Chen Xiangyu, Liang Mingbin, Zhang Jie, Xu Chunxiao, Chen Lijin, Hu Ruying, Zhong Jieming
Department of Non-Communicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China.
Nutrients. 2025 Mar 24;17(7):1125. doi: 10.3390/nu17071125.
: The objective of this study was to examine the association between non-high-density lipoprotein cholesterol (non-HDL-C) to high-density lipoprotein cholesterol (HDL-C) ratio (NHHR) and chronic kidney disease (CKD) in Chinese adults with type 2 diabetes mellitus (T2DM). : This study originated from a survey carried out in Zhejiang Province, located in eastern China, between March and November 2018. To explore the relationship between NHHR and CKD, a multivariable logistic regression model was employed. The dose-response relationship was assessed using restricted cubic spline (RCS) analysis, while generalized additive models (GAMs) were applied to examine the associations between NHHR and urinary albumin-to-creatinine ratio (UACR) as well as estimated glomerular filtration rate (eGFR). Subgroup analyses were performed across various demographic and clinical categories to assess the consistency of the NHHR-CKD association. The optimal NHHR cutoff for CKD diagnosis, its predictive accuracy, and its comparison with its components and HbA1c were determined through receiver operating characteristic (ROC) curve analysis. : The study enrolled 1756 participants, including 485 individuals with CKD and 1271 without CKD. Multivariable logistic regression revealed a significant positive association between NHHR and CKD, with each standard deviation (SD) increase in NHHR linked to a 23% higher odds of CKD (OR = 1.23, 95% CI: 1.09-1.37) after adjusting for potential confounders. When comparing quartiles, the fully adjusted ORs for Q2, Q3, and Q4 were 1.29 (0.92-1.79), 1.31 (0.94-1.83), and 1.87 (1.34-2.60), respectively, relative to Q1 ( for trend < 0.01). RCS analysis confirmed a linear dose-response relationship between NHHR and CKD in both sexes ( for nonlinearity > 0.05). GAMs indicated a significant positive correlation between NHHR and UACR (ρ = 0.109, < 0.001) but no significant association with eGFR (ρ = -0.016, = 0.502). Subgroup analyses demonstrated consistent associations across most subgroups, except for the 18-44 years age group, the well-controlled glycemic group, and the non-alcohol drinking group ( > 0.05). ROC curve analysis identified an optimal NHHR cutoff of 3.48 for CKD prediction, with an area under the curve (AUC) of 0.606 (95% CI: 0.577-0.635). Notably, NHHR outperformed its individual components and HbA1c in predictive performance. : This study revealed a linear link between higher NHHR levels and increased CKD prevalence in Chinese T2DM patients. NHHR may also serve as a potential complementary biomarker for early CKD detection, though further prospective studies are needed to confirm its predictive value and clinical utility in high-risk T2DM populations.
本研究的目的是探讨中国2型糖尿病（T2DM）成年患者中非高密度脂蛋白胆固醇（non-HDL-C）与高密度脂蛋白胆固醇（HDL-C）之比（NHHR）与慢性肾脏病（CKD）之间的关联。 本研究源自2018年3月至11月在中国东部浙江省开展的一项调查。为探究NHHR与CKD之间的关系，采用了多变量逻辑回归模型。使用受限立方样条（RCS）分析评估剂量反应关系，同时应用广义相加模型（GAMs）来检验NHHR与尿白蛋白肌酐比（UACR）以及估算肾小球滤过率（eGFR）之间的关联。 across various demographic and clinical categories进行亚组分析，以评估NHHR-CKD关联的一致性。通过受试者工作特征（ROC）曲线分析确定CKD诊断的最佳NHHR临界值、其预测准确性以及与各组分和糖化血红蛋白（HbA1c）的比较。 该研究纳入了1756名参与者，其中包括485名CKD患者和1271名非CKD患者。多变量逻辑回归显示NHHR与CKD之间存在显著正相关，在调整潜在混杂因素后，NHHR每增加一个标准差（SD），CKD的患病几率就会高出23%（比值比[OR]=1.23，95%置信区间[CI]：1.09-1.37）。在比较四分位数时，相对于第一四分位数，第二、第三和第四四分位数的完全调整后OR分别为1.29（0.92-1.79）、1.31（0.94-1.83）和1.87（1.34-2.60）（趋势P<0.01）。RCS分析证实两性中NHHR与CKD之间均存在线性剂量反应关系（非线性P>0.05）。GAMs表明NHHR与UACR之间存在显著正相关（ρ=0.109，P<0.001），但与eGFR无显著关联（ρ=-0.016，P=0.502）。亚组分析表明，除18-44岁年龄组、血糖控制良好组和不饮酒组外，大多数亚组中的关联均一致（P>0.05）。ROC曲线分析确定CKD预测的最佳NHHR临界值为3.48，曲线下面积（AUC）为0.606（95%CI：0.577-0.635）。值得注意的是，在预测性能方面，NHHR优于其各个组分和HbA1c。 本研究揭示了中国T2DM患者中较高的NHHR水平与CKD患病率增加之间存在线性关联。NHHR也可能作为早期CKD检测的潜在补充生物标志物，不过需要进一步的前瞻性研究来证实其在高危T2DM人群中的预测价值和临床效用。
