TG/HDL-C、PCSK9、LAP与胰岛素抵抗的相关性及其预测糖尿病前期进展的价值  

Relationships of TG/HDL-C,PCSK9 and LAP to Insulin Resistance and Their Values in Predicting Prediabetes Progression

作　　者：李玲[1] 刘莲 刘琳[1] 周广举[1] 廖萱[2] LI Ling;LIU Lian;LIU Lin;ZHOU Guang-ju;LIAO Xuan(Department of Endocrinology,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China;Department of Ophthalmology,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China)

机构地区：[1]川北医学院附属医院内分泌科,四川南充637000 [2]川北医学院附属医院眼科,四川南充637000

出　　处：《南昌大学学报（医学版）》2023年第4期48-52,共5页Journal of Nanchang University：Medical Sciences

基　　金：2020年四川省医学(青年创新)科研课题(S20016)。

摘　　要：目的分析甘油三酯与高密度脂蛋白胆固醇比值(TG/HDL-C)、前蛋白转化酶枯草溶菌素9(PCSK9)、脂质蓄积指数(LAP)与胰岛素抵抗的关系及其预测糖尿病前期进展的价值。方法选取川北医学院附属医院收治的糖尿病前期患者205例,根据其是否进展为糖尿病分为进展组(n=33)和未进展组(n=172);比较2组的TG/HDL-C、PCSK9、LAP、胰岛素抵抗指数(HOMA-IR);Pearson相关分析TG/HDL-C、PCSK9、LAP与HOMA-IR的关系;多因素Logistic回归分析糖尿病前期进展的影响因素;决策分析曲线(DCA)分析TG/HDL-C、PCSK9、LAP及三者联合的临床获益度;临床影响曲线(CIC)分析在各个阈概率(Pt)下被TG/HDL-C、PCSK9、LAP联合检测划分为高风险的人数与实际人数的符合情况。结果进展组TG/HDL-C、PCSK9、LAP、HOMA-IR均高于未进展组(均P<0.05);TG/HDL-C、PCSK9、LAP与HOMA-IR呈正相关(r=0.798、0.786、0.800,均P<0.05);TG/HDL-C、PCSK9、LAP是糖尿病前期进展的独立危险因素(均P<0.05);在一个较大的Pt范围内TG/HDL-C、PCSK9联合LAP较三者单独应用具有更高的临床获益度,CIC曲线横轴从0.6后,三者联合划分为高风险的人数与实际人数具有较高的符合率。结论TG/HDL-C、PCSK9、LAP与胰岛素抵抗有关,且是影响糖尿病前期患者病情转归的危险因素,三者联合预测患者临床获益具有更好的价值。Objective To analyze the relationships of triglyceride/high-density lipoprotein cholesterol ratio(TG/HDL-C),proprotein convertase subtilisin/kexin type 9(PCSK9)and lipid accumulation index(LAP)to insulin resistance,and to investigate their values in predicting prediabetes progression.Methods A total of 205 patients with prediabetes admitted to Affiliated Hospital of North Sichuan Medical College were divided into progression group(n=33)and non-progression group(n=172).The TG/HDL-C,PCSK9,LAP,and homeostatic model assessment for insulin resistance(HOMA-IR)were compared between the two groups.The relationships of TG/HDL-C,PCSK9 and LAP to HOMA-IR were analyzed using Pearson’s correlation analysis.The factors affecting prediabetes progression were analyzed using multivariate logistic regression analysis.The decision curve analysis(DCA)was used to evaluate the clinical benefits of TG/HDL-C,PCSK9,LAP and their combination.The clinical impact curve(CIC)was drawn to analyze the compliance of the number of people classified as high risk by TG/HDL-C+PCSK9+LAP with the actual situation under each threshold probability.Results TG/HDL-C,PCSK9,LAP and HOMA-IR in the progression group were higher than those in the non-progression group(P<0.05),and TG/HDL-C,PCSK9 and LAP were positively correlated to HOMA-IR(r=0.798,0.786 and 0.800,respectively;P<0.05).Multivariate logistic regression analysis showed that TG/HDL-C,PCSK9 and LAP were independent influencing factors for prediabetes progression(P<0.05).The combination of TG/HDL-C,PCSK9 and LAP had a higher clinical benefit than the three alone within a larger Pt interval.After the horizontal axis of CIC curve was 0.6,the number of people classified as high risk obtained by the combination of TG/HDL-C+PCSK9+LAP showed a high coincidence rate with the actual situation.Conclusion TG/HDL-C,PCSK9 and LAP are associated with insulin resistance,and are risk factors affecting the outcome in prediabetes patients.Moreover,the combination of these three indicators is valuable for predicting

关 键 词：糖尿病前期 糖尿病 甘油三酯与高密度脂蛋白胆固醇比值 前蛋白转化酶枯草溶菌素9 脂质蓄积指数 胰岛素抵抗 

分 类 号：R587.1[医药卫生—内分泌]