尿抗坏血酸影响因素及其与糖尿病的关联性研究

Study on the influence factors of urinary ascorbic acid and its association with diabetes mellitus

目的探讨尿抗坏血酸的影响因素及其与糖尿病患病的关联。方法基于国家重点研发计划"重大慢性非传染性疾病防控研究"项目, 自2016年12月至2017年6月, 采取分层多阶段整群抽样的方法对全国8个省共10个地区的常住居民进行横断面调查研究。收集研究对象性别、年龄、民族、血压、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)、吸烟、饮茶、饮酒、水果摄入情况、尿抗坏血酸, 测量其身高、体重并计算体重指数(BMI), 根据BMI对研究对象进行体型分类:超重为24 kg/m^(2)≤BMI<28 kg/m^(2), 肥胖为BMI≥28 kg/m^(2), 正常为18.5 kg/m^(2)≤BMI<24 kg/m^(2), 体重过低为BMI<18.5 kg/m^(2)。根据尿抗坏血酸检测结果将研究对象分为尿抗坏血酸阴性组及尿抗坏血酸阳性组, 阴性组即尿抗坏血酸结果为0, 阳性组包括尿抗坏血酸结果为1+、2+、3+。糖尿病依据《中国2型糖尿病防治指南(2020年版)》标准、糖尿病病史以及降糖药物用药史诊断。采用logistic回归模型探索尿抗坏血酸影响因素及其与糖尿病的相关性。结果共纳入11 215例研究对象, 其中尿抗坏血酸阳性者1 014例, 尿抗坏血酸阴性者10 201例。尿抗坏血酸阳性者中有172例糖尿病患者。多因素logistic回归分析结果显示, 尿抗坏血酸阳性的影响因素包括民族(以汉族为参照, 朝鲜族:OR=1.59, 95%CI 1.30~1.95;傣族:OR=1.23, 95%CI 1.01~1.49;哈萨克族:OR=0.09, 95%CI 0.04~0.17;维吾尔族:OR=0.31, 95%CI 0.22~0.43;壮族:OR=1.27, 95%CI 1.05~1.55)、性别(以女性为参照, 男性:OR=0.63, 95%CI 0.50~0.79)、年龄(OR=0.99, 95%CI 0.98~1.00)、体型(以非超重或肥胖为参照, 超重:OR=1.26, 95%CI 1.08~1.46;肥胖:OR=1.38, 95%CI 1.13~1.68)、HDL-C(OR=1.31, 95%CI 1.06~1.62)、水果摄入(以低摄入为参照, 一般摄入:OR=1.37, 95%CI 1.15~1.65, 高摄入:OR=1.48, 95%CI 1.17~1.87)。校正性别、民族、年龄、体型、血压、HDL-C、TG、吸烟、饮茶、饮酒、水果摄入后, 与尿抗坏血酸阴性者相比, 尿抗坏血酸阳性者糖尿病的患病率增加81%(OR=1.81, 95%CI 1.49~2.19)。结论民族、性别、年龄、体型、HDL-C、水果摄入是尿抗坏血酸阳性的影响因素, 尿抗坏血酸阳性人群可能存在糖代谢异常状态, 其阳性与糖尿病患病密切相关。

Objective To explore the influencing factors of urinary ascorbic acid and the association between urinary ascorbic acid positivity and diabetes.Methods Based on the“Research on the Prevention and Control of Major Chronic Noncommunicable Diseases”project of the National Key Research and Development Plan,a cross-sectional survey of permanent residents in 10 regions of 8 provinces in China was conducted from December 2016 to June 2017 using stratified and multi-stage cluster sampling method.Age,sex,ethnicity,blood pressure,high-density lipoprotein cholesterol(HDL-C),triglyceride(TG),smoking,tea drinking,alcohol consumption,fruit intake and urinary ascorbic acid of the subjects were collected,their height and weight were measured,and their body mass index(BMI)was calculated according the height and weight.Body type of the subjects was classified according to BMI.Overweight is 24 kg/m^(2)≤BMI<28 kg/m^(2),obesity is≥28 kg/m^(2),normal is 18.5 kg/m^(2)≤BMI<24 kg/m^(2),and underweight is<18.5 kg/m^(2).According to the results of urine ascorbic acid test,the study subjects were divided into urine ascorbic acid negative group and urine ascorbic acid positive group.The negative group′s urine ascorbic acid result was 0,and the positive group included 1+,2+and 3+.Diabetes was diagnosed according to the criteria of the Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes(2020 Edition),history of diabetes and history of hypoglycemic drugs.Logistic regression model was used to explore the influencing factors of urinary ascorbic acid positive and its correlation with diabetes.ResultsA total of 11215 subjects were included,of whom 1014 were ascorbate-positive and 10201 were ascorbate-negative.There were 172 diabetic patients in ascorbic acid positive urine.Multivariate logistic regression analysis showed that the influencing factors of urine ascorbic acid positive included nationality(Han nationality as the reference,Korean nationality:OR=1.59,95%CI 1.30-1.95;Dai nationality:OR=1.23,95%CI 1.01-1.49;Kazakh:OR=0.09,95%CI 0.04-0.17;Uygur:OR=0.31,95%CI 0.22-0.43;Zhuang nationality:OR=1.27,95%CI 1.05-1.55),sex(female as reference,male:OR=0.63,95%CI 0.50-0.79),age(OR=0.99,95%CI 0.99-1.00),somatotype(non-overweight or obese as reference,overweight:OR=1.26,95%CI 1.08-1.46;obesity:OR=1.38,95%CI 1.13-1.68),HDL-C(OR=1.31,95%CI 1.06-1.62),fruit intake(low intake as reference,general intake:OR=1.37,95%CI 1.15-1.65,high intake:OR=1.48,95%CI 1.17-1.87).After adjusting for sex,ethnicity,age,somatotype,hypertension,HDL-C,TG,smoking,tea consumption,alcohol consumption,and fruit intake,the prevalence of diabetes was increased by 81%in positive urine ascorbic acid subjects compared with negative subjects(OR=1.81,95%CI 1.49-2.19).Conclusions Ethnicity,sex,age,somatotype,HDL-C and fruit intake are the influencing factors of urinary ascorbic acid positivity.There may be abnormal glucose metabolism in the urinary ascorbic acid positive population,and its positive status is closely related to diabetes.