Factors influencing the occurrence of diabetic nephropathy and correlation analysis with non-HDL-C and TyG indices
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摘要:
目的 分析非高密度脂蛋白胆固醇(non-HDL-C)、甘油三酯-葡萄糖(TyG)指数与糖尿病性肾病(DN)的关系，并探究DN发生的危险因素。 方法 回顾性分析2022年7月—2024年7月黄山市人民医院收治的300例2型糖尿病(T2DM)患者的临床资料，依据有无并发DN分成发生组(120例)和未发生组(180例)，比较2组患者non-HDL-C、TyG指数等指标，使用logistic回归分析研究T2DM患者发生DN的影响因素，使用Pearson相关性分析研究non-HDL-C、TyG指数和DN发生的关系。 结果 发生组患者non-HDL-C[(4.98±1.10)mmol/L vs. (4.22±1.26)mmol/L，t=5.480，P＜0.05]、TyG指数[(9.16±2.04)mmol/L vs. (7.90±1.75)mmol/L，t=5.714，P＜0.05]均高于未发生组。non-HDL-C(OR=1.745，95% CI：1.318~2.311)以及TyG指数(OR=1.453，95% CI：1.219~1.732)均为T2DM患者发生DN的影响因素(P＜0.05)。non-HDL-C(r=0.405)及TyG指数(r=0.498)与DN发生均呈正相关关系(P＜0.05)。 结论 non-HDL-C及TyG指数为T2DM患者发生DN的影响因素，与DN发生密切相关，需结合临床尽早开展针对性干预，以减少DN发生。 -
关键词:
- 2型糖尿病 /
- 糖尿病肾病 /
- 影响因素 /
- 非高密度脂蛋白胆固醇 /
- 甘油三酯-葡萄糖指数
Abstract:Objective To analyze the relationship between non-high-density lipoprotein cholesterol (non-HDL-C), triglyceride glucose (TyG) index and diabetic nephropathy (DN), and to explore the risk factors for DN. Methods A retrospective analysis was conducted on 300 patients with type 2 diabetes mellitus (T2DM) who were admitted to Huangshan People's Hospital from July 2022 to July 2024. The patients were divided into the occurrence group (n=120) and non-occurrence group (n=180) according to the presence or absence of DN. The non-HDL-C and TyG index in the two groups were compared using a paired t-test, and the factors affecting DN were analyzed using a logistic regression analysis. The relationship between non-HDL-C, TyG index and DN was analyzed using Pearson's correlation coefficient. Results The mean levels of non-HDL-C [(4.98±1.10) mmol/L vs. (4.22±1.26) mmol/L, t=5.480, P < 0.05] and TyG index [(9.16±2.04) mmol/L vs. (7.90±1.75) mmol/L, t=5.714, P < 0.05] were higher in the occurrence group were higher than those in the non-occurrence group. The findings of this study indicate that non-HDL-C (OR=1.745, 95% CI: 1.318-2.311) and TyG index (OR=1.453, 95% CI: 1.219-1.732) are risk factors for DN in T2DM patients (P < 0.05). The present study found a positive correlation between non-HDL-C (r=0.405) and TyG index (r=0.498) and DN (P < 0.05). Conclusion The non-HDL-C and TyG index have been identified as risk factors for the development of DN in T2DM patients, and are closely associated with the occurrence of DN. In order to reduce the occurrence of DN, clinical combination and early targeted intervention are required. -
表 1 发生组和未发生组T2DM患者一般资料比较
Table 1. Comparison of general data of T2DM patients between the occurrence group and the non-occurrence group
