高密度脂蛋白胆固醇与载脂蛋白 A 比值与糖尿病视网膜病变的关系：一项横断面研究。

Association between high-density lipoprotein cholesterol to apolipoprotein A ratio and diabetic retinopathy: A cross-sectional study.

机构信息

Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China.

出版信息

J Diabetes Complications. 2023 Jun;37(6):108471. doi: 10.1016/j.jdiacomp.2023.108471. Epub 2023 Apr 18.

DOI:10.1016/j.jdiacomp.2023.108471

PMID:37127002

Abstract

AIMS

Our study is aimed to investigate the relationship between high-density lipoprotein cholesterol to apolipoprotein A ratio (HDL-C/ApoA) and diabetic retinopathy (DR) in subjects with type 2 diabetes mellitus (T2DM).

METHODS

We retrospect the consecutive medical files of 1058 subjects with T2DM and recorded their clinical information and laboratory findings. Subjects with T2DM were divided into DR group (n = 522) and non-DR group (n = 536). We compared the lipids values of the two groups. Meanwhile we also observed the prevalence of DR at different HDL-C/ApoA levels. Binary logistic regression was used to correct confounding factors. Smooth curve fitting model and subgroup analysis were used to determine the correlation, non-linear relationship and threshold effect between HDL/ApoA and DR.

RESULTS

HDL-C/ApoA value of DR group was significantly higher than non-DR group (0.88 ± 0.17 vs 0.84 ± 0.13, P < 0.05). The prevalence of DR significantly increased as HDL-C/ApoA level increased. There was association between HDL/ApoA levels and DR in the adjusted models (OR 1.55, 95%CI 0.60 to 4.02). After full adjustments for other relevant clinical covariates, patients with HDL/ApoA values in quartile 3 (Q3) had 1.50 times (95 % CI 1.00 to 2.17) and in Q4 had 2.39 times (95%CI 1.65 to 3.47) as high as the risk of DR compared with patients in Q1. HDL/ApoA showed a non-linear relationship with DR, with an inflection point value of 0.759. When HDL/ApoA>0.759, HDL/ApoA was significantly positively associated with DR (HR = 26.508, 95 % CI 7.623-92.174; P < 0.0001). Compared to patients with age < 60, HDL/ApoA was obviously associated with DR when age ≥ 60 (OR = 38.05, 95 % CI 8.06-179.69; P < 0.001).

CONCLUSIONS

HDL-C/ApoA was found to be associated with the incidence of DR in patients with T2DM. After adjusting potential related factors HDL-C/ApoA OR value was 1.55 (95%CI 0.60 to 4.02). A non-linear association between HDL/ApoA and DR was observed in T2DM. Subgroup analysis showed that age could alter the relationship between HDL/ApoA and DR.

摘要

目的

本研究旨在探讨 2 型糖尿病（T2DM）患者高密度脂蛋白胆固醇与载脂蛋白 A 比值（HDL-C/ApoA）与糖尿病视网膜病变（DR）之间的关系。

方法

我们回顾性分析了 1058 例 T2DM 患者的连续病历资料，记录了他们的临床资料和实验室检查结果。将 T2DM 患者分为 DR 组（n=522）和非 DR 组（n=536）。比较两组的血脂值。同时观察不同 HDL-C/ApoA 水平下 DR 的患病率。采用二元逻辑回归校正混杂因素。采用平滑曲线拟合模型和亚组分析确定 HDL/ApoA 与 DR 之间的相关性、非线性关系和阈值效应。

结果

DR 组的 HDL-C/ApoA 值明显高于非 DR 组（0.88±0.17 比 0.84±0.13，P<0.05）。随着 HDL-C/ApoA 水平的升高，DR 的患病率显著增加。调整其他相关临床协变量后，HDL/ApoA 水平与 DR 之间存在关联（OR 1.55，95%CI 0.60 至 4.02）。在充分调整其他相关临床协变量后，第 3 四分位（Q3）的 HDL/ApoA 值的患者发生 DR 的风险是第 1 四分位（Q1）患者的 1.50 倍（95%CI 1.00 至 2.17），第 4 四分位（Q4）的 HDL/ApoA 值的患者发生 DR 的风险是第 1 四分位（Q1）患者的 2.39 倍（95%CI 1.65 至 3.47）。HDL/ApoA 与 DR 呈非线性关系，拐点值为 0.759。当 HDL/ApoA>0.759 时，HDL/ApoA 与 DR 明显正相关（HR=26.508，95%CI 7.623-92.174；P<0.0001）。与年龄<60 岁的患者相比，年龄≥60 岁的患者 HDL/ApoA 与 DR 明显相关（OR=38.05，95%CI 8.06-179.69；P<0.001）。

结论

在 T2DM 患者中发现 HDL-C/ApoA 与 DR 的发生率有关。调整潜在相关因素后，HDL-C/ApoA 的 OR 值为 1.55（95%CI 0.60 至 4.02）。在 T2DM 中观察到 HDL/ApoA 与 DR 之间存在非线性关系。亚组分析表明，年龄可能改变 HDL/ApoA 与 DR 之间的关系。