低水平高密度脂蛋白胆固醇是糖尿病发生的独立危险因素(一项基于Dryad数据库的回顾性队列研究)

Low-level high-density lipoprotein cholesterol is an independent risk factor for incidence of diabetes mellitus:A retrospective cohort study based on Dryad database

目的:明确基线血清高密度脂蛋白胆固醇(HDL-C)水平与糖尿病发病率之间的关系,为糖尿病的预测和预防提供依据。方法:从Dryad数据库中提取2004年~2015年间日本岐阜地区NAGALA研究数据。使用多因素Cox回归模型评估基线血清HDL-C水平引起糖尿病发生的风险比,平滑曲线拟合分析HDL-C与糖尿病发生的剂量依赖关系,并且使用两分段线性回归模型寻找HDL-C的阈值。结果:该研究共纳入体检人群15453例,最长经过13年的随访,有373例被诊断为糖尿病。调整了年龄、性别、吸烟状况、酒精摄入量、BMI、腰围、甘油三酯、胆固醇、空腹血糖和糖化血红蛋白后,与HDL-C高水平的参与者相比,中、低水平参与者糖尿病发生风险升高了50%和87%[HR(95%CI)分别为1.50(1.05,2.14)和1.87(1.22,2.85)]。平滑曲线拟合显示:HDL-C<65.5mg/dl时,糖尿病发生风险随着HDL-C的升高而降低[HR 0.98(0.97,0.99),P=0.0015];HDL-C≥65.5mg/dl时,风险无明显相关[HR 1.02(0.99,1.04),P=0.232]。结论:低水平HDL-C是糖尿病发生的独立危险因素。

Objective:To examine the association between baseline serum high-density lipoprotein cholesterol(HDL-C)and incidence of diabetes mellitus(DM),provide evidence for the prediction and prevention of DM.Methods:The NAGALA study data between 2004 to 2015 in the Gifu Area,Japan were extracted from the Dryad database.The risk of incidence of DM according to baseline serum HDL-C was estimated using multivariable Cox proportional hazards models.A dose-response relationship between HDL-C and DM was analyzed using a smooth curve fit,and a two-piecewise linear regression model was established to find out the threshold value.Results:Totally 15453 cases participating physical examination were finally included in the study,373 of who were diagnosed as DM with a maximum follow-up of 13 years.The risk of developing DM increased by 50%and 87%in moderate and low levels of HDL-C vs high level of HDL-C,after adjusting age,gender,smoking status,alcohol intake,BMI,waist circumference,triglycerides,total cholesterol,fasting plasma glucose and hemoglobin A1 c.HRs(95%CI)were 1.50(1.05,2.14)and 1.87(1.22,2.85),respectively.The risk of developing DM decreased with the increase of HDL-C when serum HDL-C was less than 65.5 mg/dl[HR 0.98(0.97,0.99),P=0.0015];However,HDL-C was not associated with the risk of developing DM when serum HDL-C was higher than 65.5 mg/dl[HR 1.02(0.99,1.04),P=0.232].Conclusion:Low-level HDL-C is an independent risk factor for incidence of DM.