三酰甘油葡萄糖指数、残余胆固醇与糖尿病肾病的相关性分析

A study on correlation between triglycerides glucose index,remnant cholesterol and diabetic nephropathy

目的探讨三酰甘油葡萄糖(TyG)指数、残余胆固醇(RC)与糖尿病肾病(DN)的相关性。方法连续纳入2022年3月至2023年3月江苏省中医院内分泌科住院2型糖尿病(T2DM)患者410例,根据尿白蛋白/肌酐比值(UACR)分为单纯糖尿病(SDM)组269例,早期DN(EDN)组80例,临床DN(CDN)组61例。比较3组患者的性别、年龄、既往史、身体质量指数(BMI)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)、尿素(Urea)、肌酐(Cr)、尿酸(UA)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C),计算TyG指数与RC。采用Spearman分析UACR与各指标之间的相关性;二元Logistic回归分析DN的独立危险因素;ROC曲线分析Urea、Cr、TyG指数和RC对DN的诊断效能。结果与SDM组相比,EDN组糖尿病病程、SBP、Urea、UA、TG、TC、TyG指数、RC显著增高,差异有统计学意义(P<0.05);与SDM组相比,CDN组糖尿病病程、SBP、DBP、Urea、Cr、UA、TG、TC、LDL-C、TyG指数、RC显著增高,差异有统计学意义(P<0.05)。Spearman相关分析显示,UACR与RC(r=0.278,P<0.001)和TyG指数(r=0.239,P<0.001)呈显著正相关;RC与TyG指数(r=0.562,P<0.001)呈显著正相关。多因素Logistic回归分析显示,糖尿病病程、SBP、Urea、Cr、TyG指数(OR=2.815,95%CI:1.481~5.349,P=0.002)、RC(OR=2.179,95%CI:1.038~4.574,P=0.04)是DN的独立危险因素。RC和TyG指数预测DN发生的ROC曲线下面积(AUCROC)分别为0.670(95%CI:0.616~0.725)和0.620(95%CI:0.564~0.676)。结论TyG指数、RC与2型糖尿病患者发生DN的风险显著相关,有助于临床更早地识别和管理处于DN风险中的糖尿病患者。

Objective To explore the relationship between the triglyceride-glucose(TyG)index,residual cholesterol(RC)and diabetic nephropathy(T2DM).Methods A total of 410 patients with T2DM were consecutively selected from the Endocrinology Department of Jiangsu Provincial Traditional Chinese Medicine Hospital from March 2022 to March 2023.The patients were stratified into three groups based on their morning urinary albumin-to-creatinine ratio(UACR):269 patients were in simple diabetes mellitus(SDM)group,80 in early diabetic nephropathy(EDN)group and 61 in clinical diabetic nephropathy(CDN)group.Comparative analyses were conducted on the three groups in terms of gender,age,past medical history,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FBG),Urea,creatinine(Cr),urinary albumin(UA)total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDLC).Additionally,TyG index and RC were calculated.Spearman analysis was employed to evaluate the correlation between UACR and these various parameters.Binary Logistic regression was utilized to identify independent risk factors for diabetic nephropathy(DN).The diagnostic performances of Urea,Cr,TyG index and RC for type 2 diabetic nephropathy were assessed using receiver operating characteristic(ROC)curve analyses.Results Compared with SDM group,diabetes duration,SBP,Urea,UA,TG,TC,TyG index and RC showed significant increases in EDN group with statistically significant differences(P<0.05),and diabetes duration,SBP,DBP,Urea,Cr,UA,TG,TC,LDL-C,TyG index and RC in CDN group also exhibited significant increases,with statistically significant differences(P<0.05).Spearman rank correlation analysis revealed a positive correlation between RC and UACR(r=0.278,P<0.001),a positive correlation between TyG index and UACR(r=0.239,P<0.001)and a positive correlation between RC and TyG index(r=0.562,P<0.001).Binary logistic regression analysis showed that diabetes duration,SBP,Urea,Cr,TyG index(OR=2.815,95%CI:1.481-5.349,P=0.002),and RC(OR=2.179,95%CI:1.038-4.574,P=0.04)were independent risk factors for DN.The area under the ROC curve(AUCROC)for RC predicting DN occurrence was 0.670(95%CI:0.616-0.725),while the AUCROC for the TyG index was 0.620(95%CI:0.564-0.676).Conclusion TyG index and RC were significantly correlated with the development of DN in the patients with T2DM,which may early facilitate clinical identification and management for the patients in the risk ofr diabetic kidney disease.