人体测量指标对糖尿病前期的预测作用分析

Analysis of the predictive effects of anthropometric indicators on prediabetes

目的探讨人体测量指标对糖尿病前期的预测作用。方法为横断面研究。自2020年6月至2021年4月招募18~70岁糖尿病高风险人群及中国医科大学附属第一医院体检中心健康人群共239例作为研究对象。收集所有研究对象的性别、年龄、身高、体重、收缩压、舒张压、心率等资料, 行口服葡萄糖耐量试验(OGTT), 检测胰岛功能及糖化血红蛋白(HbA1c)。计算人体测量指标, 包括腹部容积指数(AVI)、身体圆度指数(BRI)、身体肥胖指数(BAI)、锥度指数(C-index)、体型指数(ABSI)、身体肥胖估计量(CUN-BAE)及稳态模型评估胰岛素抵抗指数(HOMA-IR)等。依据OGTT检测结果将研究对象分为糖耐量正常(NGT)组和糖尿病前期组, 使用秩和检验及χ2检验比较两组间基线资料及人体测量指标的差异, 采用Spearman相关分析法分析HbA1c、HOMA-IR与人体测量指标的相关性, 采用受试者工作特征(ROC)曲线分析人体测量指标对糖尿病前期的预测作用。利用logistic回归分析法分析糖尿病前期的影响因素。结果 NGT组119例(其中体检中心健康人群46例), 糖尿病前期组120例。两组间AVI、BRI、BAI、C-index、ABSI、CUN-BAE差异均有统计学意义(P<0.05), 且均与HbA1c和HOMA-IR均呈正相关(P<0.05)。ROC曲线分析显示, BRI以3.698为界值, ROC曲线下面积最大为0.710。单因素logistic回归分析结果显示, 校正年龄、性别、收缩压、舒张压、心率后, BRI、BAI、C-index为糖尿病前期的影响因素(OR值分别为4.408、2.915和4.540, 均P<0.05)。多因素逐步logistic回归分析结果显示, 校正年龄、性别、收缩压、舒张压、心率后, AVI、BAI、ABSI对糖尿病前期的影响作用最大(OR值分别为2.925、2.713、2.222, 均P<0.05)。AVI、BAI、ABSI联合应用预测糖尿病前期的ROC曲线下面积最大为0.735。结论 BRI、C-index对糖尿病前期预测作用较好, 但不能作为预测糖尿病前期的独立指标, AVI、BAI、ABSI联合应用预测糖尿病前期的效果较好。

Objective To explore the predictive effects of anthropometric indicators on prediabetes.Methods This study was a cross-sectional survey research.A total of 239 cases from June 2020 to April 2021 were recruited as study subjects from the people aged 18 to 70 years with high risk of diabetes and the healthy people in the Physical Examination Center of the First Affiliated Hospital of China Medical University.All patients′sex,age,height,weight,systolic blood pressure,diastolic blood pressure,heart rate and so on were collected,oral glucose tolerance test(OGTT)was performed and pancreatic islet function and glycated hemoglobin A1c(HbA1c)were detected.Anthropometric indicators including abdominal volume index(AVI),body roundness index(BRI),body adiposity index(BAI),conicity index(C-index),body shape index(ABSI),clínica universidad de navarra-body adiposity estimator(Cun-BAE)and homeostasis model assessment insulin resistance index(HOMA-IR)were calculated.All the subjects were divided into the normal glucose tolerance(NGT)group and the prediabetes group according to the OGTT test results.Rank sum test and chi-square test were used to analyze the difference in basic data between the two groups.Spearman correlation was used to analyze the correlation between HbA1c,HOMA-IR and anthropometric indicators.The receiver operating characteristic(ROC)curve and logistic regression were used to analyze the predictive effects of anthropometric indicators on prediabetes.Results There were 119 cases in NGT group(including 46 healthy people in the physical examination center),120 cases in prediabetes group.AVI,BRI,BAI,C-index,ABSI,CUN-BAE were statistically different between the two groups(all P<0.05),and they were all related to HbA1c and HOMA-IR(all P<0.05).ROC curve analysis showed that 3.698 as the boundary value the BRI had the maximum ROC area(AUC=0.710).The multivariate logistic regression analysis showed that BRI(OR=4.408),C-index(OR=4.540,all P<0.05)had the greatest influence on prediabetes,and stepwise logistic regression showed AVI,BAI and ABSI could be combined to predict prediabetes.The area under the ROC curve of the combined application of AVI,BAI and ABSI was also the largest(AUC=0.735).Conclusions BRI and C-index are good predictors of prediabetes,but they cannot be used as independent indicators for predicting prediabetes.The combined application of AVI,BAI,and ABSI is more effective in predicting prediabetes.