摘要
目的 探讨不同甘油三酯血糖(TyG)水平糖尿病患者血糖波动、维生素D水平、铁代谢失衡特征及其与糖尿病并发症的相关性.方法 回顾性选择2019年1月至2023年12月来巴彦淖尔市医院诊治的2型糖尿病患者240例,根据 TyG 四分位水平分为 Q1 组:6.41 ≤TyG＜8.45(n=58),Q2 组:8.45 ≤TyG＜8.80(n=61),Q3 组:8.80≤TyG＜9.41(n=64),Q4组:9.41≤TyG＜10.43(n=57)4组;根据患者是否合并慢性并发症,将患者分为合并组(n=155)与未合并组(n=85).收集所有患者的基本资料(性别、病程、身高、腰围、体重、臀围、计算体重指数、年龄、静息状态下的舒张压/收缩压、腰臀比),检测实验室指标[空腹血糖、糖化血红蛋白、高密度脂蛋白、总胆固醇、甘油三酯、低密度脂蛋白、丙氨转氨酶(ALT)、天冬氨酸转移酶(AST)、尿酸、肌酐、尿素氮、维生素D、铁蛋白、餐后2 h血糖].对比不同TyG水平糖尿病患者的基本资料、实验室指标水平,分析TyG与有统计学意义指标的相关性,使用单因素分析糖尿病并发症的影响因素,使用Logistic多因素回归分析糖尿病并发症的影响因素,使用ROC曲线分析TyG、维生素D、铁蛋白及三者联合对糖尿病并发症的预测价值.结果 Q1、Q2、Q3、Q4组中的高密度脂蛋白、维生素D水平逐渐降低,而空腹血糖、病程、甘油三酯、餐后2 h血糖、体重指数、低密度脂蛋白、尿酸、腰臀比、糖化血红蛋白、肌酐、总胆固醇、铁蛋白逐渐升高,4组组间比较,差异均有统计学意义(P＜0.05).TyG与病程、体重指数、腰臀比、空腹血糖、餐后2 h血糖、糖化血红蛋白、总胆固醇、甘油三酯、低密度脂蛋白、尿酸、肌酐、铁蛋白均呈正相关(P＜0.05),与高密度脂蛋白、维生素D均呈负相关(P＜0.05).单因素分析,合并组的糖化血红蛋白、TyG、低密度脂蛋白、病程、尿酸、体重指数、空腹血糖、肌酐、餐后2 h血糖、总胆固醇、腰臀比、甘油三酯、铁蛋白均明显较未合并组高,高密度脂蛋白、维生素D均明显较未合并组低,差异均有统计学意义(P＜0.05).Logistic多因素回归分析结果表明,病程、体重指数、空腹血糖、甘油三酯、铁蛋白、TyG升高是糖尿病并发症的危险因素(P＜0.05),维生素D升高是糖尿病发生并发症的保护因素(P＜0.05).TyG、维生素D、铁蛋白及三者联合对糖尿病并发症的预测价值均良好,AUC均＞0.8,P＜0.05.结论 糖尿病患者的TyG水平与血糖水平、维生素D水平、铁代谢失衡特征、糖尿病并发症显著相关,TyG水平越高,血糖水平越高,维生素D水平越低,铁代谢失衡越严重,TyG、维生素D、铁蛋白及三者联合可被用于糖尿病并发症的预测.
Abstract
Ojbective To investigate the characteristics of blood glucose fluctuation,vitamin D level and iron metabolism imbalance in di-abetic patients with different triglyceride glucose index(TyG)levels and their correlation with diabetic complications.Methods A total of 240 patients with type 2 diabetes diagnosed and treated in Bayannur Hospital from January 2019 to December 2023 were retrospectively selected.And they were divideed into four groups according to the TyG quartile level:Q1 group:6.41 ≤ TyG＜8.45(n=58),Q2 group:8.45≤TyG＜8.80(n=61),Q3 group:8.80≤ TyG＜9.41(n=64),Q4 group:9.41 ≤ TyG＜10.43(n=57).Patients were divided into the combined group(n=155)and the non combined group(n=85)according to whether they had chronic complications.The basic datas of all patients(gender,course of disease,height,waist circumference,weight,hip circumference,calculation of body mass index,age,diastolic/systolic pressure at rest,waist hip ratio)were collected,the laboratory indicators[fasting blood-glucose,glycosylated hemoglobin,high-density lipoprotein,total cholesterol,triglyceride,low-density lipoprotein,alanine aminotransferase(ALT),aspartate aminotransferase(AST),uric acid,creatinine,u-rea nitrogen,vitamin D,ferritin,and 2 h postprandial blood glucose]were tested.The basic data and laboratory index levels of diabetes patients with different TyG levels were compared,the correlation between TyG and statistically significant indicators were analyzed,the influencing factors of diabetes complications were analyzed using single factor analysis,the influencing factors of diabetes complications was analyzed using Logistic multiple factor regression analysis,and the predictive value of TyG,vitamin D,ferritin and their combination on diabetes complications was ana-lyzed using receiver operating characteristic(ROC)curve.Results The levels of high density lipoprotein and vitamin D in Q1,Q2,Q3 and Q4 groups decreased gradually,while fasting blood glucose,course of disease,triglyceride,2 h postprandial blood glucose,body mass index,low density lipoprotein,uric acid,waist-to-hip ratio,glycosylated hemoglobin,creatinine,total cholesterol and ferritin increased gradually.There were statistically significant differences among the four groups(P＜0.05).TyG was positively correlated with course of disease,body mass in-dex,waist-to-hip ratio,fasting blood glucose,2 h postprandial blood glucose,glycosylated hemoglobin,total cholesterol,triglyceride,low density lipoprotein,uric acid,creatinine and ferritin(P＜0.05),and negatively correlated with high density lipoprotein and vitamin D(P＜0.05).Univariate analysis showed that glycosylated hemoglobin,TyG,low-density lipoprotein,course of disease,uric acid,body mass index,fasting blood glucose,creatinine,2 h postprandial blood glucose,total cholesterol,waist-hip ratio,triglyceride and ferritin in the combined group were significantly higher than those in the non-combined group,while high-density lipoprotein and vitamin D were significantly lower than those in the non-combined group,and the differences were statistically significant(P＜0.05).Logistic multivariate regression analysis showed that the increase of disease course,body mass index,fasting blood glucose,triglyceride,ferritin and TyG was the risk factor for diabetes complica-tions(P＜0.05),and the increase of vitamin D was the protective factor for diabetes complications(P＜0.05).TyG,vitamin D,ferritin and the three combinations had good predictive value for diabetic complications,P＜0.05.Conclusion The level of TyG in diabetic patients is sig-nificantly correlated with the level of blood glucose,vitamin D,iron metabolism imbalance,and complications of diabetes.The higher the level of TyG,the higher the level of blood glucose,the lower the level of vitamin D,and the more serious the imbalance of iron metabolism.TyG,vitamin D,ferritin and the combination of the three can be used to predict the complications of diabetes.
基金项目
内蒙古自治区医学继续教育项目(2020060306064)
维普
万方数据