三酰甘油葡萄糖指数对2型糖尿病人群蛋白尿发生风险的中介效应OACSTPCD
Mediating effect of triglyceride-glucose index on the risk of proteinuria in patients with type 2 diabetes mellitus
目的 探讨三酰甘油葡萄糖(TyG)指数对2型糖尿病人群蛋白尿发生风险的中介效应.方法 选取2023年3月至2023年5月于上海市曲阳路街道社区卫生服务中心进行体检的2型糖尿病患者734例,收集其临床资料、生化指标、腹部超声等结果.将所有患者分为正常组、微量蛋白尿组,大量蛋白尿组,并进行糖化血红蛋白(HbA1c)和体质量指数(BMI)、TyG指数以及有无非酒精性脂肪性肝病(NAFLD)分层,分析影响2型糖尿病患者蛋白尿的因素,采用多因素logistic回归分析TyG指数、NAFLD对2型糖尿病人群蛋白尿的影响,用回归系数依次检验法分析TyG是否介导NAFLD相关蛋白尿.结果 正常组、微量蛋白尿组、大量蛋白尿组的年龄、BMI、尿肌酐、HbA1c、TyG指数等差异有统计学意义(P＜0.05);性别在3组间差异无统计学意义.多因素logistic回归分析显示,以HbA1c＜7％且BMI＜24 kg/m2患者为参照,HbA1c≥7％且BMI≥24 kg/m2患者蛋白尿患病风险最高(P=0.022),HbAlc≥7％且BMI＜24 kg/m2患者次之(P=0.039).以TyG指数7.65～8.69患者为参照,9.45～11.90患者蛋白尿风险增加至3.321倍(P＜0.001).中介效应分析显示,TyG可能介导NAFLD相关蛋白尿发生(P＜0.001);中介效应占总效应的55.70％.结论TyG指数可能是2型糖尿病人群蛋白尿发生的独立相关因素,HbAlc控制不良且BMI超标者的蛋白尿发生率高;TyG部分介导2型糖尿病人群蛋白尿发生.
Objective To explore the mediating effect of triglyceride-glucose(TyG)index on the risk of proteinuria in patients with type 2 diabetes mellitus(T2DM).Methods 734 patients with T2DM who underwent routine physical examination in Quyang Road Community Health Service Center,Shanghai from March 2023 to May 2023 were enrolled.The results of basic information,biochemical indicators,abdominal ultrasound and other results were collected.All patients were divided into the normal group,microproteinuria group,and massiveproteinuria group,and stratification analyses were underwent according to glycated hemoglobin(HbA1c),body mass index(BMI),TyG index,and presence or absence of non-alcoholic fatty liver disease(NAFLD).Factors affecting proteinuria in T2DM patients were analyzed.Multivariate logistic regression was used to analyze the impact of TyG index and NAFLD on proteinuria in type 2 diabetes population.Regression coefficient sequential test was used to analyze whether TyG mediates NAFLD associated proteinuria.Results There were statistically significant differences in age,BMI,urinary creatinine,HbA1c,TyG index,etc.among the normal group,microproteinuria group,and massiveproteinuria group(all P＜0.05);there was no statistically significant difference in gender among the three groups.Multivariate logistic regression analysis showed that taking the HbA1c＜7％and BMI＜24 kg/m2 group as a reference,the patients with HbA1c≥7％and BMI≥24 kg/m2 had the highest risk of proteinuria(P=0.022),followed by the HbA1c≥7％and BMI＜24 kg/m2 group(P=0.039).Taking the TyG index(7.65-8.69)as a reference,the risk of proteinuria in the(9.45-11.90)group was 3.321 times(P＜0.001).The mediation effect analysis showed that the TyG mediated NAFLD associated proteinuria(P＜0.001),with the mediation effect accounting for 55.70％of the total effect.Conclusion TyG index may be an independent risk factor for proteinuria in patients with T2DM,and the prevalence of proteinuria is high in patients with poor control in HbA1c and excessive BMI,and TyG may partially mediate the risk of proteinuria in patients with T2DM.
薄其凤;陈羽嫣;郭宝林;桑至剑;章丹婷;岳江
上海市虹口区曲阳路街道社区卫生服务中心全科,上海 200437上海医大医院病理科,上海 201702上海市公共卫生临床中心口腔科,上海 200083香港大学李嘉诚医学院肾内科,香港 999077上海交通大学医学院附属仁济医院内分泌科,上海 200127
临床医学
2型糖尿病蛋白尿尿白蛋白/肌酐比值三酰甘油葡萄糖指数非酒精性脂肪性肝病
type 2 diabetes mellitusproteinuriaurinary albumin/creatinine ratiotriglyceride-glucose indexnon-alcoholic fatty liver disease
《中国临床医学》 2024 (003)
463-469 / 7
评论