不同胰岛素抵抗替代指数对中老年2型糖尿病患者发生高尿酸血症的预测价值研究  

Study on the Predictive Value of Different Insulin Resistance Replacement Indices for Hyperuricemia in Middle-aged and Elderly Patients with Type 2 Diabetes

作　　者：黄书玮 周志衡 冯天元[3] 刘莉[2] 邓光璞[2] 李尧天 朱宏 HUANG Shuwei;ZHOU Zhiheng;FENG Tianyuan;LIU Li;DENG Guangpu;LI Yaotian;ZHU Hong(School of Public Health,Southern Medical University,Guangzhou 510515,China;Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Shenzhen Pingshan General Hospital,Southern Medical University,Shenzhen 518118,China)

机构地区：[1]南方医科大学公共卫生学院,广东省广州市510515 [2]南方医科大学南方医院,广东省广州市510515 [3]南方医科大学深圳坪山总医院,广东省深圳市518118

出　　处：《中国全科医学》2024年第19期2364-2374,共11页Chinese General Practice

基　　金：国家重点研发计划项目(2020YFC2006400)。

摘　　要：背景我国2型糖尿病(T2DM)患者的数量庞大,其继发高尿酸血症(HUA)的风险较高。一旦T2DM患者继发HUA,将进一步加剧其他潜在并发症的风险,导致不良健康后果。因此,及时识别出这些继发HUA高风险的患者,并对其进行早期预防和治疗,显得尤为重要。目的探讨中老年T2DM患者常见胰岛素抵抗(IR)替代指标对发生HUA的预测价值,并选择合适指标作为预测HUA发生和发展的工具。方法采取分层随机抽样的方法,于深圳市某区7个社区卫生服务中心2023年1—3月就诊的T2DM患者中选取HUA患者479例和非高尿酸血症患者(NHUA)1528例。采用多因素Logistic回归分析评估三酰甘油葡萄糖(TyG)指数、三酰甘油葡萄糖体质量(TyG-BMI)指数、三酰甘油葡萄糖腰围(TyG-WC)指数、三酰甘油-高密度脂蛋白胆固醇(TG/HDL-C)指数、非高密度脂蛋白胆固醇-高密度脂蛋白胆固醇(Non-HDL-C/HDL-C)指数、胰岛素抵抗代谢(METS-IR)指数等IR替代指标及其四分位数对中老年T2DM患者发生HUA的影响。使用受试者工作特征(ROC)曲线评估不同IR替代指标对于中老年T2DM患者发生HUA的预测价值。并从CHARLS数据库中筛选2011年和2015年队列数据,组成巢式病例对照,验证几种IR替代指标预测HUA发生的有效性。结果多因素Logistic回归分析结果显示,TyG指数、TyG-BMI指数、TyG-WC指数、TG/HDL-C指数、Non-HDL-C/HDL-C指数、METS-IR指数是发生HUA的独立影响因素(P<0.05)。ROC曲线提示TyG-WC指数、Non-HDL-C/HDL-C指数和METS-IR指数对预测HUA的发生具有较高的价值,ROC曲线下面积(AUC)分别为0.811、0.796和0.791。巢式病例对照研究结果显示,高水平TyG-WC指数、Non-HDL-C/HDL-C指数和METS-IR指数相较于低水平,发生HUA的风险分别是2.083倍、2.152倍、2.263倍(P<0.05)。结论TyG指数、TyG-BMI指数、TyG-WC指数、TG/HDL-C指数、Non-HDL-C/HDL-C指数、METS-IR指数均能预测HUA发生,其中TyG-WC指数、METS-IR指数和NoBackground In China,there is a significant prevalence of type 2 diabetes patients(T2DM),who also have an increased risk of developing secondary hyperuricemia(HUA).Patients with T2DM who develops HUA are at increased risk of developing further problems,which could have detrimental effects on their health.Consequently,it is crucial to promptly identify individuals who have a high risk of developing secondary HUA and to begin early prevention and therapy.Objective Exploring the predictive value of common insulin resistance(IR)surrogates for the HUA in middle-aged and elderly T2DM patients.And employ a subset of these metrics as predictive metrics for the occurrence and progression of HUA.Methods Using stratified random sampling,479 individuals with type 2 diabetes mellitus(T2DM)and 1528 patients with non-hyperuricemia(NHUA)were chosen from seven community health service centers in Shenzhen between January and March 2023.Multivariate Logistic regression analysis was used to evaluate the effects of various insulin resistance(IR)metrics and their quartiles on the incidence of HUA in middle-aged and older type 2 diabetic patients.Triglyceride-high density lipoprotein cholesterol(TG/HDL-C)index,non-high density lipoprotein cholesterol ratio(Non-HDL-C/HDL-C)index,triglyceride glucose(TyG)index,triglyceride glucose body mass(TyG-BMI)index,triglyceride glucose waist circumference(TyG-WC)index,and insulin resistance metabolism(METS-IR)index are some of these metrics.The predictive efficacy of several IR substitution measures for HUA in middle-aged and older T2DM patients was assessed using the ROC curve.The CHARLS database's cohort data from 2011 and 2015 were filtered in order to create a nested case-control that would validate the predictive power of different IR alternative indicators for the likelihood of HUA.Results Multivariate Logistic regression study revealed that the METS-IR index,TG/HDL-C index,Non HDL-C/HDL-C index,TyG index,TyG-BMI index,TyG-WC index,and TG/HDL-C index were independent influencing factors for th

关 键 词：糖尿病 2型 高尿酸血症 中年人 老年人 胰岛素抵抗 风险评估 

分 类 号：R587.1[医药卫生—内分泌] R589.9[医药卫生—内科学]