Gao Chuang, Yu Cailing, Shi Peijie, Liu Dehong, Li Qiming, Han Yong
Department of Emergency, Shenzhen Dapeng New District Kuichong People's Hospital, Shenzhen, China.
Department of Emergency, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China.
Front Endocrinol (Lausanne). 2025 Jul 7;16:1552044. doi: 10.3389/fendo.2025.1552044. eCollection 2025.
Current research on the association between the Gamma-glutamyl transferase to high-density lipoprotein ratio (GHR) and the risk of prediabetes (pre-DM) remains scarce. This study aims to explore the potential link between GHR and the risk of progression from normoglycemia to pre-DM.
This retrospective cohort study included 8,168 individuals who voluntarily underwent health examinations at Shenzhen Dapeng New District Kuichong People's Hospital between January 2018 and December 2023. To assess the association between GHR and the risk of developing pre-DM, Cox proportional hazards regression models were employed. Cox proportional hazards regression model with cubic spline function was further utilized to investigate potential nonlinear association. Moreover, a competing risk Cox proportional hazards model was applied to account for the progression from normoglycemia to diabetes (DM) as a competing event in the progression from normoglycemia to pre-DM. Subgroup analyses and multiple sensitivity analyses were also performed to ensure the robustness of the findings.
Following multivariate adjustment, elevated GHR demonstrated a significant correlation with increased risk of progression from normoglycemia to pre-DM, showing a hazard ratio(HR) of 1.061 (95% CI: 1.028-1.095) for each 5-unit increment. A nonlinear relationship between them was identified, with an inflection point at a GHR value of 24.37. On the left side of the inflection point, the HR for the association between GHR (per 5-unit increase) and pre-DM risk was 1.394 (95% CI: 1.197, 1.623). Furthermore, the competing risk model revealed an HR of 1.05 (95% CI: 1.02, 1.09) for the association between GHR (per 5-unit increase) and pre-DM risk. Multiple sensitivity analyses confirmed the stability and reliability of these results.
This study demonstrates that elevated GHR exhibits both a positive and nonlinear relationship with the risk of progression from normoglycemia to pre-DM among Chinese adults. Maintaining GHR values below the threshold of 24.37, coupled with further reduction efforts, may serve as an effective strategy to minimize pre-DM risk.
目前关于γ-谷氨酰转移酶与高密度脂蛋白比值（GHR）与糖尿病前期（pre-DM）风险之间关联的研究仍然较少。本研究旨在探讨GHR与血糖正常进展为糖尿病前期风险之间的潜在联系。
这项回顾性队列研究纳入了2018年1月至2023年12月期间在深圳大鹏新区葵涌人民医院自愿接受健康检查的8168名个体。为评估GHR与发生糖尿病前期风险之间的关联，采用了Cox比例风险回归模型。进一步使用带有三次样条函数的Cox比例风险回归模型来研究潜在的非线性关联。此外，应用竞争风险Cox比例风险模型，将血糖正常进展为糖尿病（DM）作为血糖正常进展为糖尿病前期过程中的竞争事件进行考量。还进行了亚组分析和多项敏感性分析以确保研究结果的稳健性。
经过多变量调整后，GHR升高与血糖正常进展为糖尿病前期的风险增加显著相关，每增加5个单位，风险比（HR）为1.061（95%CI：1.028 - 1.095）。确定了它们之间的非线性关系，拐点处的GHR值为24.37。在拐点左侧，GHR（每增加5个单位）与糖尿病前期风险之间关联的HR为1.394（95%CI：1.197，1.623）。此外，竞争风险模型显示GHR（每增加5个单位）与糖尿病前期风险之间关联的HR为1.05（95%CI：1.02，1.09）。多项敏感性分析证实了这些结果的稳定性和可靠性。
本研究表明，在中国成年人中，GHR升高与血糖正常进展为糖尿病前期的风险呈正相关且非线性相关。将GHR值维持在24.37以下，并进一步努力降低，可能是降低糖尿病前期风险的有效策略。