项目 发生组(n=120) 未发生组(n=180) 统计量 P值 性别[例(%)] 0.328a 0.567 男性 72(60.00) 102(56.67) 女性 48(40.00) 78(43.33) 年龄(x±s，岁) 62.35±6.20 62.78±6.34 0.581b 0.562 T2DM病程[例(%)] 27.650c ＜0.001 ≤5年 26(21.67) 82(45.56) ＞5~10年 58(48.33) 80(44.44) ＞10年 36(30.00) 18(10.00) 吸烟史[例(%)] 24(20.00) 34(18.89) 0.057a 0.811 饮酒史[例(%)] 20(16.67) 28(15.56) 0.066a 0.797 合并高血压[例(%)] 40(33.33) 12(6.67) 35.732a ＜0.001 合并脑卒中[例(%)] 10(8.33) 14(7.78) 0.030a 0.862 用药情况[例(%)] ACEI/ARB降压治疗 20(16.67) 50(27.78) 4.969a 0.026 调脂治疗 28(23.33) 48(26.67) 4.108a 0.043 GLP-1RA/SGLT-2降糖治疗 50(41.67) 96(53.33) 3.923a 0.048 BMI(x±s) 23.24±2.56 21.40±2.45 6.259b ＜0.001 FBG(x±s，mmol/L) 6.86±1.25 7.10±1.32 1.671b 0.116 2hPG(x±s，mmol/L) 13.28±2.46 13.60±2.54 1.082b 0.280 HbA1c(x±s，%) 9.35±1.88 8.46±1.90 3.991b ＜0.001 BUN(x±s，mmol/L) 8.30±1.50 8.18±1.45 0.693b 0.489 Cr(x±s，μmol/L) 97.42±11.35 92.50±10.48 3.853b ＜0.001 UACR(x±s，mg/g) 38.22±4.36 35.75±5.35 4.210b ＜0.001 eGFR(x±s，min·1.73m2) 45.30±8.62 48.10±10.48 2.429b 0.016 TC(x±s，mmol/L) 6.80±1.28 5.95±1.35 5.454b ＜0.001 TG[M(P25, P75)，mmol/L] 1.85(1.50, 2.20) 1.75(1.28, 2.22) -1.396c 0.085 HDL-C[M(P25, P75)，mmol/L] 1.06(0.86, 1.26) 1.70(1.45, 1.95) -17.954c ＜0.001 non-HDL-C(x±s，mmol/L) 4.98±1.10 4.22±1.26 5.480b ＜0.001 TyG指数(x±s) 9.16±2.04 7.90±1.75 5.714b ＜0.001 注：a为χ2值，b为t值，c为Z值。 
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表 2 变量赋值情况
Table 2. Variable assignment
变量 赋值方法 DN发生情况 未发生DN=0，发生DN=1 T2DM病程 ≤5年或＞5~10年=0，＞10年=1 合并高血压 无=0，有=1 ACEI/ARB降压治疗 否=0，是=1 调脂治疗 否=0，是=1 GLP-1RA/SGLT-2降糖治疗 否=0，是=1 HbA1c 以实际值赋值 BMI 以实际值赋值 Cr 以实际值赋值 UACR 以实际值赋值 eGFR 以实际值赋值 TC 以实际值赋值 HDL-C 以实际值赋值 non-HDL-C 以实际值赋值 TyG指数 以实际值赋值
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表 3 T2DM患者发生DN影响因素的logistic回归分析
Table 3. Logisitic regression analysis of DN in T2DM patients
变量 B SE Waldχ2 P值 OR值 95% CI T2DM病程 0.554 0.143 15.077 ＜0.001 1.741 1.316~2.303 合并高血压 1.137 0.341 11.105 0.001 3.117 1.597~6.082 ACEI/ARB降压治疗 -0.403 0.101 16.097 ＜0.001 0.668 0.549~0.814 调脂治疗 -0.373 0.087 18.246 ＜0.001 0.689 0.580~0.817 GLP-1RA/SGLT-2降糖治疗 -1.054 0.301 10.498 ＜0.001 0.348 0.302~0.468 HbA1c 0.981 0.333 8.658 0.003 2.667 1.388~5.125 BMI 1.045 0.331 10.000 0.002 2.844 1.488~5.437 Cr 1.582 0.254 38.712 ＜0.001 4.863 2.955~8.004 UACR 1.014 0.327 9.612 0.002 2.757 1.452~5.236 eGFR -0.191 0.057 11.074 0.001 0.826 0.739~0.925 TC 0.305 0.069 19.368 ＜0.001 1.357 1.184~1.554 HDL-C -0.004 0.001 19.586 ＜0.001 0.996 0.994~0.998 non-HDL-C 0.557 0.143 15.108 ＜0.001 1.745 1.318~2.311 TyG指数 0.374 0.090 17.443 ＜0.001 1.453 1.219~1.732
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[1] DEMIRELLI B, BOZTEPE B, şENOL E G, et al. Non-diabetic nephropathy in diabetic patients: incidence, HbA1c variability and other predictive factors, and implications[J]. Int Urol Nephrol, 2024, 56(9): 3091-3100. doi: 10.1007/s11255-024-04066-w [2] PEÑA A S, CURRAN J A, FUERY M, et al. Screening, assessment and management of type 2 diabetes mellitus in children and adolescents: australasian paediatric endocrine group guidelines[J]. Med J Aust, 2020, 213(1): 30-43. doi: 10.5694/mja2.50666 [3] LIU X M, GUO Y P, WU J, et al. Discrimination of chronic kidney disease and diabetic nephropathy and analysis of their related influencing factors[J]. Diabetes Metab Syndr Obes, 2020, 13: 5085-5096. doi: 10.2147/DMSO.S275398 [4] 冯玲, 梁维, 赵静, 等. 糖尿病肾病患者临床特点及预后影响因素分析[J]. 海南医学, 2021, 32(22): 2915-2917.FENG L, LIANG W, ZHAO J, et al. Analysis of clinical characteristics and prognostic factors affecting patients with diabetic nephropathy[J]. Hainan Medicine, 2021, 32(22): 2915-2917. [5] 荣萍萍, 黄宇玲, 张欣悦, 等. 