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摘要:
目的 探讨脂质蓄积指数(lipid accumulation product, LAP)与糖尿病患病风险的关系，并比较不同肥胖评价指标对糖尿病患病风险的预测价值。 方法 2016年6月―2017年12月，采取多阶段分层整群抽样的方法，选择上海市松江区4个社区20~74岁常住居民作为研究对象，对其进行问卷调查及体格、生化检查，并通过健康云平台获取体格检查前1年在区内医疗机构就诊记录。采用二分类Logistic回归分析模型探讨LAP与糖尿病的关系，通过计算受试者工作特征(receiver operating characteristic, ROC)曲线下面积(area under curve, AUC)，比较各肥胖指标对糖尿病患病风险的预测价值。 结果 男女性FPG、糖化血红蛋白均随LAP的增加而增加(P < 0.05)，LAP值最高的第四组(Q4组)男性和女性罹患糖尿病的风险分别是LAP值最低组(Q1组)的1.81倍(95% CI: 1.53~2.14)和2.87倍(95% CI: 2.43~3.40)。总人群LAP预测糖尿病患病风险的AUC大于BMI(P < 0.05)的AUC，且在女性中，LAP的AUC高于BMI和腰围(P < 0.05)的AUC，在男性和女性中的最佳截断值分别是23.30 cm·mmol/L和30.41 cm·mmol/L。 结论 LAP可用于糖尿病患病风险的预测，尤其在女性中预测价值更高。 Abstract:Objective To explore the relationship between lipid accumulation product (LAP) and the risk of diabetes among adults, and to compare the effectiveness of different obesity indicators in predicting diabetes. Methods A multi-stage stratified cluster sampling method was conducted among adults aged 20-74 in 4 communities in Songjiang District of Shanghai during June 2016 to December 2017. Questionnaire investigation, physical and biochemical examination were used to collect data. Logistic regression analysis models were used to evaluate the association LAP and diabetes, and receiver operating characteristics curve (ROC) was used to evaluate the predictive value of various obesity indicators in diabetes. Results The level of fasting blood glucose and HbA1c was increased with the increasing of LAP (P < 0.05). Compared to the first quintile of LAP level, risk of having diabetes in the fourth quintile were 1.81 times (95% CI: 1.53-2.14) for male and 2.87 times (95% CI: 2.43-3.40) for female respectively. The predictive value of LAP was higher than BMI (P < 0.05) both in male and female. It was also higher than waist circumference in female (P < 0.05). The cut-off point for LAP in predicting diabetes was 23.30 cm·mmol/L for male and 30.41 cm·mmol/L for female. Conclusion LAP could be used to predict the risk of diabetes, especially in women. -
Key words:
- Lipid accumulation product /
- Diabetes /
- Obesity
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表 1 研究人群的基本特征[n(%)]
Table 1. Characteristics of survey population [n(%)]
变量 男性
(n=14 391)女性
(n=21 055)χ2/Z值 P值 年龄组(岁) 259.905 < 0.001 < 45 1 903(13.2) 3 147(15.0) 45~ < 55 3 304(23.0) 5 943(28.2) 55~ < 65 4 802(33.4) 6 992(33.2) ≥65 4 382(30.4) 4 973(23.6) 婚姻状况 127.949 < 0.001 在婚 13 637(94.8) 19 290(91.6) 非在婚a 754(5.2) 1 765(8.4) 受教育年限(年) 591.394 < 0.001 < 6 5 633(39.1) 10 930(51.9) 6~ < 10 7 878(54.7) 8 848(42.0) ≥10 880(6.2) 1 277(6.1) 吸烟 15 550.557 < 0.001 是 8 276(57.5) 63(0.3) 否 6 115(42.5) 20 992(99.7) 饮酒 7 176.681 < 0.001 是 4 607(32.0) 159(0.8) 否 9 784(68.0) 20 896(99.2) 锻炼 0.687 0.407 是 4 615(32.1) 6 663(31.7) 否 9 743(67.9) 14 340(68.3) BMI b
[kg/m2, M (P25~P75)]24.62
(22.57~26.74)23.92
(21.83~26.28)17.229 < 0.001 WC b
[cm, M (P25~P75)]85.00
(79.00~90.33)79.60
(73.00~86.00)49.530 < 0.001 WHR b
[%, M (P25~P75)]90.22
(86.60~93.55)86.75
(82.26~90.91)46.742 < 0.001 注：a非在婚包括未婚、离婚和丧偶；b采用Kruskal-Wallis H检验。 
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表 2 不同人群LAP分布情况[n(%)]
Table 2. LAP distribution in different populations [n(%)]
变量 男性 χ2/Z值 P值 女性 χ2/Z值 P值 Q1
(< 15.18)Q2
(15.18~ < 27.20)Q3
(27.20~ < 46.00)Q4
(≥46.00)Q1
(< 16.35)Q2
(16.35~ < 28.48)Q3
(28.48~ < 46.72)Q4
