Ram Nanik, Ahmed Bilal, Hashmi Fauzan, Jabbar Abdul
J Pak Med Assoc. 2014 Feb;64(2):124-8.
To study the correlation between Non-high-density lipoprotein and low-density lipoprotein cholesterol in patients with Type 2 diabetes mellitus and the proportion of patients achieving Adult Treatment Panel III recommended goals.
The cross sectional study was conducted at the Diabetic Clinic, Aga Khan University Hospital, Karachi. Data of Type 2 diabetes mellitus patients who attended the clinic bewteen 2007 and 2011 was reviewed. All Type 2 diabetic patients of either gender with fasting lipid profile irrespective of taking lipid lowering therapy were included.Type-1 DM, gestational diabetes, type 2 diabetes patients with pregnancy and those with incomplete data were excluded. Correlation between the low-density lipoprotein and Non-high-density lipoprotein was assessed by applying Cramer V and phi. Proportion of patients achieving Adult Treatment Panel III recommended goals was checked. Multivariable regression was done to identify common factors associated with elevated Non-high-density lipoprotein cholesterol.
A total of 1352 patients fulfilling the eligibility criteria were included in the study. Mean age of the patients was 54.5 +/- 11.3 years; 797 (59%) were males; 1122 (83%) had Body Mass Index above 25; and 1016 (75%) had HbA1c > or = 7%. Mean Non-high-density lipoprotein cholesterol was 129 +/- 42 mg/dl. Mean low-density lipoprotein cholesterol was 100 +/- 37 mg/dl. Both low-density lipoprotein < or = 100 and Non-HDL < or = 130 mg/dl was achieved in 645 (48%) patients. It is important to note that although 728 (53.8%) patients achieved target LDL cholesterol of < or = 100 mg/dl, among them 83 (11.4%) had Non-high-density lipoprotein cholesterol still above the target > 130 mg/dl (p < 0.05). Out of 752 patients with Non-high-density lipoprotein cholesterol < or = 130 mg/dl, 645 (86%) had low-density lipoprotein cholesterol below 100 mg/dl. Cramer V and Phi showed that correlation between Non-high-density lipoprotein and low-density lipoprotein cholesterol was 0.71 (p value < 0.01). After adjusting for other covariates, low-density lipoprotein cholesterol > 100 mg/dl was independently associated with having Non-high-density lipoprotein cholesterol > 130 mg/dl (Adjusted Odds Ratio 38.6; 95% Confidance Interval = 28.1-53.1). Similarly, age < or = 60 years was 60% more likely to have Non-high-density lipoprotein cholesterol > 130 mg/dl (Adjusted Odds Ratio 1.6; 95% Confidance Interval = 1.01 - 2.3). Whereas having obesity Body Mass Index > 25 was 3.6 times more associated to have Non-high-density lipoprotein > 130 mg/dl (Adjusted Odds Ratio 3.6; 95% Confidance Interval = 1.6-7.7). In patients with coronary artery disease, combined goal achievement of low-density lipoprotein < or = 70 mg/dl and Non-high-density lipoprotein cholesterol < or = 100 mg/dl was seen in 59 (35%). Among patients with high-density lipoprotein < or = 70 mg/dl, 8 (10%) had Non-high-density lipoprotein > 100 mg/dl (p < 0.05).
The study showed a correlation between Non-high-density lipoprotein and low-density lipoprotein cholesterol. As measuring Non-high-density lipoprotein cholesterol in Type 2 DM patients is simple, cost-effective and convenient because it does not require 12-hour fasting which may be a risk for hypoglycaemia in these patients, clinicians may choose Non-high-density lipoprotein as a routine measure in everyday practice.
研究2型糖尿病患者中非高密度脂蛋白与低密度脂蛋白胆固醇之间的相关性，以及达到成人治疗小组第三次报告推荐目标的患者比例。
本横断面研究在卡拉奇阿迦汗大学医院糖尿病门诊进行。回顾了2007年至2011年期间到该门诊就诊的2型糖尿病患者的数据。纳入所有无论是否接受降脂治疗、有空腹血脂谱的2型糖尿病患者，男女不限。排除1型糖尿病、妊娠期糖尿病、妊娠合并2型糖尿病患者以及数据不完整的患者。应用克莱姆V系数和φ系数评估低密度脂蛋白与非高密度脂蛋白之间的相关性。检查达到成人治疗小组第三次报告推荐目标的患者比例。进行多变量回归分析以确定与非高密度脂蛋白胆固醇升高相关的常见因素。
共有1352例符合纳入标准的患者纳入本研究。患者的平均年龄为54.5±11.3岁；797例（59%）为男性；1122例（83%）体重指数高于25；1016例（75%）糖化血红蛋白≥7%。平均非高密度脂蛋白胆固醇为129±42mg/dl。平均低密度脂蛋白胆固醇为100±37mg/dl。645例（48%）患者的低密度脂蛋白≤100mg/dl且非高密度脂蛋白≤130mg/dl。需要注意的是，尽管728例（53.8%）患者达到了低密度脂蛋白胆固醇≤100mg/dl的目标，但其中83例（11.4%）患者的非高密度脂蛋白胆固醇仍高于目标值>130mg/dl（P<0.05）。在752例非高密度脂蛋白胆固醇≤130mg/dl的患者中，645例（86%）患者的低密度脂蛋白胆固醇低于100mg/dl。克莱姆V系数和φ系数显示非高密度脂蛋白与低密度脂蛋白胆固醇之间的相关性为0.71（P值<0.01）。在对其他协变量进行调整后，低密度脂蛋白胆固醇>100mg/dl与非高密度脂蛋白胆固醇>130mg/dl独立相关（调整后的优势比为38.6；95%置信区间=28.1-53.1）。同样，年龄≤60岁的患者发生非高密度脂蛋白胆固醇>130mg/dl的可能性高出60%（调整后的优势比为1.6；95%置信区间=1.01-2.3）。而肥胖（体重指数>25）患者发生非高密度脂蛋白>130mg/dl的相关性高3.6倍（调整后的优势比为3.6；95%置信区间=1.6-7.7）。在冠心病患者中，59例（35%）患者同时达到了低密度脂蛋白≤70mg/dl和非高密度脂蛋白胆固醇≤100mg/dl的联合目标。在高密度脂蛋白≤70mg/dl的患者中，8例（10%）患者的非高密度脂蛋白>100mg/dl（P<0.05）。
本研究显示非高密度脂蛋白与低密度脂蛋白胆固醇之间存在相关性。由于测量2型糖尿病患者的非高密度脂蛋白胆固醇简单、经济有效且方便（因为它不需要12小时禁食，而禁食可能会使这些患者发生低血糖的风险增加），临床医生在日常实践中可选择将非高密度脂蛋白作为常规检测指标。
