糖化血红蛋白与血浆致动脉粥样硬化指数对中老年2型糖尿病发生风险的联合预测价值  

Predictive value of glycated hemoglobin A1c combined with atherogenic index of plasma for the risk of type 2 diabetes mellitus in middle-aged and older adults

作　　者：赵薇 罗兰 刘栩晗 李珅 李欣宇 高政南 Zhao Wei;Luo Lan;Liu Xuhan;Li Shen;Li Xinyu;Gao Zhengnan(Department of Endocrinology and Metabolism,Dalian Central Hospital Affiliated to Dalian Medical University,Dalian 116033,China)

机构地区：[1]大连医科大学附属大连市中心医院内分泌科,大连116033

出　　处：《中华糖尿病杂志》2022年第2期153-158,共6页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家科技支撑计划项目(2013BAI09B13)。

摘　　要：目的探讨糖化血红蛋白(HbA1c)和血浆致动脉粥样硬化指数(AIP)对中老年2型糖尿病(T2DM)发生风险的联合预测价值。方法本研究依托中国T2DM患者肿瘤发生风险的流行病学研究(REACTION),对2011至2014年在大连社区40周岁及以上人群中开展的流行病学调查资料进行回顾性分析,筛选基线无糖尿病的研究对象4628例,3年随访后最终纳入4033例。对研究对象进行标准问卷调查、体格检查,并检测血脂、HbA1c、空腹血糖(FPG)、糖负荷后2 h血糖(2hPG)等指标。通过二元logistic回归分析法分析基线HbA1c、AIP与随访时新发T2DM的关系,并构建二者对T2DM的联合预测因子。通过受试者工作特征(ROC)曲线评价HbA1c和AIP对T2DM发生风险的联合预测价值。结果与基线比较,3年随访时饮酒率、高血压患病率、2hPG、AIP水平升高,FPG及HbA1c水平降低(均P<0.05)。3年随访时新诊断T2DM 268例(6.65%)。二元logistic回归分析结果显示,校正年龄、性别、吸烟史、糖尿病家族史、体重指数、腰围、高血压、总胆固醇、低密度脂蛋白胆固醇后,基线HbA1c和AIP升高均是T2DM发生的独立危险因素(OR=6.490,95%CI 4.406~9.560,P<0.01;OR=2.237,95%CI 1.352~3.700,P<0.01)。ROC曲线分析显示,基线HbA1c、AIP联合预测T2DM发生的曲线下面积(AUC)为0.712(P<0.05),合适切点为0.0688,大于二者单独的预测的AUC(Z=3.100,P<0.05;Z=5.190,P<0.05)。结论基线HbA1c、AIP升高是3年后T2DM发病的独立危险因素,二者联合对T2DM的发生具有较好的预测价值。Objective To investigate the predictive value of glycated hemoglobin A1c(HbA1c)combined with atherogenic index of plasma(AIP)for the risk of type 2 diabetes mellitus(T2DM)in middle-aged and older people.Methods In this retrospective cohort study deriving from the Risk Evaluation of cAncers in Chinese diabeTic Individuals:A lONgitudinal Study(REACTION study),epidemiologic data of residents≥40 years old in Dalian communities from 2011 to 2014 were analyzed.A total of 4628 non-diabetic participants in baseline were followed up in 2014,and the final analysis consisted of 4033 participants.All participants accomplished a standard questionnaire,a physical examination and blood tests including lipid profile,HbA1c,fasting plasma glucose(FPG),two-hour postprandial plasma glucose(2hPG),etc.Binary logistic regression models were adopted to analyze the relationship between HbA1c,AIP and incident T2DM,and the combined predictor was built.Receiver operating characteristic(ROC)curves were built to estimate the predictive value of the combined predictor for T2DM.Results In the 3-year follow-up,drinking rate,prevalence of hypertension,levels of 2hPG and AIP increased significantly compared with baseline,while levels of FPG and HbAlc declined,there were statistical differences(all P<0.05).Two hundred and sixty-eitht(6.65%)participants were diagnosed with T2DM in follow-up.Binary logistic regression analysis showed that,after adjusting for age,gender,smoking history,family history of diabetes,body mass index,waist circumference,hypertension,total cholesterol,low-density lipoprotein-cholesterol,increased HbA1c and AIP were both independent risk factors of T2DM(OR=6.490,95%CI 4.406—9.560,P<0.01;OR=2.237,95%CI 1.352—3.700,P<0.01).ROC curve analysis showed that area under curve(AUC)of the combined predictor was 0.712(P<0.05),which was larger than AUCs of HbA1c and AIP(Z=3.100,P<0.05;Z=5.190,P<0.05),and the optimal cut-off point was 0.0688.Conclusions Increased HbA1c and AIP in baseline are independent risk factors for the inciden

关 键 词：糖尿病 2型 血红蛋白A 糖基化 血浆致动脉粥样硬化指数 联合预测因子 

分 类 号：R587.1[医药卫生—内分泌]