美国糖尿病成年患者中应激性高血糖比值与慢性肾脏病的发生和严重程度的关系。
Association of stress hyperglycemia ratio with presence and severity of chronic kidney disease among US adults with diabetes mellitus.
机构信息
Heyuan People's Hospital, Guangdong Provincial People's Hospital, Heyuan Hospital, Heyuan, China.
School of Foreign Studies, Southern Medical University, Guangzhou, Guangdong, China.
出版信息
Front Endocrinol (Lausanne). 2024 Oct 22;15:1446390. doi: 10.3389/fendo.2024.1446390. eCollection 2024.
BACKGROUND
Among diabetes mellitus (DM) patients, stress hyperglycemia ratio (SHR) is a strong predictor of short- and long-term prognosis, and adverse cardiovascular events. However, whether SHR is associated with increased risk of presence and severity of chronic kidney (CKD) disease remains undetermined.
METHODS
Patients with DM from the National Health and Nutrition Examination Survey (NHANES) database (1999-2020) were included and divided into 5 groups according to their SHR level (quintile 1 to 5). Study outcomes were CKD, advanced CKD (ACKD), and CKD severity. Logistic regression and restricted cubic spline (RCS) were used to assess the association between the SHR and outcomes.
RESULTS
Totally, 6,119 patients were included. After adjustment, compared to patients with SHR in quintile 3 (as reference), the risk of CKD is 1.50 (P<0.001) for quintile 1, 1.23 (P=0.140) for quintile 2, 1.95 (P<0.001) for quintile 4, and 1.79 (P<0.001) for quintile 5. For the risk of ACKD, the OR is 1.46 (P=0.410) for quintile 1, 1.07 (P=0.890) for quintile 2, 3.28 (P=0.030) for quintile 4, and 3.89 (P=0.002) for quintile 5. For the CKD severity, the OR is 1.46 (P<0.001) for quintile 1, 1.20 (P=0.163) for quintile 2, 1.84 (P<0.001) for quintile 4, and 1.83 (P<0.001) for quintile 5. RCS analysis also showed a U-shaped association between SHR and outcomes (All P for nonlinearity<0.05).
CONCLUSION
Our study demonstrated that too low or too high SHR level is significantly associated with adverse renal outcomes in patients with DM.
背景
在糖尿病（DM）患者中，应激性高血糖比值（SHR）是短期和长期预后以及不良心血管事件的强有力预测因子。然而，SHR 是否与慢性肾脏病（CKD）疾病的发生和严重程度增加相关仍未确定。
方法
本研究纳入了来自国家健康和营养检查调查（NHANES）数据库（1999-2020 年）的 DM 患者，并根据 SHR 水平（五分位 1 到 5）将其分为 5 组。研究结果为 CKD、晚期 CKD（ACKD）和 CKD 严重程度。采用 logistic 回归和限制性三次样条（RCS）评估 SHR 与结局之间的关系。
结果
共纳入 6119 例患者。经调整后，与 SHR 五分位 3（参考组）相比，SHR 五分位 1 的 CKD 风险为 1.50（P<0.001），五分位 2 为 1.23（P=0.140），五分位 4 为 1.95（P<0.001），五分位 5 为 1.79（P<0.001）。对于 ACKD 的风险，五分位 1 的比值比（OR）为 1.46（P=0.410），五分位 2 为 1.07（P=0.890），五分位 4 为 3.28（P=0.030），五分位 5 为 3.89（P=0.002）。对于 CKD 严重程度，五分位 1 的 OR 为 1.46（P<0.001），五分位 2 为 1.20（P=0.163），五分位 4 为 1.84（P<0.001），五分位 5 为 1.83（P<0.001）。RCS 分析也显示 SHR 与结局之间呈 U 型关联（所有非线性 P 值均<0.05）。
结论
本研究表明，DM 患者的 SHR 水平过低或过高与不良肾脏结局显著相关。
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