中性粒细胞计数与高密度脂蛋白胆固醇比值与早发冠心病的相关性分析[J]. 医学研究杂志, 2023, 52(8): 100-104, 117.RONG P P, HUANG Y L, ZHANG X Y, et al. Correlation analysis of neutrophil count and high-density lipoprotein cholesterol ratio with early-onset coronary heart disease[J]. Journal of Medical Research, 2023, 52(8): 100-104, 117. [6] RAMDAS NAYAK V K, SATHEESH P, SHENOY M T, et al. Triglyceride glucose (TyG) index: a surrogate biomarker of insulin resistance[J]. J Pak Med Assoc, 2022, 72(5): 986-988. doi: 10.47391/JPMA.22-63 [7] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华内分泌代谢杂志, 2021, 13(4): 315-409.Chinese Society of Diabetics. Chinese Guidelines for the Prevention and treatment of type 2 diabetes(2020 edition)[J]. Chinese Journal of Endocrinology and Metabolism, 2021, 13(4): 315-409. [8] 中华医学会肾脏病学分会专家组. 糖尿病肾脏疾病临床诊疗中国指南[J]. 中华肾脏病杂志, 2021, 37(3): 255-304.Chinese Society of Nephrology expert group. Chinese guide for clinical diagnosis and treatment of diabetic kidney disease[J]. Chinese Journal of Nephrology, 2021, 37(3): 255-304. [9] KONDAPI K, SILAMBANAN S, MOORTHY S, et al. A study of the risk factors and urinary podocin as an early prognostic indicator of renal injury in diabetic nephropathy[J]. J Assoc Physicians India, 2021, 69(6): 11-12. [10] 王雅灏, 王颜刚, 周月, 等. 水飞蓟素对糖尿病肾病蛋白尿水平影响Meta分析[J]. 青岛大学学报(医学版), 2020, 56(6): 667-670.WANG Y H, WANG Y G, ZHOU Y, et al. Meta-analysis of the effect of silymarin on the level of proteinuria in diabetic nephropathy[J]. Journal of Qingdao University(Med Edition), 2020, 56(6): 667-670. [11] SIDDIQUI K, GEORGE T P, JOY S S, et al. Risk factors of chronic kidney disease among type 2 diabetic patients with longer duration of diabetes[J]. Front Endocrinol(Lausanne), 2022, 12(13): 1079725. DOI: 10.3389/fendo.2022.1079725. [12] 杨建享, 林永强. 高通量血液透析对老年糖尿病肾病患者心功能超声指标、血清心肌损伤及炎症生化指标的远期改善作用[J]. 中华全科医学, 2024, 22(11): 1884-1886, 1989. doi: 10.16766/j.cnki.issn.1674-4152.003756YANG J X, LIN Y Q. Long-term improvement of ultrasound indexes, serum myocardial injury and inflammatory biochemical indexes in elderly patients with diabetic nephropathy by high-throughput hemodialysis[J]. Chinese Journal of General Medicine, 2024, 22(11): 1884-1886, 1989. doi: 10.16766/j.cnki.issn.1674-4152.003756 [13] 任梦玉, 周婉, 范文华, 等. 2型糖尿病患者合并肾脏病的相关危险因素分析[J]. 中国临床保健杂志, 2023, 26(2): 233-236.REN M Y, ZHOU W, FAN W H, et al. Risk factors related to kidney disease in patients with type 2 diabetes mellitus[J]. Chinese Journal of Clinical Health, 2023, 26(2): 233-236. [14] TAO L C, XU J N, WANG T T, et al. Triglyceride-glucose index as a marker in cardiovascular diseases: landscape and limitations[J]. Cardiovasc Diabetol, 2022, 21(1): 68. DOI: 10.1186/s12933-022-01511-x. [15] MA Y, REN Y Q, HUI D, et al. Nomogram analysis of the influencing factors of rapid renal decline in patients with biopsy-proven diabetic nephropathy in type 2 diabetes[J]. Clin Nephrol, 2023, 99(6): 274-282. doi: 10.5414/CN111065 [16] 李涛, 张曼. 基于Cox回归分析筛选2型糖尿病肾病发生的危险因素[J]. 