脂代谢和肝功能指标对糖尿病前期的预测作用  

Analysis of the Predictive Effects of Lipid Metabolism and Liver Function Indicators on Prediabetes

作　　者：马燕粉[1] 刘洒洒 胡健[1] 蔡德佩 乔永峰[3] 王晓琴[1] MA Yanfen;LIU Sasa;HU Jian;CAI Depei;QIAO Yongfeng;WANG Xiaoqin(Dept.of Clinical Laboratory,The 1st Affiliated Hospital of Xi’an JiaoTong University,Xi’an Shanxi 710061;Dept.of Clinical Laboratory,Xi’an Aerospace General Hospital,Xi’an Shanxi 710199;Dept.of Clinical Laboratory,Hanzhong Central Hospital,Hanzhong Shanxi 723099,China)

机构地区：[1]西安交通大学第一附属医院检验科,陕西西安710061 [2]西安航天总医院检验科,陕西西安710199 [3]汉中市中心医院检验科,陕西汉中723099

出　　处：《昆明医科大学学报》2024年第12期153-159,共7页Journal of Kunming Medical University

基　　金：陕西省自然科学基金青年项目(2022JQ-866)。

摘　　要：目的研究脂代谢与肝功能指标在糖尿病前期人群中的关系,探讨其对糖尿病前期的预测价值。方法选择2020年4月至2021年8月在西安交通大学第一附属医院进行健康体检的546例糖尿病前期患者作为病例组(PreDM组),546例糖耐量正常者作为对照组(NGT组),2组基线资料经倾向评分匹配后差异无统计学意义(P>0.05)。比较2组脂代谢和肝功能指标的水平;分析PreDM组脂代谢指标与肝功能指标的相关性;应用二元Logistic回归分析筛选糖尿病前期的影响因素;采用ROC曲线判断脂代谢和肝功能指标对糖尿病前期的预测作用。结果PreDM组的谷丙转氨酶(ALT)、谷丙转氨酶/谷草转氨酶比值(ALT/AST)、胆碱酯酶(CHE)、γ-谷氨酰基转移酶(GGT)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇/高密度脂蛋白胆固醇比值(TC/HDL-C)和甘油三酯/高密度脂蛋白胆固醇比值(TG/HDLC)水平高于NGT组(P<0.05);Spearman相关分析显示PreDM组TG/HDL-C与ALT、ALT/AST、CHE和GGT呈正相关(r=0.256、0.256、0.293、0.122,P<0.05);多因素逐步logistic回归分析结果显示ALT/AST、GGT、TC/HDL-C和TG/HDL-C对糖尿病前期的影响作用最大(OR=2.124、1.027、1.196、1.260,P<0.05),并且4者联合比较其它单项指标,有最高的鉴别诊断价值(AUC>0.7)。结论糖尿病前期人群血脂和肝酶谱异常者较多,ALT/AST、GGT、TC/HDL-C和TG/HDL-C 4者联合预测糖尿病前期的效果较好。Objective To study the relationship between lipid metabolism and liver function indexes in prediabetic population,and explore the predictive value of these indexes for prediabetes.Methods 546 patients with prediabetes who underwent physical examination in the First Affiliated Hospital of Xi’an Jiaotong University from April 2020 to August 2021 were selected as case group(PreDM group)and 546 patients with normal glucose tolerance as control group(NGT group).There was no significant difference in baseline data between the two groups after tendency matching score.The levels of lipid metabolism and liver function indicators were compared between the two groups;the correlation between lipid metabolism and liver function indicators in the PreDM group was analyzed;the influencing factors of prediabetes were screened by using binary logistic regression analysis;the predictive effect of lipid metabolism and liver function indicators on prediabetes was judged by using the ROC curve.Results Glutamic pyruvic transaminase(ALT),glutamic pyruvic transaminase/glutamic oxaloacetic transaminase ratio(ALT/AST),cholinesterase(CHE),gamma glutamyltransferase(GGT),total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),total cholesterol/high density lipoprotein cholesterol ratio(TC/HDL-C)and triglyceride/high density lipoprotein cholesterol ratio(TG/HDL-C)in PreDM group were higher than those in NGT group(all P<0.05).Spearman correlation analysis showed that TG/HDL-C in PreDM group had the positive correlation with ALT,ALT/AST,CHE and GGT(r=0.256,0.256,0.293,0.122,all P<0.05).Multivariate stepwise logistic regression analysis showed that ALT/AST,GGT,TC/HDL-C and TG/HDL-C had the greatest effect on prediabetes(OR=2.124,1.027,1.196,1.260),and the combination of the four had the highest differential diagnostic value(AUC>0.70).Conclusion There are more abnormal indexes of blood lipid and liver zymogram in prediabetic population,and the combination of ALT/AST,GGT,TC/HDL

关 键 词：糖尿病前期 体检 脂代谢 相关性 肝功能 

分 类 号：R446.11[医药卫生—诊断学]