TyG指数、LDL/ApoB对糖尿病肾病的预测价值研究

Study on predictive value of TyG index and LDL/ApoB for diabetic nephropathy

目的研究三酰甘油-葡萄糖(TyG)指数、低密度脂蛋白与载脂蛋白B的比值(LDL/ApoB)与糖尿病肾病患者的相关性,并探讨两者及其联合应用对糖尿病肾病的预测价值。方法收集该院内分泌科2021年10月至2023年9月2型糖尿病(T2DM)住院患者160例,研究人群根据尿白蛋白与肌酐比值(UACR)分为3组:单纯糖尿病组(UACR<30 mg/g,78例)、早期糖尿病肾病组(UACR 30~<300 mg/g,45例)及中期糖尿病肾病组(UACR≥300 mg/g,37例)。分析3组患者一般临床资料、生化指标、LDL/ApoB和TyG指数的差异。此外,将患者分为非糖尿病肾病组(UACR<30 mg/g,78例)和糖尿病肾病组(UACR≥30 mg/g,82例),分析TyG指数、LDL/ApoB对糖尿病肾病的预测价值。结果3组患者的病程、糖化血红蛋白(HbA1c)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL)、载脂蛋白B(ApoB)、肌酐、肾小球滤过率(eGFR)、LDL/ApoB、TyG指数比较差异有统计学意义(P<0.05)。TyG水平在单纯糖尿病组、早期糖尿病肾病组、中期糖尿病肾病组中依次降低,且3组组间比较差异有统计学意义(P<0.05)。而中期糖尿病肾病组及早期糖尿病肾病组中的LDL/ApoB的水平均低于单纯糖尿病组,组间比较差异均有统计学意义(P<0.05);中期糖尿病组的LDL/ApoB水平与早期糖尿病肾病组比较,差异无统计学意义(P>0.05)。TyG指数预测糖尿病肾病的受试者工作特征(ROC)曲线下面积(AUC)为0.759,LDL/ApoB预测糖尿病肾病的ROC AUC为0.701,两指标联合预测糖尿病肾病ROC AUC为0.824。结论LDL/ApoB、TyG指数均可以作为2型糖尿病肾病的预测指标,两者联合对糖尿病肾病更有预测价值。

Objective To investigate the correlation between TyG index,LDL/ApoB and type 2 diabetic nephropathy(DN),and to explore the predictive value of the both and their combined application in type 2 diabetic nephropathy.Methods A total of 160 inpatients with type 2 diabetes mellitus(T2DM)in the endocrinology department of this hospital from October 2021 to September 2023 were collected and divided into the three groups based on the urinary albumin-to-creatinine ratio(UACR):simple diabetes group(UACR<30 mg/g,78 cases),early diabetic nephropathy group(UACR 30-<300 mg/g,45 cases)and middle stage diabetic nephropathy group(UACR≥300 mg/g,37 cases).The differences in the general clinical data,biochemical indicators and LDL/ApoB and TyG index were compared among the three groups.In addition,the patients were divided into the non-diabetic nephropathy group(UACR<30 mg/g,78 cases)and diabetic nephropathy group(UACR≥30 mg/g,82 cases).The predictive value of TyG index and LDL/ApoB to diabetic nephropathy was analyzed.Results The disease duration,HbA1c,TC,TG,HDL,ApoB,creatinine,estimated glomerular filtration rate(eGFR),LDL/ApoB and TyG index had statistical differences among the three groups(P<0.05).The TyG level in the simple diabetic group,early diabetic nephropathy group and middle stage diabetic nephropathy group was decreased successively,and the differences among the three groups had statistical significant(P<0.05).The level of LDL/ApoB in the middle stage diabetic nephropathy group and early stage diabetic nephropathy group was lower than that in the simple diabetic group,and the difference was statistically significant(P<0.05).The LDL/ApoB level had no statistical difference between the middle stage diabetic group and early stage diabetic nephropathy group(P>0.05).The area under the receiver operating characteristic(ROC)curve(AUC)of TyG index for predicting diabetic nephropathy was 0.759,which of LDL/ApoB for predicting diabetic nephropathy was 0.701,and which of the two indexes combination for predicting diabetic nephropathy was 0.824.Conclusion LDL/ApoB and TyG index all could serve as the predictive indicators for type 2 diabetic nephropathy,and their combination has more predictive value for diabetic nephropathy.