标记免疫分析与临床, 2023, 30(10): 1649-1653.LI T, ZHANG M. Screening risk factors for type 2 diabetic nephropathy based on Cox regression analysis[J]. Journal of Marker Immunoassay and Clinical Analysis, 2023, 30(10): 1649-1653. [17] 王丹丹, 李瑾. 血NLR及Cysc评估早期糖尿病肾病的预测价值研究[J]. 医药论坛杂志, 2023, 44(2): 5-8.WANG D D, LI J. Study on predictive value of blood NLR and Cysc in evaluating early diabetic nephropathy[J]. Journal of Medical Forum, 2023, 44(2): 5-8. [18] SOHOULI M H, MIRMIRAN P, SERAJ S S, et al. Impact of low-protein diet on cardiovascular risk factors and kidney function in diabetic nephropathy: a systematic review and meta-analysis of randomized-controlled trials[J]. Diabetes Res Clin Pract, 2022, 191: 110068. DOI: 10.1016/j.diabres.2022.110068. [19] Al-ZAHRANI N, ALSWAT H K, ALQARNI A M, et al. Prevalence and risk factors of diabetic nephropathy among saudi type-1 diabetic patients in Taif City, Saudi Arabia[J]. Diabetes Metab Syndr Obes, 2023, 11(16): 3609-3616. [20] NATESAN V, KIM S J. Diabetic nephropathy-a review of risk factors, progression, mechanism, and dietary management[J]. Biomol Ther(Seoul), 2021, 29(4): 365-372. doi: 10.4062/biomolther.2020.204 [21] JANSEN R B, HOLSTEIN P E, JORGENSEN B, et al. Risk factors for development of nephropathy in patients with a diabetic charcot foot[J]. BMC Res Notes, 2021, 14(1): 403. DOI: 10.1186/s13104-021-05811-5. [22] 田蓉, 傅桂芬, 李丽蓉, 等. 老年T2DM合并高血压患者发生糖尿病肾病的影响因素[J]. 心血管康复医学杂志, 2023, 32(1): 4-8.TIAN R, FU G F, LI L R, et al. Influence factors of diabetic nephropathy in elderly patients with T2DM combined with hypertension[J]. Journal of Cardiovascular Rehabilitation Medicine, 2023, 32(1): 4-8. [23] 张健, 胡怡. 2型糖尿病患者并发糖尿病肾病的危险因素及Nomogram风险预测模型构建[J]. 广西医科大学学报, 2023, 40(11): 1843-1849.ZHANG J, HU Y. Construction of a Nomogram risk prediction model and risk factors of diabetic nephropathy in type 2 diabetic patients[J]. Journal of Guangxi Medical University, 2023, 40(11): 1843-1849. [24] 孙水雅, 桂薇薇, 贾程芳, 等. 浙江省基层2型糖尿病患者糖尿病肾病危险因素的列线图分析[J]. 中华内科杂志, 2023, 62(2): 169-175.SUN S Y, GUI W W, JIA C F, et al. Analysis of risk factors of diabetic nephropathy in patients with type 2 diabetes mellitus in Zhejiang Province[J]. Chinese Journal of Internal Medicine, 2023, 62(2): 169-175. [25] 雷程灏, 尹倩, 朱叶. 糖化血红蛋白变异指数与2型糖尿病肾病的相关性研究[J]. 临床内科杂志, 2022, 39(6): 396-399.LEI C H, YIN Q, ZHU Y. Association between hemoglobin glycation index and diabetic nephropathy of type 2 diabetic mellitus[J]. Journal of Clinical Internal Medicine, 2022, 39(6): 396-399. [26] YU D H, WANG Z, ZHANG X X, et al. Remnant cholesterol and cardiovascular mortality in patients with type 2 diabetes and Incident diabetic nephropathy[J]. J Clin Endocrinol Metab, 2021, 106(12): 3546-3554. [27] XUAN X P, HAMAGUCHI M, CAO Q L, et al. U-shaped association between the triglyceride-glucose index and the risk of incident diabetes in people with normal glycemic level: a population-base longitudinal cohort study[J]. Clin Nutr, 2021, 40(4): 1555-1561. doi: 10.1016/j.clnu.2021.02.037 -
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