Nutrition Department, Harvard School of Public Health, Boston, MA (F.M.S., L.B.); Cliniques universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium (M.P.H.); Department of Medicine, University of Padova, Padova, Italy (P.F., I.B.); Department of Endocrinology Diabetology Nutrition, Jean Verdier Hospital, AP-HP, Le Centre de Recherché en Nutrition Humaine d'Ille de France, Paris Nord University, Bondy, France (P.V.); University of Western Australia, Crawley, Australia (T.D.); Harvard Medical School, Joslin Diabetes Center, Boston, MA (E.H., S.H.-B.); University of Würzburg, Würzburg, Germany (C.W.); College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia (K.A.-R.); LMC Diabetes and Endocrinology, Toronto, Ontario, Canada (R.A.); Department of Medicine, Section of Endocrinology, University of Verona, Verona, Italy (E.B., G.Z.); Ramathibodi Hospital, Bangkok, Thailand (P.B.); Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (L.-M.C., Y.-D.J.); Rangsit School of Medicine, Rajavithi Hospital, Bangkok, Thailand (C.D.); North York General Hospital and LMC Diabetes and Endocrinology Centres, Toronto, Ontario, Canada (R.G.); Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA (B.H., N.L., V.J.C.); CIBERDEM and Vall d'Hebron Research Institute, Barcelona, Spain (C.H., R.S.); Keio University School of Medicine, Tokyo, Japan (H.I., M.T.); Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Jiaotong University, Affiliated Sixth People's Hospital, Shanghai, China (W.J.); Department of Diabetes and Metabolic Diseases, The University of Tokyo, Tokyo, Japan (T.K.); University of Toronto, Toronto, Ontario, Canada (L.L.); Tokyo Medical University, Tokyo, Japan (T.M., M.O.); Department of General Internal Medicine, National Cancer Center Hospital, Tokyo, Japan (K.O.); Tokyo Medical University Hachioji Medical Center, Tokyo, Japan (A.O.); Beijing 301 Mili
Circulation. 2014 Mar 4;129(9):999-1008. doi: 10.1161/CIRCULATIONAHA.113.002529. Epub 2013 Dec 18.
Microvascular renal and retinal diseases are common major complications of type 2 diabetes mellitus. The relation between plasma lipids and microvascular disease is not well established.
The case subjects were 2535 patients with type 2 diabetes mellitus with an average duration of 14 years, 1891 of whom had kidney disease and 1218 with retinopathy. The case subjects were matched for diabetes mellitus duration, age, sex, and low-density lipoprotein cholesterol to 3683 control subjects with type 2 diabetes mellitus who did not have kidney disease or retinopathy. The study was conducted in 24 sites in 13 countries. The primary analysis included kidney disease and retinopathy cases. Matched analysis was performed by use of site-specific conditional logistic regression in multivariable models that adjusted for hemoglobin A1c, hypertension, and statin treatment. Mean low-density lipoprotein cholesterol concentration was 2.3 mmol/L. The microvascular disease odds ratio increased by a factor of 1.16 (95% confidence interval, 1.11-1.22) for every 0.5 mmol/L (≈1 quintile) increase in triglycerides or decreased by a factor of 0.92 (0.88-0.96) for every 0.2 mmol/L (≈1 quintile) increase in high-density lipoprotein cholesterol. For kidney disease, the odds ratio increased by 1.23 (1.16-1.31) with triglycerides and decreased by 0.86 (0.82-0.91) with high-density lipoprotein cholesterol. Retinopathy was associated with triglycerides and high-density lipoprotein cholesterol in matched analysis but not significantly after additional adjustment.
Diabetic kidney disease is associated worldwide with higher levels of plasma triglycerides and lower levels of high-density lipoprotein cholesterol among patients with good control of low-density lipoprotein cholesterol. Retinopathy was less robustly associated with these lipids. These results strengthen the rationale for studying dyslipidemia treatment to prevent diabetic microvascular disease.
微血管肾脏和视网膜疾病是 2 型糖尿病的常见主要并发症。血浆脂质与微血管疾病之间的关系尚未明确。
本病例研究对象为 2535 名患有 2 型糖尿病的患者，平均病程为 14 年，其中 1891 名患者患有肾病，1218 名患者患有视网膜病变。这些病例研究对象按照糖尿病病程、年龄、性别和低密度脂蛋白胆固醇与 3683 名未患有肾病或视网膜病变的 2 型糖尿病对照研究对象相匹配。该研究在 13 个国家的 24 个地点进行。主要分析包括肾病和视网膜病变病例。通过使用多变量模型中的特定地点条件逻辑回归进行匹配分析，模型调整了血红蛋白 A1c、高血压和他汀类药物治疗。平均低密度脂蛋白胆固醇浓度为 2.3mmol/L。每增加 0.5mmol/L（≈1 个五分位）甘油三酯，微血管疾病的比值比增加 1.16（95%置信区间，1.11-1.22）；每增加 0.2mmol/L（≈1 个五分位）高密度脂蛋白胆固醇，比值比降低 0.92（0.88-0.96）。对于肾病，甘油三酯的比值比增加 1.23（1.16-1.31），高密度脂蛋白胆固醇的比值比降低 0.86（0.82-0.91）。在匹配分析中，视网膜病变与甘油三酯和高密度脂蛋白胆固醇相关，但在进一步调整后无统计学意义。
在良好控制低密度脂蛋白胆固醇的患者中，全球范围内糖尿病肾病与血浆甘油三酯水平升高和高密度脂蛋白胆固醇水平降低有关。视网膜病变与这些脂质的相关性较弱。这些结果为研究血脂异常治疗以预防糖尿病微血管疾病提供了更有力的依据。
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