青少年新型简化胰岛素抵抗指标与骨矿物质含量的关系  

Relationship between new surrogate marks of insulin resistance and bone mineral content in adolescents

作　　者：马晓燕 田梅 刘建熹 佟玲玲 丁文清[1,2] MA Xiaoyan;TIAN Mei;LIU Jianxi;TONG Lingling;DING Wenqing(School of Public Health,Ningxia Medical University,Yinchuan(750004),Ningxia Hui Autonomous Region,China)

机构地区：[1]宁夏医科大学公共卫生学院,银川750004 [2]宁夏环境因素与慢性病控制重点实验室

出　　处：《中国学校卫生》2024年第4期570-574,共5页Chinese Journal of School Health

基　　金：宁夏自然科学基金项目(2023AAC03180);国家自然科学基金项目(82160641)。

摘　　要：目的分析青少年新型简化胰岛素抵抗(IR)指标与骨矿物质含量(BMC)的关系及其对骨量低下的评估效果,为早期识别和防治青少年骨骼相关疾病提供科学依据。方法于2017年9月—2020年9月,通过方便抽样和分层整群随机抽样的方法抽取银川市1594名12~18岁青少年,并计算三酰甘油-葡萄糖指数(TyG)、三酰甘油葡萄糖-体重指数(TyG-BMI)及三酰甘油和高密度脂蛋白胆固醇比值(TG/HDL-C)作为新型简化IR指标。使用偏相关分析不同简化IR指标与BMC水平的相关性,使用二元Logistic回归分析青少年IR指标与骨量低下的关系,构建受试者工作特征(ROC)曲线分析其对骨量低下的评估效果。结果校正性别、年龄、吸烟、饮酒、高血压家族史、收缩压(SBP)、舒张压(DBP)混杂因素后,新型简化IR指标与BMC水平均呈正相关(TyG:r=0.11;TyG-BMI:r=0.58;TG/HDL-C:r=0.21);进一步调整体质量指数(BMI)、体脂肪(FM)、瘦体重(LM)指标后,IR指标与BMC的关系转为负相关(TyG:r=-0.20;TyG-BMI:r=-0.18;TG/HDL-C:r=-0.14)(P值均<0.01)。Logistic回归分析结果显示,调整性别、年龄、吸烟、饮酒、高血压家族史、SBP、DBP因素后,TyG、TyG-BMI、TG/HDL-C水平升高青少年发生骨量低下的可能性降低(TyG:OR=0.63,95%CI=0.40~0.98;TyG-BMI:OR=0.94,95%CI=0.93~0.96;TG/HDL-C:OR=0.31,95%CI=0.17~0.58,P值均<0.05);调整BMI、FM、LM指标后,TyG和TG/HDL-C值高的女生发生骨量低下的可能性分别是低水平女生的4.95和4.38倍(TyG:OR=4.95,95%CI=1.29~18.95;TG/HDL-C:OR=4.38,95%CI=1.04~18.50,P值均<0.05)。ROC曲线显示,TyG-BMI对骨量低下的评估效果最佳(AUC=0.80,95%CI=0.77~0.83,P<0.01)。结论青少年新型简化IR指标与BMC呈负相关,其中TyG-BMI对骨量低下的评估效果最佳,可作为早期识别骨量低下的可靠指标。Objective To analyze the relationship between new surrogate marks of insulin resistance(IR)and bone mineral content(BMC)in adolescents,and predictive value of the new surrogate marks on low bone mass,so as to provide scientific basis for early identification and prevention of skeletal-related diseases in adolescents.Methods A total of 1594 adolescents aged 12-18 years in Yinchuan City were selected by convenience sampling and stratified cluster random sampling from September 2017 to September 2020,and triglyceride and glucose index(TyG),triglyceride glucose-body mass index(TyG-BMI)and triglyceride/high-density lipoprotein cholesterol(TG/HDL-C)were calculated as new simplified IR index.The correlation between different simplified IR indexes and BMC level was analyzed by partial correlation.Binary Logistic regression was used to analyze the relationship between IR index and low bone mass,and receiver operating characteristic(ROC)curve was constructed to analyze its evaluation effect on low bone mass.Results After adjusting for confounding factors such as gender,age,smoking,drinking,family history of hypertension,systolic blood pressure(SBP)and diastolic blood pressure(DBP),the new surrogate marks of IR were positively correlated with BMC level(TyG:r=0.11,TyG-BMI:r=0.58,TG/HDL-C:r=0.21,P<0.01).After further adjustment of body mass index(BMI),fat mass(FM)and lean mass(LM),the relationship between IR indexes and BMC turned into negative correlation(TyG:r=-0.20,TyG-BMI:r=-0.18,TG/HDL-C:r=-0.14,P<0.01).After adjusting for confounding factors such as gender,age,smoking,drinking,family history of hypertension,SBP and DBP,Logistic regression results showed that the increase of TyG,TyG-BMI and TG/HDL-C levels reduced the possibility of low bone mass in adolescents(TyG:OR=0.63,95%CI=0.40-0.98,TyG-BMI:OR=0.94,95%CI=0.93-0.96,TG/HDL-C:OR=0.31,95%CI=0.17-0.58,P<0.01).After adjusting BMI,FM and LM,the above results were completely reversed.Girls with high TyG and TG/HDL-C levels were 4.95 and 4.38 times more likely to have low b

关 键 词：胰岛素抵抗 骨和骨组织 矿物质 生长和发育 回归分析 青少年 

分 类 号：R179[医药卫生—妇幼卫生保健]