血脂水平及血脂异常不同临床分类与糖尿病肾病的相关性及预测价值研究

Blood Lipid Indicators and Different Clinical Classifications of Dyslipidemia and Diabetic Kidney Disease:Correlation and Predictive Value

目的探讨血脂各项指标及血脂异常不同临床分类与糖尿病肾病(diabetic kidney disease,DKD)的关系,并比较血脂异常不同临床分类对DKD的预测价值。方法连续纳入2020年10月–2021年10月重庆医科大学附属永川医院和重庆医科大学附属第一医院收治的2型糖尿病(type 2 diabetes mellitus,T2DM)患者356例作为研究对象,按照是否合并DKD分为DKD组(n=126)和单纯T2DM组(n=230),并选取同期健康体检者250例作为对照组,测定3组的血压、血脂、血糖、肾功能等指标,采用非条件logistic回归模型分析血脂异常不同临床分类对DKD的影响,进一步构建ROC曲线,并计算曲线下面积(area under the curve,AUC),分析血脂异常不同临床分类对DKD的预测价值。结果DKD组和单纯T2DM组患者的舒张压(diastolic blood pressure,DBP)、收缩压(systolic blood pressure,SBP)、总胆固醇(total cholesterol,TC)、三酰甘油(triacylglycerol,TG)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、血清肌酐(serum creatinine,Scr)、尿酸(uric acid,UA)和糖化血红蛋白A1c(glycosylated hemoglobin A1c,HbA1c)均分别高于对照组,而两组的高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)则分别低于对照组,差异均有统计学意义(均P<0.05);DKD组患者的T2DM病程、DBP、SBP、TC、TG、Scr、UA和HbA1c均高于单纯T2DM组,差异均有统计学意义(均P<0.05)。在校正T2DM病程、DBP、SBP、Scr、UA和HbA1c的影响后,结果显示:TC(OR=1.426,95%CI:1.088~1.868)和TG(OR=1.404,95%CI:1.075~1.833)是DKD发病的独立危险因素;高胆固醇血症(OR=1.817,95%CI:1.040~3.177)和混合型高脂血症(OR=2.148,95%CI:1.110~4.159)均为DKD的独立危险因素(均P<0.05)。高胆固醇血症的AUC(95%CI)为0.789(0.729~0.871),混合型高脂血症AUC(95%CI)为0.671(0.579~0.760);高胆固醇血症对DKD的诊断预测价值更大。结论血脂水平中,TC和TG是DKD的独立危险因素,血脂异常临床分类中,高胆固醇血症和混合型高脂血症是DKD的独立危险因素;高胆固醇血症可以作为T2DM患者中DKD筛查的预测因子,适合在门诊患者中进行筛查推广。

Objective To explore the relationship between blood lipid indicators and different clinical classifications of dyslipidemia and diabetic kidney disease(DKD)and to compare the value of different clinical classifications of dyslipidemia for predicting DKD.Methods Continuously enrollment of subjects was conducted at the First Affiliated Hospital of Chongqing Medical University and the Yongchuan Hospital of Chongqing Medical University between October 2020 and October 2021.A total of 356 type 2 diabetes mellitus(T2DM)patients admitted to the two hospitals were enrolled.They were divided into DKD group(n=126)and simple T2DM group(n=230)according to whether their T2DM was combined with DKD.In addition,250 healthy individuals undergoing physical examination during the same period were enrolled for the control group.The blood pressure,blood lipid,blood glucose,and the kidney function indicators of the three groups were measured.The effects of different classifications of dyslipidemia on DKD were analyzed with unconditional logistic regression models,the receiver operating characteristic(ROC)curve was constructed,the area under the curve(AUC)of ROC was calculated,and the value of different classifications of dyslipidemia for predicting DKD was analyzed.Results The diastolic blood pressure(DBP),systolic blood pressure(SBP),total cholesterol(TC),triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C),serum creatinine(Scr),uric acid(UA),and glycosylated hemoglobin A1c(HbA1c)of the DKD group and the simple T2DM group were significantly higher than those of the control group,while the high-density lipoprotein cholesterol(HDL-C)levels of the DKD group and the simple T2DM group were lower than that of the control group(all P<0.05).The disease course of T2DM,DBP,SBP,TC,TG,Scr,UA and HbA1c of the DKD group were significantly higher than those of the T2DM group(all P<0.05).After adjusting for the effects of T2DM disease course,DBP,SBP,Scr,UA and HbA1c,the results showed that TC(OR=1.426,95%CI:1.088-1.868)and TG(OR=1.404,95%CI:1.075-1.833)were independent risk factors for DKD,and that hypercholesterolemia(OR=1.817,95%CI:1.040-3.177)and mixed hyperlipidemia(OR=2.148,95%CI:1.110-4.159)were independent risk factors for DKD(all P<0.05).The AUC(95%CI)of hypercholesterolemia was 0.789(0.729-0.871).The AUC(95%CI)of mixed hyperlipidemia was 0.671(0.579-0.760).Hypercholesterolemia showed better predictive value for the diagnosis and prediction of DKD.Conclusion Among the blood lipid indicators,TC and TG are independent risk factors of DKD.In the clinical classifications of dyslipidemia,hypercholesterolemia and mixed hyperlipidemia are independent risk factors of DKD.Hypercholesterolemia can be used as a predictor to screen for DKD among T2DM patients and is well suited for extensive application in outpatient screening.