三酰甘油/低密度脂蛋白胆固醇比值是 2 型糖尿病患者小而密 LDL 增加的最有价值的预测指标。
Triglyceride/low-density-lipoprotein cholesterol ratio is the most valuable predictor for increased small, dense LDL in type 2 diabetes patients.
机构信息
Department of Emergency and Critical Care Medicine, University of the Ryukyus Hospital, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
Department of Internal Medicine, Okinawa Medical Hospital, 2310 Tsuhako-Nishihara, Sashiki, Nanjo, Okinawa, 901-1414, Japan.
出版信息
Lipids Health Dis. 2022 Jan 7;21(1):4. doi: 10.1186/s12944-021-01612-8.
BACKGROUND
Small, dense low-density lipoprotein (sd-LDL) increases in type 2 diabetes patients and causes arteriosclerosis. Non-high-density-lipoprotein cholesterol (non-HDL-C) is thought to be useful for predicting arteriosclerosis and sd-LDL elevation; however, there are no data about whether the triglyceride /low-density-lipoprotein cholesterol (TG/LDL-C) ratio is a valuable predictor for sd-LDL.
METHODS
A total of 110 type 2 diabetes patients with hypertriglyceridemia were analyzed. No patients were treated with fibrates, but 47 patients were treated with statins. LDL-C was measured by the direct method. LDL-migration index (LDL-MI) using electrophoresis (polyacrylamide gel, PAG) was calculated, and a value ≥0.400 was determined to indicate an increase in sd-LDL. Simple regression analyses were carried out between LDL-MI and lipid markers. Receiver operating characteristic curves of lipid markers for predicting high LDL-MI were applied to determine the area under the curve (AUC), sensitivity, specificity, and cut-off point.
RESULTS
LDL-MI correlated negatively with LDL-C (P = 0.0027) and PAG LDL fraction (P < 0.0001) and correlated positively with TGs, non-HDL-C, TG/LDL-C ratio, TG/HDL-C ratio, and non-HDL-C/HDL-C ratio among all study patients. Similar results were obtained for patients analyzed according to statin treatment. The AUCs (95% confidence interval) were 0.945 (0.884-1.000) for TG/LDL-C ratio and 0.614 (0.463-0.765) for non-HDL-C in patients without statins (P = 0.0002). The AUCs were 0.697 (0.507-0.887) for TG/LDL-C and 0.682 (0.500-0.863) for non-HDL-C in patients treated with statins. The optimal cut-off point for TG/LDL-C ratio for increased LDL-MI was 1.1 (molar ratio) regardless of statin treatment. The sensitivity and specificity of the TG/LDL-C ratio (90.0 and 93.9%, respectively) were higher than those of non-HDL-C (56.7 and 78.8%, respectively) in patients without statins.
CONCLUSIONS
The TG/LDL-C ratio is a reliable surrogate lipid marker of sd-LDL and superior to non-HDL-C in type 2 diabetes patients not treated with statins.
背景
2 型糖尿病患者的小而密低密度脂蛋白（sd-LDL）增加，导致动脉硬化。非高密度脂蛋白胆固醇（non-HDL-C）被认为可用于预测动脉硬化和 sd-LDL 升高；然而，尚无关于甘油三酯/低密度脂蛋白胆固醇（TG/LDL-C）比值是否是 sd-LDL 的有价值预测因子的数据。
方法
共分析了 110 例伴有高甘油三酯血症的 2 型糖尿病患者。未用贝特类药物治疗，但 47 例用他汀类药物治疗。用直接法测定 LDL-C。用电泳（聚丙烯酰胺凝胶，PAG）计算 LDL 迁移指数（LDL-MI），并将≥0.400 定义为 sd-LDL 增加。对 LDL-MI 与血脂标志物之间进行简单回归分析。应用脂质标志物的受试者工作特征曲线确定曲线下面积（AUC）、灵敏度、特异性和截断点。
结果
LDL-MI 与 LDL-C（P=0.0027）和 PAG LDL 部分（P<0.0001）呈负相关，与 TGs、非-HDL-C、TG/LDL-C 比值、TG/HDL-C 比值和非-HDL-C/HDL-C 比值呈正相关。对接受他汀类药物治疗的患者进行分析时，也得到了相似的结果。在未接受他汀类药物治疗的患者中，TG/LDL-C 比值的 AUC（95%置信区间）为 0.945（0.884-1.000），非-HDL-C 的 AUC 为 0.614（0.463-0.765）（P=0.0002）。在接受他汀类药物治疗的患者中，TG/LDL-C 的 AUC 为 0.697（0.507-0.887），非-HDL-C 的 AUC 为 0.682（0.500-0.863）。对于 LDL-MI 升高，TG/LDL-C 比值的最佳截断值为 1.1（摩尔比），无论是否接受他汀类药物治疗。在未接受他汀类药物治疗的患者中，TG/LDL-C 比值的灵敏度和特异性（分别为 90.0%和 93.9%）均高于非-HDL-C（分别为 56.7%和 78.8%）。
结论
在未接受他汀类药物治疗的 2 型糖尿病患者中，TG/LDL-C 比值是 sd-LDL 的可靠替代脂质标志物，优于非-HDL-C。
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