2型糖尿病患者高乳酸水平的危险因素分析

Risk factors analysis for high lactic acid levels in patients with type 2 diabetes mellitus

目的:分析2型糖尿病(T2DM)患者乳酸水平的分布差异和相关因素,并评估其高乳酸血症的风险因素。方法:对1243例2型糖尿病患者进行回顾性横断面研究,统计血乳酸和其他代谢和临床指标,进行相关性分析和回归分析以确定与乳酸水平相关的因素和高乳酸血症独立危险因素。结果:与乳酸正常组相比,高乳酸血症组体质量指数(BMI)、二甲双胍服用史比例、血尿酸(SUA)、甘油三酯(TG)、胰岛素5时相、胰岛素晚相分泌、胰岛素抵抗指数(HOMA-IR)、胰岛素抵抗程度(TyG)更高,年龄、尿素氮(BUN)、高密度脂蛋白(HDL-C)和酮体更低,代谢综合征和血脂异常的患病率更高,酮症患病率更低。多因素分析显示,BMI(OR=1.050,95%CI:1.008~1.090)、BUN(OR=0.895,95%CI:0.829~0.966)、HDL-C(OR=0.565,95%CI:0.358~0.891)和血酮体(OR=0.824,95%CI:0.718~0.944)是高乳酸血症的独立危险因素。结论:对于T2DM患者,乳酸浓度是一个值得评估的研究因素,T2DM患者高乳酸血症患病率高,血乳酸水平受BMI、血脂、血酮体等多种因素影响,且与代谢综合征、血脂异常等多种糖尿病合并症具有相关性。

Objective:To analyze the distributional differences and associated factors of lactate levels in patients with type 2 diabetes mellitus(T2DM)and evaluate their risk factors for hyperlactatemia.Methods:In this retrospective cross-sectional study of 1243 T2DM patients,and in order to identify factors associated with lactate levels and independent risk factors for hyperlactatemia,we collected the data of serum lactate and other metabolic and clinical indicators,and performed correlation and regression analysis.Results:Compared with the regular lactate group,the hyperlactatemia group had higher levels of body mass index(BMI),rate of metformin-taking history,serum uric acid(SUA),triglyceride(TG),insulin 5-phase,late-phase insulin secretion,insulin resistance index,and insulin resistance(TyG),while the patients were younger and their levels of blood urea nitrogen(BUN),high density lipoprotein(HDL-C),and ketone bodies were lower.In addition,the hyperlactatemia group had a higher prevalence of metabolic syndrome and dyslipidemia and a lower prevalence of ketosis.Multivariate analysis showed that BMI(OR=1.050,95%CI:1.008-1.090),BUN(OR=0.895,95%CI:0.829-0.966),HDL-C(OR=0.565,95%CI:0.358-0.891),and blood ketone bodies(OR=0.824,95%CI:0.718-0.944)were independent risk factors for hyperlactatemia.Conclusion:In patients with T2DM,lactate concentration is a worthwhile research factor to evaluate,and it is associated with multiple diabetic comorbidities.Patients with T2DM have a high prevalence of hyperlacteamia,which are affected by various factors such as BMI,blood lipids and ketone body,and are associated with various comorbidities such as metabolic syndrome and dyslipidemia.