糖尿病合并代谢综合征中预测价值

The predictive value of serum TG/HDL-C ratio in type 2 diabetes mellitus with metabolic syndrome

目的探讨血清三酰甘油(TG)/高密度脂蛋白胆固醇(HDL-C)比值预测2型糖尿病合并代谢综合征的价值。方法收集2018年9月至2019年7月徐州医科大学附属医院收治的2型糖尿病病人495例,根据是否合并代谢综合征(MS),分为MS组和非MS组。比较两组性别、年龄、血脂、血压、体质量指数(BMI)、腰围(WC)等指标的水平,并计算TG/HDL-C、胰岛素抵抗指数(HOMA-IR)。使用受试者工作曲线(ROC)得出TG/HDL-C值预测MS的最佳切点。结果两组性别、年龄、病程、吸烟史、饮酒史、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FBG)、糖化血红蛋白(HbA1C)差异无统计学意义(P>0.05),非MS组与MS组高血压史(14.0%比51.4%)、WC[(86.90±9.37)cm比(96.82±9.27)cm]、BMI[(23.46±3.12)kg/m2比(27.43±3.19)kg/m^(2)]、收缩压(SBP)[(123.12±13.20)mmHg比(128.59±11.98)mmHg]、舒张压(DBP)[(78.20±7.49)mmHg比(82.77±8.12)mmHg]、尿酸(UA)[(263.28±72.91)μmol/L比(317.24±75.24)μmol/L]、TG[(1.49±1.36)mmol/L比(2.82±2.35)mmol/L]、HDL-C[(1.29±0.32)mmol/L比(1.07±0.26)mmol/L]、空腹胰岛素(FINS)[(82.55±104.91)pmol/L比(97.13±94.00)pmol/L]、HOMA-IR[(4.35±5.16)比(5.55±6.32)]、TG/HDL-C比值[(1.34±1.80)比(2.98±3.05)]比较,差异有统计学意义(P<0.05)。采用四分位法,根据TG/HDL-C比值高低分组,男性2型糖尿病病人BMI、WC、DBP、UA、TC、TG、MS患病率随TG/HDL-C比值增加而增加,而年龄、HDL-C随TG/HDL-C比值增高而降低;而在女性病人中BMI、WC、DBP、UA、TG、FINS、HOMA-IR、MS患病率呈上升趋势,而HDL-C呈下降趋势(P<0.05)。ROC曲线分析发现,2型糖尿病病人中,当男性TG/HDL-C比值达到1.49时,对MS的诊断效率最高(AUC为0.817,95%CI:0.767~0.867,P<0.001),灵敏度为74.8%、特异性为78.8%;女性TG/HDL-C比值取1.36时,对MS的诊断效率最高(AUC为0.787,95%CI:0.724~0.851,P<0.001),灵敏度为72.9%、特异度为77.9%;结论2型糖尿病合并代谢综合征TG/HDL-C比值明显高于不合并MS病人,并且随着TG/HDL-C比值升高,2型糖尿病合并代谢综合征患病率随之增加。因此TG/HDL-C比值能够较好预测2型糖尿病病人中代谢综合征发生。

Objective To explore the value of serum triglyceride(TG)/high-density lipoprotein cholesterol(HDL-C)ratio in predicting type 2 diabetes mellitus with metabolic syndrome.Methods Totally 495 patients with type 2 diabetes admitted to the Department of Endocrinology of The Affiliated Hospital of Xuzhou Medical University from September 2018 to July 2019 were collected as subjects.According to whether combined with metabolic syndrome(MS),the patients were assigned into MS group and non-MS group.The levels of indicators such as gender,age,blood lipid,blood pressure,body mass index(BMI)and waist circumference(WC)in the two groups were compared,and TG/HDL-C and insulin resistance index(HOMA-IR)were calculated.Receiver operating characteristic curve(ROC)was used to obtain the optimal tangent point of TG/HDL-C prediction for MS.Results There were no statistically significant differences between the two groups in the subjects’gender,age,disease course,smoking history,drinking history,total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),fasting blood glucose(FBG),and glycosylated hemoglobin(HbA1C)(P>0.05),and statistically significant differences were found between the non-MS group and the MS group in the history of hypertension(14.0%vs.51.4%),WC[(86.90±9.37)cm vs.(96.82±9.27)cm],BMI[(23.46±3.12)kg/m^(2) vs.(27.43±3.19)kg/m^(2)],systolic blood pressure(SBP)[(123.12±13.20)mmHg vs.(128.59±11.98)mmHg],diastolic blood pressure(DBP)[(78.20±7.49)mmHg vs.(82.77±8.12)mmHg],uric acid(UA)[(263.28±72.91)μmol/L vs.(317.24±75.24)μmol/L],TG[(1.49±1.36)mmol/L vs.(2.82±2.35)mmol/L],HDL-C[(1.29±0.32)mmol/L vs.(1.07±0.26)mmol/L],fasting insulin(FINS)[(82.55±104.91)pmol/L vs.(97.13±94.00)pmol/L],HOMA-IR[(4.35±5.16)vs.(5.55±6.32)],TG/HDL-C ratio[(1.34±1.80)vs.(2.98±3.05)](P<0.05).Patients were assigned into groups with quartile according to TG/HDLC ratio.The prevalence of BMI,WC,DBP,UA,TC,TG and MS in male patients with type 2 diabetes increased with the increase of TG/HDL-C ratio,while age and HDL-C decreased with the increase of TG/HDL-C ratio.The prevalence of BMI,WC,DBP,UA,TG,FINS,HOMA-IR,and MS in female patients with type 2 diabetes increased while HDL-C decreased.ROC curve analysis showed that,when the TG/HDL-C ratio of male patients with type 2 diabetes reached 1.49,the diagnosis efficiency of MS reached the highest(AUC=0.817,95%CI:0.767-0.867,P<0.001)with a sensitivity of 74.8%and specificity of 78.8%.When the TG/HDL-Cratio of female patients with type 2 diabetes was 1.36,the diagnosis efficiency of MS reached the highest(AUC:0.787,95%CI:0.724-0.851,P<0.001),with a sensitivity of 72.9%and specificity of 77.9%.Conclusions The TG/HDL-C ratio of patients with type 2 diabetes combined with metabolic syndrome was significantly higher than that of patients without MS,and the prevalence of type 2 diabetes combined with metabolic syndrome increased with the increase of TG/HDL-C ratio.Therefore,TG/HDL-C ratio can predict the occurrence of metabolic syndrome in patients with type 2 diabetes.