2 型糖尿病患者脂蛋白血浆浓度与下肢外周动脉疾病风险的关系：SURDIAGENE 研究。

AIMS/HYPOTHESIS: The lipid profile has not been fully investigated in individuals with peripheral artery disease (PAD). We aimed to evaluate the relationship between plasma concentrations of lipoproteins and the prevalence of lower-limb PAD at baseline and its incidence during follow-up in people with type 2 diabetes. METHODS: Plasma concentrations of total cholesterol, HDL-cholesterol, triacylglycerol and apolipoprotein (Apo) A-I, ApoA-II, ApoB-100 and Apo(a) were measured at baseline using colorimetric or MS methods in the SURDIAGENE cohort. Total cholesterol/HDL-cholesterol ratio, non-HDL-cholesterol and LDL-cholesterol were estimated using computation formulas. Logistic and Cox proportional hazard regression models were fitted to estimate OR or HR, with related 95% CI, for baseline prevalence or incidence of major PAD (lower-limb amputation or requirement of revascularisation) during follow-up by increasing lipoprotein tertiles, after adjustment for key confounders. RESULTS: Among 1468 participants (women 42%, mean ± SD age 65 ± 11 years, duration of diabetes 14 ± 10 years at baseline), 129 (8.8%) had a baseline history of major PAD. Major PAD was less prevalent at baseline in the highest (vs lowest) tertile of HDL-cholesterol (OR 0.42 [95% CI 0.26, 0.71], p = 0.001) and ApoA-I (OR 0.39 [95% CI 0.23, 0.67], p = 0.0007), and more frequent in the highest tertile of total cholesterol/HDL-cholesterol ratio (OR 1.95 [95% CI 1.18, 3.24], p = 0.01). Among 1339 participants without a history of PAD at baseline, incident PAD occurred in 97 (7.2%) during a median (25th-75th percentile) duration of follow-up of 7.1 (4.4-10.7) years, corresponding to 9685 person-years and an incidence rate of 9.8 (95% CI 8.0, 12.0) per 1000 person-years. The risk of incident PAD was lower in the top (vs bottom) tertile of HDL-cholesterol (HR 0.54 [95% CI 0.30, 0.95], p = 0.03) or ApoA-I (HR 0.50 [95% CI 0.28, 0.86], p = 0.01) and higher in the top tertile of total cholesterol/HDL-cholesterol ratio (HR 2.81 [95% CI 1.61, 5.04], p = 0.0002) and non-HDL-cholesterol (HR 1.80 [95% CI 1.06, 3.12], p = 0.03). CONCLUSIONS/INTERPRETATION: We reported independent associations between HDL-cholesterol, ApoA-I, total cholesterol/HDL-cholesterol ratio or non-HDL-cholesterol and the prevalence or the incidence of major PAD in people with type 2 diabetes. Our findings provide a picture of lipoprotein profile in people with type 2 diabetes. Graphical abstract.

目的/假设：外周动脉疾病（PAD）患者的血脂谱尚未得到充分研究。我们旨在评估 2 型糖尿病患者基线时脂蛋白血浆浓度与下肢 PAD 的患病率及其随访期间的发生率之间的关系。

方法：在 SURDIAGENE 队列中，使用比色法或 MS 方法在基线时测量总胆固醇、高密度脂蛋白胆固醇、三酰甘油和载脂蛋白（Apo）A-I、ApoA-II、ApoB-100 和 Apo(a)的浓度。使用计算公式估计总胆固醇/高密度脂蛋白胆固醇比值、非高密度脂蛋白胆固醇和低密度脂蛋白胆固醇。使用逻辑和 Cox 比例风险回归模型来估计 OR 或 HR，在调整了关键混杂因素后，通过增加脂蛋白三分位数，估计基线时主要 PAD（下肢截肢或需要血运重建）的患病率或随访期间的发病率（OR 或 HR 及其相关 95%CI）。

结果：在 1468 名参与者（女性 42%，平均年龄 65±11 岁，基线时糖尿病病程 14±10 年）中，129 名（8.8%）有基线主要 PAD 病史。与最低三分位相比，最高三分位的高密度脂蛋白胆固醇（OR 0.42 [95%CI 0.26, 0.71], p=0.001）和 ApoA-I（OR 0.39 [95%CI 0.23, 0.67], p=0.0007）的基线主要 PAD 患病率较低，总胆固醇/高密度脂蛋白胆固醇比值最高三分位（OR 1.95 [95%CI 1.18, 3.24], p=0.01）的患病率较高。在基线时无 PAD 病史的 1339 名参与者中，97 名（7.2%）在中位（25 至 75 百分位）随访 7.1（4.4 至 10.7）年后发生 PAD 事件，对应的人年数为 1339 人年，发生率为 9.8（95%CI 8.0, 12.0）/1000 人年。与最低三分位相比，最高三分位的高密度脂蛋白胆固醇（HR 0.54 [95%CI 0.30, 0.95], p=0.03）或 ApoA-I（HR 0.50 [95%CI 0.28, 0.86], p=0.01）的发生 PAD 风险较低，总胆固醇/高密度脂蛋白胆固醇比值最高三分位（HR 2.81 [95%CI 1.61, 5.04], p=0.0002）和非高密度脂蛋白胆固醇（HR 1.80 [95%CI 1.06, 3.12], p=0.03）的风险较高。

结论/解释：我们报告了高密度脂蛋白胆固醇、ApoA-I、总胆固醇/高密度脂蛋白胆固醇比值或非高密度脂蛋白胆固醇与 2 型糖尿病患者主要 PAD 的患病率或发生率之间的独立关联。我们的研究结果提供了 2 型糖尿病患者脂蛋白谱的图片。

新学期，新优惠

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新学期，新优惠

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Plasma concentrations of lipoproteins and risk of lower-limb peripheral artery disease in people with type 2 diabetes: the SURDIAGENE study.

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