血脂变异度对2型糖尿病患者全因死亡和心血管疾病死亡的影响  

Effect of blood lipid variability on all-cause mortality and cardiovascular disease mortality in patients with type 2 diabetes mellitus

作　　者：张焕文 巴合古·依明尼亚孜 罗涛 张沁宇 阿丽亚·艾木都拉 乔婷婷 初蕾 穆凯丽 戴江红[1] ZHANG Huanwen;BAHEGU Yimingniyazi;LUO Tao;ZHANG Qinyu;ALIYA Aimudula;QIAO Tingting;CHU Lei;MU Kaili;DAI Jianghong(School of Public Health,Xinjiang Medical University,Urumqi,Xinjiang Uygur Autonomous Region,830017,China;不详)

机构地区：[1]新疆医科大学公共卫生学院,新疆维吾尔自治区乌鲁木齐市830017 [2]新疆医科大学附属中医医院 [3]新疆医科大学护理学院

出　　处：《中国预防医学杂志》2025年第2期143-149,共7页Chinese Preventive Medicine

基　　金：国家重点研发计划(2017YFC0907203);国家自然科学基金资助项目(82160640);新疆维吾尔自治区研究生教育创新计划项目(XJ2022G182);新疆医科大学大学生创新创业训练计划项目(CX2021035)。

摘　　要：目的调查2型糖尿病(type 2 diabetes mellitus,T2DM)患者血脂变异度与全因死亡、心血管疾病(cardiovascular disease,CVD)死亡间的关系及其对全因死亡、CVD死亡风险的预测价值。方法以“新疆多民族自然人群队列建设及健康随访研究”中参加2017年健康体检时诊断为T2DM的患者为研究对象,收集研究对象基本信息、血脂数据及至2020年12月31日死亡情况;使用变异系数计算研究对象2017—2019年的血脂变异度,采用Cox比例风险回归模型和限制性立方样条分析血脂变异度与全因死亡、CVD死亡的关联;采用C指数、整体鉴别指数(integrated discrimination improvement,IDI)、净重新分类指数(net reclassification improvement,NRI)评估血脂变异度对全因死亡及CVD死亡风险的预测价值。结果T2DM患者1241例,死亡22例,其中CVD死亡13例。T2DM患者三酰甘油(triglyceride,TG)变异度和总胆固醇(totalcholesterol,TC)变异度与全因死亡的风险比(hazardratio,HR)(95%CI)分别为1.28(1.14~1.44)、1.32(1.19~1.46),与CVD死亡的HR(95%CI)分别为1.48(1.29~1.71)、1.32(1.17~1.48),未发现低密度脂蛋白胆固醇变异度和高密度脂蛋白胆固醇变异度与死亡风险间的关联。在全因死亡分析中,加入TG和TC变异度后,C指数分别提升1%和13%(P>0.05),IDI分别改善5%和7%(P<0.05),NRI中TG提升11%(P>0.05),TC提升23%(P<0.05)。CVD死亡分析中,基础模型加入TG和TC变异度后,C指数分别提升6%和8%(P>0.05),IDI分别改善20%和9%(P<0.05),NRI分别提升40%和44%(P<0.05)。男性(HR_(全因死亡)=1.44,HR_(CVD死亡)=1.64)、体质量指数≥24 kg/m^(2)(HR_(全因死亡)=1.36,HR_(CVD死亡)=1.56)的T2DM患者TG变异度与死亡风险关联强度较高。结论TG变异度和TC变异度是T2DM患者全因死亡和CVD死亡风险的预测因子,尤其是TC变异度对全因死亡和CVD死亡具有良好预测价值。男性及BMI较高者TG变异度与死亡的关联效应较高,提示未来T2DM人群应更加关注血脂变异�Objective To investigate the relationship between lipid variability and all-cause mortality and cardiovascular disease(CVD)mortality in patients with type 2 diabetes mellitus(T2DM),and to assess the predictive value of lipid variability for these mortality risks.Methods Patients diagnosed with T2DM during health screenings in 2017 from the"Xinjiang Multinational Natural Population Cohort Construction and Health Follow-up study"were included.Data on basic demographics,lipid profiles,and mortality status up to 31 December 2020,were collected.The coefficient of variation was used to calculate lipid variability from 2017 to 2019.Cox proportional hazards regression models and restricted cubic splines were employed to analyze the association between lipid variability and all-cause mortality and CVD mortality.The predictive value of lipid variability for all-cause mortality and CVD mortality risks was evaluated using the C-index,integrated discrimination improvement(IDI),and net reclassification improvement.Results Among 1241 patients with T2DM,22 deaths occurred,with 13 attributed to CVD.The hazard ratios(HR)for all-cause mortality associated with triglyceride(TG)variability and total cholesterol(TC)variability were 1.28(95%CI:1.14-1.44)and 1.32(95%CI:1.19-1.46),respectively.For CVD mortality,the HR were 1.48(95%CI:1.29-1.71)for TG variability and 1.32(95%CI:1.17-1.48)for TC variability.No significant associations were found between low-density lipoprotein cholesterol variability or high-density lipoprotein cholesterol variability and mortality risk.In the all-cause mortality analysis,the inclusion of TG and TC variability improved the C-index by 1%and 13%,respectively(P>0.05),while the IDI improved by 5%and 7%,respectively(P<0.05).In the CVD mortality analysis,the C-index increased by 6%and 8%(P>0.05)with the addition of TG and TC variability,and the IDI improved by 20%and 9%(P<0.05),respectively.The NRI increased by 40%and 44%(P<0.05)for TG and TC variability,respectively.Notably,TG variability was more strongly asso

关 键 词：2型糖尿病 全因死亡 心血管疾病死亡 血脂变异度 成年人 

分 类 号：R195[医药卫生—卫生统计学]