比较 2 型糖尿病患者多种血脂指标与糖尿病肾病的关系：一项横断面研究。
Comparisons of the Relationships Between Multiple Lipid Indices and Diabetic Kidney Disease in Patients With Type 2 Diabetes: A Cross-Sectional Study.
机构信息
Department of Endocrinology, Affiliated Hospital 2 of Nantong University and First People's Hospital of Nantong City, Nantong, China.
Department of Neurosurgery, Affiliated Hospital 2 of Nantong University and First People's Hospital of Nantong City, Nantong, China.
出版信息
Front Endocrinol (Lausanne). 2022 Jul 6;13:888599. doi: 10.3389/fendo.2022.888599. eCollection 2022.
BACKGROUND
Dyslipidemia is a well-recognized risk factor for diabetic kidney disease (DKD) in patients with type 2 diabetes (T2D). Growing evidences have shown that compared with the traditional lipid parameters, some lipid ratios may provide additional information of lipid metabolism. Thus, the present study aimed to investigate which lipid index was most related to DKD.
METHODS
This study was a cross-sectional study that enrolled patients with T2D from January 2021 to October 2021. Each participant was screened for DKD, and the diagnostic criterion for DKD is estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m or urinary albumin-to-creatinine ratio (UACR) ≥ 30 mg/g for 3 months. Fasting blood was collected to determine lipid profiles by an automatic biochemical analyzer, and lipid ratios were calculated based on corresponding lipid parameters. Spearman's correlation analyses were conducted to assess the correlations between lipid indices and kidney injury indices, and binary logistic regression analyses were conducted to explore the relationship between lipid indices and the risk of DKD.
RESULTS
A total of 936 patients with T2D were enrolled in the study, 144 (15.38%) of whom had DKD. The LDL-C/Apo B ratios were positively correlated with eGFR ( 0.146, 0.05) and inversely correlated to cystatin C and UACR ( -0.237 and -0.120, both 0.001). Multiple logistic regression demonstrated that even after adjusting for other clinical covariates, the LDL-C/Apo B ratios were negatively related to DKD, and the odds ratio (95% confidence interval) was 0.481 (0.275-0.843). Furthermore, subgroup analyses revealed that compared with patients with normal lipid profiles and a high LDL-C/Apo B ratio, the odds ratio of DKD in patients with normal lipid metabolism and a low LDL-C/Apo B ratio was 2.205 (1.136-4.280) after adjusting for other clinical covariates.
CONCLUSION
In patients with T2D, the LDL-c/Apo B ratio was most closely associated with DKD among various lipid indices, and a lower LDL-C/Apo B ratio was associated with increased risks of DKD among patients with T2D.
背景
血脂异常是 2 型糖尿病（T2D）患者糖尿病肾病（DKD）的公认危险因素。越来越多的证据表明，与传统血脂参数相比，某些血脂比值可能提供更多的脂质代谢信息。因此，本研究旨在探讨哪种血脂指标与 DKD 最相关。
方法
这是一项横断面研究，纳入了 2021 年 1 月至 2021 年 10 月期间的 T2D 患者。每位患者均接受 DKD 筛查，DKD 的诊断标准为估算肾小球滤过率（eGFR）<60ml/min/1.73m 或尿白蛋白与肌酐比值（UACR）≥30mg/g 持续 3 个月。采集空腹血样，采用自动生化分析仪测定血脂谱，并根据相应的血脂参数计算血脂比值。采用 Spearman 相关分析评估血脂指标与肾脏损伤指标的相关性，采用二元逻辑回归分析探讨血脂指标与 DKD 风险的关系。
结果
共纳入 936 例 T2D 患者，其中 144 例（15.38%）患有 DKD。LDL-C/ApoB 比值与 eGFR 呈正相关（0.146，0.05），与胱抑素 C 和 UACR 呈负相关（-0.237 和-0.120，均 P<0.001）。多因素逻辑回归显示，即使在调整其他临床协变量后，LDL-C/ApoB 比值仍与 DKD 呈负相关，比值比（95%可信区间）为 0.481（0.275-0.843）。此外，亚组分析显示，与血脂谱正常且 LDL-C/ApoB 比值高的患者相比，在调整其他临床协变量后，血脂代谢正常且 LDL-C/ApoB 比值低的患者发生 DKD 的比值比为 2.205（1.136-4.280）。
结论
在 T2D 患者中，各种血脂指标中 LDL-c/ApoB 比值与 DKD 最密切相关，LDL-C/ApoB 比值较低与 T2D 患者 DKD 风险增加相关。
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