不同血脂谱与2型糖尿病患者肾功能关系的研究  

Relationship between different lipid profiles and renal function in patients with type 2 diabetes mellitus

作　　者：张蕊 李和俊 李梅[2] 王玉婵 朱延华[1] 蔡梦茵[1] 唐喜香[2] 陈燕铭[1] Zhang Rui;Li Hejun;Li Mei;Wang Yuchan;Zhu Yanhua;Cai Mengyin;Tang Xixiang;Chen Yanming(Department of Endocrinology and Metabolism,Third Affiliated Hospital of Sun Yat-sen University,Guangdong Provincial Key Laboratory of Diabetology,Guangzhou Key Laboratory of Mechanistic and Translational Obesity Research,Guangzhou 510630,China;Department of Special Clinic Center,Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院内分泌与代谢病学科、广东省糖尿病防治重点实验室、广州市肥胖分子机理与转化重点实验室,广州510630 [2]中山大学附属第三医院特诊医疗中心,广州510630

出　　处：《中华糖尿病杂志》2024年第10期1091-1098,共8页CHINESE JOURNAL OF DIABETES MELLITUS

摘　　要：目的探讨不同血脂谱与2型糖尿病(T2DM)患者肾功能的关系。方法本研究为横断面研究。纳入从2016年1月至2018年12月于中山大学附属第三医院内分泌科住院治疗的T2DM患者2784例,收集患者的临床资料,包括年龄、吸烟史、饮酒史、用药史、病程、体重指数(BMI)、糖化血红蛋白(HbA1c)、空腹血糖(FPG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)及脂蛋白(a)[Lp(a)]、估算的肾小球滤过率(eGFR)及尿白蛋白/肌酐比值(UACR)。以LDL-C、HDL-C、TG、Lp(a)作为聚类变量进行二阶聚类分析(K=4)。聚类分析后总结各亚型患者的临床特点,采用单因素方差分析、非参数检验、χ^(2)检验比较各亚型患者eGFR及UACR等肾功能相关的生化指标,最后采用二分类logistic回归分析法分析各亚型与DKD的相关性。结果纳入本研究的T2DM患者通过二阶聚类分析得到了4个聚类亚型:亚型1血脂相对正常,纳入1602例;亚型2以Lp(a)[648.5(455.5,955.7)mg/L]升高为主要特征,纳入243例,患者年龄最大、病程最长、HbA1c水平最高(P<0.05);亚型3以高TG[2.66(2.05,4.20)mmol/L]、低HDL-C[(0.87±0.19)mmol/L]为主要特征,纳入472例,男性患者居多,吸烟、饮酒患者比例较高(P<0.01);亚型4以LDL-C[(3.85±0.91)mmol/L]升高为主,纳入467例,患者BMI和FPG最高(P<0.001)。进一步分析发现,与亚型1相比,亚型2~4的患者eGFR水平下降和(或)UACR水平升高,其中亚型2的患者eGFR[(59.38±30.21)ml·min^(-1)·(1.73 m^(2))^(-1)]水平最低、UACR[12.46(6.99,27.59)mg/g]水平最高(P<0.01)。对各亚型与DKD进行二分类logistic回归分析发现,与亚型1相比,只有亚型2与DKD显著相关,校正各项混杂因素及用药情况后,该亚型患者的DKD发生风险增加了0.98倍[OR值(95%CI)为1.98(1.04~3.80),P=0.039]。结论本研究通过二阶聚类分析发现T2DM患者存在不同的血脂谱亚型,其中Lp(a)升高亚型(亚型2)的肾功能受损最严重,与DKDObjective To investigate the relationship between different lipid profiles and renal function in type 2 diabetes mellitus(T2DM)patients.Methods This was a cross-sectional retrospective study.Clinical data were collected from 2784 T2DM patients who were hospitalized at the Department of Endocrinology,the Third Affiliated Hospital of Sun Yat-sen University from January 2016 to December 2018.These clinical data included age,smoking history,history of alcohol use,history of drug use,disease course,body mass index(BMI),glycated hemoglobin A 1c(HbA 1c),fasting plasma glucose(FPG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),triglycerides(TG),and lipoprotein(a)[Lp(a)],estimated glomerular filtration rate(eGFR)and urinary albumin to creatinine ratio(UACR).LDL-C,HDL-C,TG and LP(a)were used as cluster variables for second-order cluster analysis(K=4).Then the clinical characteristics of each subgroup were analyzed,and biochemical indicators related to renal function such as eGFR and UACR among T2DM patients of different subtypes were compared by one-way analysis of variance(ANOVA),non-parametric test,orχ^(2) test.Finally,binary logistic regression analysis was used to assess the association between different lipid profiles and the prevalence of diabetic kidney disease(DKD).Results The T2DM patients were classified into 4 subtypes by second-order cluster analysis:serum lipids of the patients in cluster 1 were relatively normal and 1602 patients were included;patients in cluster 2 were characterized by the remarkable increase of Lp(a)[648.5(455.5,955.7)mg/L]and 243 cases were included,who had the oldest age,the longest duration of diabetes and the highest level of HbA 1c(P<0.05);the patients in cluster 3 were characterized by elevated TG[2.66(2.05,4.20)mmol/L]and low HDL-C[(0.87±0.19)mmol/L]levels and 472 patients were included,with the majority being male patients with a high prevalence of smoking and alcohol consumption(P<0.01);patients in cluster 4 exhibited predominantly high le

关 键 词：糖尿病 2型 血脂 聚类分析 肾功能 

分 类 号：R587.1[医药卫生—内分泌]