Zhang Ruo, Jiao Yang, Wu Yuchao, Yan Lijing, Zhang Chunhong, Xu Jing
Department of Endocrinology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China.
J Inflamm Res. 2024 Dec 24;17:11545-11559. doi: 10.2147/JIR.S493681. eCollection 2024.
This study aimed to explore the association of globulin and albumin-to-globulin ratio (AGR) with diabetic kidney disease (DKD) and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).
This study used data from the China National Diabetic Chronic Complications Study in Shaanxi Province. From April to May 2019, T2DM patients at disease surveillance sites in Shaanxi Province were investigated using a stratified multi-stage sampling method. The participants completed questionnaire surveys, anthropometric and blood pressure measurements, laboratory tests, and fundus photograph examinations. Multivariate Logistic regression and restricted cubic spline model were used to analyze the association of globulin and AGR with DKD and DR, and subgroup analysis was performed according to age, sex, and diabetes duration to test the stability of the results.
A total of 1494 T2DM patients were enrolled in this study, including 495 patients with DKD (33.1%) and 341 patients with DR (22.8%). After adjusting for all covariates, globulin and AGR were linearly associated with DKD. For every 1g/L increase in globulin level, the risk of DKD increased by 7% (OR=1.07, 95% CI=1.04, 1.10). For every 1 unit increase in AGR, the risk of DKD was reduced by 55% (OR=0.45, 95% CI=0.28, 0.72). Subgroup analysis showed that the association between globulin and DKD was consistent across all subgroups, and the association between AGR and DKD was consistent across subgroups of age and diabetes duration; however, only in males, higher AGR was associated with a reduced risk of DKD. No association was found between globulin and AGR with DR.
Globulin is an independent risk factor and AGR is an independent protective factor for DKD. Screening for DKD should be performed in T2DM patients with high globulin and low AGR levels, especially in men.
本研究旨在探讨2型糖尿病（T2DM）患者中球蛋白及白蛋白与球蛋白比值（AGR）与糖尿病肾病（DKD）和糖尿病视网膜病变（DR）的相关性。
本研究使用了中国陕西省糖尿病慢性并发症研究的数据。2019年4月至5月，采用分层多阶段抽样方法对陕西省疾病监测点的T2DM患者进行调查。参与者完成问卷调查、人体测量和血压测量、实验室检查及眼底照相检查。采用多因素Logistic回归和限制性立方样条模型分析球蛋白和AGR与DKD和DR的相关性，并根据年龄、性别和糖尿病病程进行亚组分析以检验结果的稳定性。
本研究共纳入1494例T2DM患者，其中495例患有DKD（33.1%），341例患有DR（22.8%）。在调整所有协变量后，球蛋白和AGR与DKD呈线性相关。球蛋白水平每升高1g/L，DKD风险增加7%（OR=1.07，95%CI=1.04，1.10）。AGR每升高1个单位，DKD风险降低55%（OR=0.45，95%CI=0.28，0.72）。亚组分析显示，球蛋白与DKD的相关性在所有亚组中均一致，AGR与DKD的相关性在年龄和糖尿病病程亚组中也一致；然而，仅在男性中，较高的AGR与较低的DKD风险相关。未发现球蛋白和AGR与DR之间存在相关性。
球蛋白是DKD的独立危险因素，AGR是DKD的独立保护因素。对于球蛋白水平高和AGR水平低的T2DM患者，尤其是男性，应进行DKD筛查。