(≥46.72)年龄组(岁) 301.031 < 0.001 2 974.270 < 0.001 < 45 500(26.2) 414(21.8) 416(21.9) 573(30.1) 1 847(58.7) 673(21.4) 373(11.9) 254(8.0) 45~ < 55 645(19.5) 712(21.5) 844(25.5) 1 103(33.5) 1 623(27.3) 1 690(28.4) 1 374(23.1) 1 256(21.2) 55~ < 65 1 222(25.4) 1 251(26.1) 1 207(25.1) 1 122(23.4) 1 207(17.2) 1 780(25.5) 1 980(28.3) 2 025(29.0) ≥65 1 228(28.0) 1 216(27.7) 1 134(25.9) 804(18.4) 585(11.7) 1 119(22.5) 1 535(30.9) 1 734(34.9) 婚姻状况 48.384 < 0.001 1.757 0.624 在婚 3 332(24.4) 3 408(25.0) 3 464(25.4) 3 433(25.2) 4 811(24.9) 4 839(25.1) 4 828(25.0) 4 812(24.9) 非在婚 263(34.90) 185(24.5) 137(18.2) 169(22.4) 451(25.6) 423(24.0) 434(24.6) 457(25.8) 受教育年限(年) 128.759 < 0.001 1 702.999 < 0.001 < 6 1 567(27.8) 1 489(26.4) 1 402(24.9) 1 175(20.9) 1 743(15.9) 2 675(24.5) 3 158(28.9) 3 354(30.7) 6~ < 10 1 766(22.4) 1 890(24.0) 2 006(25.5) 2 216(28.1) 2 746(31.0) 2 330(26.3) 1 962(22.2) 1 810(20.5) ≥10 262(29.8) 214(24.3) 193(21.9) 211(24.0) 773(60.5) 257(20.1) 142(11.1) 105(8.3) 吸烟 12.537 0.006 6.645 0.084 是 2 104(25.4) 1 994(24.1) 2 045(24.7) 2 133(25.8) 16(25.4) 11(17.5) 12(19.0) 24(38.1) 否 1 491(24.4) 1 599(26.2) 1 556(25.4) 1 469(24.0) 5 246(25.0) 5 251(25.0) 5 250(25.0) 5 245(25.0) 饮酒 28.379 < 0.001 0.840 0.840 是 1 062(23.1) 1 133(24.6) 1 141(24.8) 1 271(27.6) 42(26.5) 43(27.0) 38(23.9) 36(22.6) 否 2 533(25.9) 2 460(25.1) 2 460(25.1) 2 331(23.9) 5 220(25.0) 5 219(25.0) 5 224(25.0) 5 233(25.0) 锻炼 24.627 < 0.001 8.589 0.035 是 1 034(22.4) 1 198(26.0) 1 180(25.5) 1 203(26.1) 1 702(25.5) 1 679(25.2) 1 699(25.5) 1 583(23.8) 否 2 554(26.2) 2 386(24.5) 2 412(24.8) 2 391(24.5) 3 552(24.8) 3 561(24.8) 3 553(24.8) 3 674(25.6) FPG
(mmol/L)4.64
(4.22~5.23)4.68
(4.24~5.33)4.75
(4.25~5.49)4.85
(4.32~5.71)155.81 < 0.001 4.61
(4.23~5.02)4.68
(4.23~5.26)4.79
(4.28~5.47)4.95
(4.36~5.82)570.947 < 0.001 糖化血红蛋白
(%)5.50
(5.20~5.80)5.60
(5.30~5.90)5.70
(5.40~6.00)5.80
(5.40~6.20)474.92 < 0.001 5.40
(5.10~5.70)5.60
(5.30~5.90)5.70
(5.40~6.00)5.90
(5.50~6.30)2 166.426 < 0.001
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表 3 LAP与糖尿病患病关系的Logistic回归分析
Table 3. Logistic regression analysis of the relationship between LAP and diabetes
LAP
分组模型1 模型2 模型3 OR(95% CI)值 P值 OR(95% CI)值 P值 OR(95% CI)值 P值 男性 Q1 1.00 1.00 1.00 Q2 1.36(1.18~1.57) < 0.001 1.24(1.07~1.44) 0.005 1.08(0.93~1.27) 0.312 Q3 1.79(1.56~2.06) < 0.001 1.58(1.37~1.83) < 0.001 1.28(1.09~1.50) 0.003 Q4 2.57(2.25~2.93) < 0.001 2.45(2.13~2.83) < 0.001 1.81(1.53~2.14) < 0.001 女性 Q1 1.00 1.00 1.00 Q2 2.31(1.97~2.70) < 0.001 1.49(1.27~1.75) < 0.001 1.40(1.19~1.66) 0.001 Q3 3.86(3.33~4.48) < 0.001 2.08(1.78~2.43) < 0.001 1.80(1.52~2.12) < 0.001 Q4 7.31(6.34~8.42) < 0.001 3.63(3.13~4.22) < 0.001 2.87(2.43~3.40) < 0.001 总人群 Q1 1.00 1.00 1.00 Q2 1.74(1.57~1.93) < 0.001 1.33(1.20~1.49) < 0.001 1.20(1.07~1.34) 0.001 Q3 2.62(2.37~2.89) < 0.001 1.80(1.62~1.99) < 0.001 1.49(1.33~1.66) < 0.001 Q4 4.44(4.04~4.89) < 0.001 3.02(2.73~3.34) < 0.001 2.28(2.03~2.55) < 0.001
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表 4 不同肥胖指标与糖尿病患病风险关系的ROC曲线分析
Table 4. ROC curve analysis of the relationship between different obesity indexes and the risk of diabetes
变量 AUC(95% CI) Z值 P值 总人群 LAP 0.645(0.640~0.651) BMI 0.631(0.626~0.637) 3.495 < 0.001 WC 0.639(0.633~0.644) 1.868 0.062 WHR 0.639(0.633~0.644) 1.553 0.120 男性 LAP 0.600(0.591~0.609) BMI 0.606(0.598~0.615) 1.051 0.293 WC 0.599(0.590~0.607) 0.322 0.748 WHR 0.598(0.589~0.607) 0.340 0.734 女性 LAP 0.682(0.675~0.689) BMI 0.648(0.641~0.655) 6.533 < 0.001 WC 0.668(0.661~0.675) 3.115 0.002 WHR 0.672(0.665~0.679) 1.933 0.053 注：Z值、P值为相应变量的AUC与由LAP获得的AUC比较的结果。
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