非高密度与高密度脂蛋白胆固醇比值及其动态变化和2型糖尿病发病风险的前瞻性研究  

Associations between non-HDL-c/HDL-c, its dynamics changes and incident type 2 diabetes mellitus in a prospective cohort study

作　　者：余杨文[1] 吴延莉 苏旭 王艺颖 周婕[1] 刘涛[1] 付朝伟[2] YU Yang-wen;WU Yan-li;SU Xu;WANG Yi-ying;ZHOU Jie;LIU Tao;FU Chao-wei(Guizhou Center for Disease Control and Prevention,Guiyang,Guizhou 550004,China;不详)

机构地区：[1]贵州省疾病预防控制中心,贵州贵阳550004 [2]复旦大学公共卫生学院公共卫生安全教育部重点实验室国家卫生健康委员会卫生技术评估重点实验室

出　　处：《现代预防医学》2022年第7期1175-1180,1211,共7页Modern Preventive Medicine

基　　金：贵州省科技支撑计划项目(黔科合支撑[2018]2819);贵州省卫生健康委科学技术基金项目(gzwjkj2019-1-223)。

摘　　要：目的 探索非高密度脂蛋白胆固醇(Non-high-density lipoprotein cholesterol, non-HDL-c)/高密度脂蛋白胆固醇(HDL-c)及其变化与2型糖尿病发病风险的关联,为2型糖尿病防控提供依据。方法 2010年采用多阶段分层整群抽样抽取9 280人建立贵州自然人群队列,并于2016—2020年,对所有队列人群进行随访,随访到8 163人,剔除基线时患有糖尿病者、服用降血脂药物、基线总胆固醇、HDL-c缺失者或极值者后,最终有5 078人纳入分析。non-HDL-c为总胆固醇与HDL-c差值。动态变化由随访non-HDL-c/HDL-c值减去基线non-HDL-c/HDL-c值得出。采用Cox回归分析non-HDL-c/HDL-c值与糖尿病发病的关联及调整风险比(adjusted hazard ratio,aHR)和其95%可信限(confidential interval,CI)。采用限制性立方样条进行剂量反应关系描述。结果 中位随访时间为6.58年,共新发2型糖尿病820例。与位于non-HDL-c/HDL-c第1四分位数区间对象相比,位于第2四分位数,第3四分位数和第4四分位数区间对象的2型糖尿病发病风险aHR值分别为1.065(95%CI:0.855~1.325)、1.272(95%CI:1.037~1.562)、1.266(95%CI:1.022~1.569)。亚组分析中,在男性、年龄大于45岁和超重肥胖人群中,与位于non-HDL-c/HDL-c第1四分位数区间对象相比、第3四分位数和第4四分位数区间对象的2型糖尿病发病风险aHR值分别为1.529(95%CI:1.130~2.067)、1.748(95%CI:1.279~2.388)、1.389(95%CI:1.046~1.844)、1.394(95%CI:1.049~1.854)、1.380(95%CI:0.955~1.994)、1.462(95%CI:1.014~2.107),且趋势性检验P<0.05。与non-HDL-c/HDL-c动态变化值的第2四分位数区间对象相比,第1四分位数,第3四分位数和第4四分位数区间对象的2型糖尿病发病风险aHR值分别为1.258(95%CI:0.999~1.582)、1.390(95%CI:1.115~1.731)、1.530(95%CI:1.228~1.906)。限制性立方样条显示non-HDL-c/HDL-c与糖尿病发病风险呈正相关。结论 non-HDL-c/HDL-c值的增高将增加糖尿病发病的风险,尤其在男性,年龄大于45岁和超重肥胖�Objective To explore associations between the ratio of non-high density lipoprotein cholesterol(HDL-c) to HDL-c(non-HDL-c/HDL-c) and the incident type 2 diabetes mellitus(T2 DM) so as to provide evidences for the prevention and control of T2 DM. Methods A multi-stage stratified cluster sampling method was used to target 9 280 adults in a natural population cohort in 2010. From 2016 to 2020, a total of 8 163 subjects were followed up. After exclusion of those with diabetes at baseline, taking lipid lowering drugs, with missing or extreme values of total cholesterol and HDL-c baseline, 5 078 subjects were included in this analysis finally. Non-HDL-c was derived from the difference between total cholesterol and HDL-c. Dynamic changes were calculated from non-HDL-c/HDL-c at follow-up minus non-HDL-c/HDL-c at baseline. Cox model was occupied to explore associations between non-HDL-c/HDL-c, its changes and the incident T2 DM, and to estimate the adjusted hazard ratio(aHR) and its 95% confidential interval(CI). The dose-response relationship was presented by using restricted cubic spline. Results With the median follow-up of 6.58 years, a total of 820 new cases of T2 DM were identified. Compared with the first quantile of non-HDL-c/HDL-c, the aHR values of diabetes in the second, third and fourth quantiles were 1.065(95%CI: 0.855-1.325), 1.272(95%CI: 1.037-1.562), 1.266(95% CI: 1.022-1.569) respectively. In subgroup analysis, among men, those older than 45, and those who were overweight and obese, compared with the first quartile of non-HDL-C/HDL-C, The risk of type 2 diabetes in the third and fourth quartile of non-HDL-c/HDL-c adjusted hazard ratio were 1.529(95%CI: 1.130-2.067), 1.748(95%CI: 1.279-2.388), 1.389(95%CI: 1.046-1.844), 1.394(95%CI: 1.049-1.854), 1.380(95%CI: 0.955-1.994), 1.462(95%CI: 1.014-2.107), respectively, and the trend test P<0.05. Compared with the second quartile of non-HDL-c/HDL-c dynamic variation, the aHR values of diabetes in the first, third and fourth quantiles were 1.258(95%CI: 0.999-1.582

关 键 词：非高密度脂蛋白胆固醇 糖尿病 前瞻性研究 

分 类 号：R587.1[医药卫生—内分泌]