血脂与 2 型糖尿病患者的微血管并发症有关吗？来自中国上海的一项横断面研究。
Are blood lipids associated with microvascular complications among type 2 diabetes mellitus patients? A cross-sectional study in Shanghai, China.
机构信息
Department of General Practice, Zhongshan Hospital of Fudan University, Shanghai, China.
Department of General Practice, University of Melbourne, Carlton, Melbourne, VIC, Australia.
出版信息
Lipids Health Dis. 2019 Jan 18;18(1):18. doi: 10.1186/s12944-019-0970-2.
BACKGROUND
Although there are several studies to investigate the association between blood lipids and microvascular complications, these studies reported conflicting results. The aim of the current study was to explore the association between blood lipid parameters and the risk of microvascular complications, especially the dose-response association between them, among community patients with type 2 diabetes mellitus (T2DM) in Shanghai, China.
METHODS
The cross-sectional study was conducted in 6 community health service centers in Shanghai between December 2014 and December 2016.The associations between blood lipids and diabetic kidney disease (DKD) or diabetic retinopathy (DR) were assessed using multiple logistic regression. Restricted cubic spline (RCS) was employed to estimate the dose-response relation of blood lipids and the risk of microvascular complications.
RESULTS
A total of 3698 participants were included in the final analysis to study the association between blood lipids and DKD, wherein 33.2% of participants had DKD and 1374 were included for the analysis of the association between blood lipids and DR, wherein 23.2% of participants had DR. DKD odds ratio was increased by 1.16(95%CI,1.08-1.25), 1.21(95%CI,1.13-1.30), 1.18(95%CI,1.10-1.26) for comparing fourth to first quartiles of triglycerides (TG), TG/high-density lipoprotein cholesterol (HDL-C), non-HDL-C/HDL-C, respectively, and decreased by 0.83(95%CI,0.78-0.89) for comparing fourth to first quartiles of HDL-C. Furthermore, the dose-response association between TG, HDL-C, TG/HDL-C, non-HDL-C/HDL-C and the risk of DKD demonstrated turning points in TG of 1.90 mmol/L, HDL-C of 1.62 mmol/L, TG/HDL-C of 2.00, non-HDL-C/HDL-C of 3.09, respectively. However, no significant association was found between blood lipid parameters and DR.
CONCLUSIONS
This community-based study indicated that TG, HDL-C, TG/HDL-C, non-HDL-C/HDL-C were independently associated with DKD but not DR.
背景
虽然有几项研究调查了血脂与微血管并发症之间的关系，但这些研究的结果存在冲突。本研究旨在探索血脂参数与微血管并发症风险之间的关系，尤其是在中国上海社区 2 型糖尿病（T2DM）患者中它们之间的剂量-反应关系。
方法
该横断面研究于 2014 年 12 月至 2016 年 12 月在上海 6 家社区卫生服务中心进行。使用多因素 logistic 回归评估血脂与糖尿病肾病（DKD）或糖尿病视网膜病变（DR）之间的关系。采用限制性三次样条（RCS）估计血脂与微血管并发症风险之间的剂量-反应关系。
结果
共有 3698 名参与者纳入最终分析，以研究血脂与 DKD 之间的关系，其中 33.2%的参与者患有 DKD；有 1374 名参与者纳入血脂与 DR 之间关系的分析，其中 23.2%的参与者患有 DR。与第 1 四分位相比，第 4 四分位的甘油三酯（TG）、TG/高密度脂蛋白胆固醇（HDL-C）、非 HDL-C/HDL-C 使 DKD 比值增加 1.16（95%CI，1.08-1.25）、1.21（95%CI，1.13-1.30）、1.18（95%CI，1.10-1.26），与第 1 四分位相比，第 4 四分位的 HDL-C 使 DKD 比值降低 0.83（95%CI，0.78-0.89）。此外，TG、HDL-C、TG/HDL-C、非 HDL-C/HDL-C 与 DKD 风险之间的剂量-反应关系在 TG 为 1.90mmol/L、HDL-C 为 1.62mmol/L、TG/HDL-C 为 2.00、非 HDL-C/HDL-C 为 3.09 时出现拐点。然而，血脂参数与 DR 之间无显著相关性。
结论
本社区研究表明，TG、HDL-C、TG/HDL-C、非 HDL-C/HDL-C 与 DKD 独立相关，但与 DR 无关。
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