中国成人血浆糖化血红蛋白/高密度脂蛋白比值与尿白蛋白/肌酐比值的关系  

Association between plasma-glycosylated hemoglobin A 1c/high-density lipoprotein cholesterol ratio and urinary albumin-creatinine ratio in Chinese adults

作　　者：董文静 庞萍[2] 宋凌云 孙迪 颜世举 杨国庆[2] 母义明[1] 谷伟军[1] Dong Wenjing;Pang Ping;Song Lingyun;Sun Di;Yan Shiju;Yang Guoqing;Mu Yiming;Gu Weijun(Department of Endocrinology,the First Medical Center of Chinese PLA General Hospital,Beijing 100039,China;Department of Endocrinology,Hainan Hospital of Chinese PLA General Hospital,Sanya 572013,China;Department of Orthopedics,Hainan Hospital of Chinese PLA General Hospital,Sanya 572013,China)

机构地区：[1]解放军总医院第一医学中心内分泌科,北京100039 [2]解放军总医院海南医院内分泌科,三亚572013 [3]解放军总医院海南医院骨科,三亚572013

出　　处：《中华内科杂志》2024年第12期1228-1237,共10页Chinese Journal of Internal Medicine

摘　　要：目的探讨在中国普通成年人群中血浆糖化血红蛋白(HbA1c)/高密度脂蛋白(HDL-C)比值与尿白蛋白/肌酐比值(UACR)的关系。方法横断面研究。收集并分析于2012年3至12月进行的中国糖尿病个体的癌症风险评估研究(REACTION研究)共计43820名年龄>40岁的社区居民的临床资料,涉及中国8个地区(辽宁、广东、上海、甘肃、广西、河南、湖北、四川)。研究对象根据UACR水平分为3组:<10 mg/g、10~30 mg/g和>30 mg/g组;根据HbA1c/HDL-C四分位数分为Q1(<3.79),Q2(3.79~<4.59),Q3(4.59~5.66),Q4(>5.66)组。采用多元有序logistic回归模型法分析探讨HbA1c/HDL-C与UACR的关系。利用受试者工作特征(ROC)曲线分析HbA1c/HDL-C对于UACR升高的预测价值。结果43820名参与者的年龄为(58.00±0.05)岁,其中男性13452人(30.70%),女性30368人(69.30%)。单因素分析显示,HbA1c/HDL-C随UACR升高而升高(F=495.73,P<0.001)。logistic回归模型在校正其他临床相关混杂变量后,与HbA1c/HDL-C比值最低(Q1组)的患者相比,Q4组女性患者UACR升高的风险为1.483倍(95%CI 1.376~1.598,P<0.001),而男性患者为1.161倍(95%CI 1.019~1.323,P<0.001)。ROC曲线分析显示,HbA1c/HDL-C预测UACR升高的曲线下面积为0.623,95%CI为0.597~0.606,敏感度为60.18%,特异度为54.91%,与血糖、血脂等指标相比具有最高的预测价值。在HbA1c正常(<6.5%)或HDL-C正常(≥1.0 mmol/L)的情况下,HbA1c/HDL-C仍与UACR升高的风险独立相关(HbA1c<6.5%时Q4组比Q1组:OR=1.563,95%CI 1.210~2.019,P=0.001;HDL-C≥1.0 mmol/L时Q4组比Q1组:OR=1.822,95%CI 1.687~1.968,P<0.001)。结论HbA1c/HDL-C比值作为评价血糖稳态和血脂异常的新型复合指标,在中国普通成年人群(年龄>40岁)中,其与UACR增加的风险显著相关,优于血糖、血脂参数等单一指标。ObjectiveTo explore the relationship between glycosylated hemoglobin A 1c/high-density lipoprotein cholesterol ratio(HbA 1c/HDL-C)and urinary albumin-creatinine ratio(UACR)in Chinese adults.MethodsIn this cross-sectional study,the clinical data of 43820 community residents(age>40 years)from the Risk Evaluation of Cancers in Chinese Diabetic Individuals(REACTION study;March-December 2012)across eight centers(Liaoning,Guangdong,Shanghai,Gansu,Guangxi,Henan,Hubei,and Sichuan)in China were collected and analyzed.Participants were divided into three groups based on UACR levels:<10 mg/g,10-30 mg/g,and>30 mg/g.The HbA 1c/HDL-C ratio was divided into four groups according to quartile division of the subjects:1st quartile(Q1<3.79),2nd quartile(3.79≤Q2<4.59),3rd quartile(4.59≤Q3≤5.66),and 4th quartile(Q4>5.66).Multivariate ordinal logistic regression model was used to analyze the relationship between HbA 1c/HDL-C and UACR.Receiver operating characteristic(ROC)analysis was used to explore the predictive value of HbA 1c/HDL-C to UACR.ResultsThe 43820 subjects included 13452(30.70%)male and 30378(69.30%)female patients,with an average age of(58.00±0.05)years.According to results of one-way analysis of variance analysis,the HbA 1c/HDL-C ratio was significantly associated with the risk of increased UACR(F=495.73,P<0.001).After adjusting for clinically relevant confounding variables in logistic regression model,compared with participants with the lowest HbA 1c/HDL-C ratio(Q1),women with the highest HbA 1c/HDL-C ratio(Q4)had a 1.483-fold(95%CI 1.376-1.598,P<0.001)and men had a 1.161-fold(95%CI 1.019-1.323,P<0.001)increased risk of UACR.The ROC curve analysis showed that the area under the curve of HbA 1c/HDL-C for predicting increased UACR was 0.623(95%CI 0.597-0.606),with a sensitivity of 60.18%and a specificity of 54.91%.The HbA 1c/HDL-C ratio showed the highest predictive value of all glycemic and lipidemic parameters.In individuals with well-controlled blood glucose(HbA 1c<6.5%)or lipid levels(HDL-C≥1.0 mmol/L),the H

关 键 词：血红蛋白A 糖基化 血脂异常 心血管疾病 血浆糖化血红蛋白/高密度脂蛋白比值 尿白蛋白/肌酐比值 

分 类 号：R54[医药卫生—心血管疾病] R446.1[医药卫生—内科学]