血浆致动脉硬化指数联合胰岛素抵抗指数对2型糖尿病患者估算肾小球滤过率降低的预测价值

Prediction value of plasma arteriosclerosis index and insulin resistance index in combination in decreased estimated glomerular filtration rate in patients with type 2 diabetes mellitus

目的探讨血浆致动脉硬化指数(AIP)联合胰岛素抵抗指数(HOMA-IR)对2型糖尿病(T2DM)患者估算肾小球滤过率(eGFR)降低的预测价值。方法收集125例T2DM患者的一般资料和生化指标,包括年龄、病程、收缩压(SBP)、舒张压(DBP)、空腹血糖(FBS)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(TG)、极低密度脂蛋白胆固醇(VLDL-C)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、eGFR、胱抑素C(CysC)、脂蛋白a[Lp(a)]、肌酐(Cr)、尿酸(UA)、24 h尿蛋白,并计算AIP和HOMA-IR。依据eGFR水平,将患者分为单纯T2DM组[eGFR≥90 mL/(min·1.73 m^(2))]76例和eGFR降低组[eGFR<90 mL/(min·1.73 m^(2))]49例,比较2组一般资料、生化指标、HOMA-IR和AIP。采用二元Logistic回归分析明确AIP、HOMA-IR与T2DM患者eGFR降低的关系,并构建联合预测模型。绘制受试者工作特征(ROC)曲线,分析HOMA-IR、AIP单独及联合预测T2DM患者eGFR降低的价值。结果2组患者AIP、HOMA-IR、年龄、病程、DBP、FINS、TG、Cys C、Lp(a)、Cr、UA、24 h尿蛋白比较,差异有统计学意义(P<0.05);AIP、HOMA-IR升高均为T2DM患者eGFR降低的独立危险因素(P<0.05),联合预测模型为Logit(P)=-1.764+0.765×AIP+0.157×HOMA-IR。ROC曲线显示,单独AIP、单独HOMA-IR的曲线下面积(AUC)分别为0.605(95%CI:0.501~0.709)、0.707(95%CI:0.600~0.810),截断值分别为0.48、0.32,此时敏感度分别为27%、66%,特异度分别为96%、76%;两者联合预测的AUC为0.710(95%CI:0.600~0.820),截断值为0.31,敏感度为66%,特异度为73%。结论AIP、HOMA-IR均为T2DM患者eGFR降低的独立危险因素,两者联合预测eGFR降低的价值高于单独预测。

Objective To investigate the combined prediction value of plasma arteriosclerosis index(AIP)and insulin resistance index(HOMA-IR)in the reduction of estimated glomerular filtration rate(eGFR)in patients with type 2 diabetes mellitus(T2DM).Methods The clinical data and biochemical indexes of 125 patients with T2DM were collected,such as age,disease course,diastolic blood pressure(DBP),systolic blood pressure(SBP),fasting blood glucose(FBS),fasting insulin(FINS),glycosylated hemoglobin(HbA1c),total cholesterol(TC),triglycerides(TG),very low density lipoprotein cholesterol(VLDL-C),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),eGFR,cystatin C(CysC),lipoprotein a[Lp(a)],creatinine(Cr),uric acid(UA),24-hour urinary protein,and AIP and HOMA-IR were calculated.According to the eGFR level,the patients were divided into T2DM group[76 cases,eGFR≥90 mL/(min·1.73 m^(2))]and eGFR reduced group[49 cases,eGFR<90 mL/(min·1.73 m^(2))].The clinical data,biochemical indexes,HOMA-IR and AIP between the two groups were compared.The relationships of AIP and HOMA-IR with the decrease of eGFR in T2DM patients were analyzed by binary Logistic regression,and the combined prediction model was constructed.Receiver operating characteristic(ROC)curve was drawn to analyze the value of HOMA-IR or AIP alone and their combination in predicting eGFR reduction in T2DM patients.Results There were significant differences in AIP,HOMA-IR,age,course of disease,DBP,FINS,TG,CysC,Lp(a),Cr,UA and 24 h urinary protein between the two groups(P<0.05).Increased levels of AIP and HOMA-IR were independent risk factors for decreased eGFR in T2DM patients(P<0.05),and the joint predictor of both was Logit(P)=-1.764+0.765×AIP+0.157×HOMA-IR.ROC curve analysis results showed that the areas under the curve(AUC)of AIP alone and HOMA-IR alone were 0.605(95%CI,0.501 to 0.709)and 0.707(95%CI,0.600 to 0.810),respectively.The cut-off values were 0.48 and 0.32,and the sensitivities were 27%and 66%,and the specificities were 96%and 76%,respectively.The AUC of their combined prediction was 0.710(95%CI,0.600 to 0.820),the cut-off value was 0.31,the sensitivity was 66%,and the specificity was 73%.Conclusion AIP and HOMA-IR are independent risk factors for eGFR reduction in T2DM patients,and the value of eGFR reduction predicted by both AIP and HOMA-IR is higher than that predicted separately.