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应用单核细胞/高密度脂蛋白胆固醇比值联合体质量指数评估胰岛素抵抗

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目的 探讨新型炎性指标单核细胞/高密度脂蛋白胆固醇比值(monocyte/high density lipoprotein-cholesterol ratio,MHR)与体质量指数(body mass index,BMI)对新诊断2 型糖尿病(type 2 diabetes mellitus,T2DM)患者胰岛素抵抗(insulin resistance,IR)的评估价值.方法 选取2022年1月至2023年12月于首都医科大学附属北京友谊医院内分泌科就诊的新诊断T2DM患者400例,检测血常规、超敏C反应蛋白(high sensitivity C-reactive protein,HsCRP)、空腹血糖、空腹胰岛素、血脂谱.计算稳态模型评估胰岛素抵抗(homeostasis model assessment of insulin resistance,HOMA-IR)指数,以 HOMA-IR 中位数分为高 HOMA-IR 组和低 HOMA-IR 组;按照 MHR 三分位数分为 Q1(MHR≤0.25)、Q2(0.25<MHR≤0.34)、Q3(MHR>0.34)3 组.分别比较不同组间糖脂代谢指标和炎性指标的差异.采用Spearman相关分析和多因素Logistic回归,分析MHR、BMI与IR的相关性.采用受试者工作特征(receiver operating characteristic,ROC)曲线分析MHR联合BMI对IR的诊断效能.结果 高HOMA-IR组HsCRP水平[2.77(1.06,5.46)vs 1.43(0.69,2.94)]、MHR[0.32(0.26,0.41)vs 0.27(0.21,0.34)]均高于低 HOMA-IR 组,差异有统计学意义(P值均<0.001).MHR Q3组HOMA-IR水平显著高于Q2、Q1组(P<0.001).Spearman相关分析显示,HOMA-IR与 MHR(r=0.294,P<0.001)、HsCRP(r=0.281,P<0.001)及 BMI(r=0.501,P<0.001)均呈显著正相关.对 MHR 进行标准化后进行多因素Logistic回归分析,结果显示MHR、BMI均为HOMA-IR指数的独立影响因素,OR值分别为1.766(95%CI:1.189~2.625,P=0.005)、1.192(95%CI:1.052~1.351,P=0.006).ROC 曲线分析显示与 MHR 和 BMI 相比,二者联合系数绘制的ROC曲线下面积最大,为0.754(95%CI:0.706~0.801),其诊断IR效能最高.结论 MHR联合BMI对于评估新诊断T2DM患者IR效能较单独使用MHR更高,可以作为一种简易手段用于评估新诊断T2DM患者IR.
Effect of monocyte/high density lipoprotein-cholesterol ratio combined with body mass index in evaluating insulin resistance
Objective To explore the value of monocyte/high density lipoprotein-cholesterol ratio(MHR)combined with body mass index(BMI)in evaluating insulin resistance(IR)in the patients with newly diagnosed type 2 diabetes mellitus(T2DM).Methods A total of 400 T2DM patients who were newly diagnosed in Department of Endocrinology,Beijing Friendship Hospital,Capital Medical University,were enrolled in the study from January 2022 to December 2023.The inflammatory markers included white blood cell,neutrophile granulocyte,lymphocyte,monocyte and high sensitivity C-reactive protein(HsCRP)were examined,together with metabolic indicators included blood glucose,insulin and lipid.According to median value of homeostasis model assessment of insulin resistance(HOMA-IR),participants were divided into high-HOMA-IR and low-HOMA-IR group.According to the MHR tertiles,three groups were divided into Q1(MHR≤0.25)、Q2(0.25<MHR≤0.34)and Q3(MHR>0.34)for analysis and comparison.Spearman correlation analysis and multiple logistic regression were used to analyze the relationship between MHR,BMI and IR.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of MHR combined with BMI on IR.Results Both the HsCRP level[2.77(1.06,5.46)vs 1.43(0.69,2.94),P<0.001]and the MHR in high-HOMA-IR group[0.32(0.26,0.41)vs 0.27(0.21,0.34)]was significantly higher than that of low-HOMA-IR group(P<0.001).HOMA-IR in MHR Q3 group was significantly higher than that in Q2 and Q1 groups(P<0.001).Spearman correlation analysis showed that HOMA-IR was positively correlated with MHR(r=0.294,P<0.001)、HsCRP(r=0.281,P<0.001)and BMI(r=0.501,P<0.001).Logistic regression analysis showed that MHR and BMI were independent influencing factors of HOMA-IR,the OR values are respectively 1.766(95%CI:1.189-2.625,P=0.005)and 1.192(95%CI:1.052-1.351,P=0.006).ROC curve analysis showed that compared with MHR and BMI,the area under ROC curve by the combined coefficient of MHR and BMI was the largest 0.754(95%CI:0.706-0.801),with the highest efficiency in the diagnosis of insulin resistance.Conclusions MHR combined with BMI has a higher efficiency for evaluating IR in the patients with newly diagnosed T2DM,which could be used as a simple indicator to evaluate IR in these patients.

type 2 diabetes mellitusmonocyte to high density lipoprotein-cholesterol ratiobody mass indexinsulin resistance

祝英娜、李晓辉、袁明霞

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首都医科大学附属北京友谊医院内分泌科,北京 100050

2型糖尿病 单核细胞/高密度脂蛋白胆固醇比值 体质量指数 胰岛素抵抗

2024

首都医科大学学报
首都医科大学

首都医科大学学报

CSTPCD北大核心
影响因子:1.511
ISSN:1006-7795
年,卷(期):2024.45(6)