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脂质蓄积指数与糖尿病患病风险的关系

邵琦, 吴毅凌, 江峰, 刘星, 王娜, 姜永根, 赵根明, 赵琦. 脂质蓄积指数与糖尿病患病风险的关系[J]. 中华疾病控制杂志, 2022, 26(2): 125-130, 243. doi: 10.16462/j.cnki.zhjbkz.2022.02.001
引用本文: 邵琦, 吴毅凌, 江峰, 刘星, 王娜, 姜永根, 赵根明, 赵琦. 脂质蓄积指数与糖尿病患病风险的关系[J]. 中华疾病控制杂志, 2022, 26(2): 125-130, 243. doi: 10.16462/j.cnki.zhjbkz.2022.02.001
SHAO Qi, WU Yi-ling, JIANG Feng, LIU Xing, WANG Na, JIANG Yong-gen, ZHAO Gen-ming, ZHAO Qi. The relationship between lipid accumulation product and the risk of diabetes[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2022, 26(2): 125-130, 243. doi: 10.16462/j.cnki.zhjbkz.2022.02.001
Citation: SHAO Qi, WU Yi-ling, JIANG Feng, LIU Xing, WANG Na, JIANG Yong-gen, ZHAO Gen-ming, ZHAO Qi. The relationship between lipid accumulation product and the risk of diabetes[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2022, 26(2): 125-130, 243. doi: 10.16462/j.cnki.zhjbkz.2022.02.001

脂质蓄积指数与糖尿病患病风险的关系

doi: 10.16462/j.cnki.zhjbkz.2022.02.001
基金项目: 

国家重点研发计划精准医学重点专项 2017YFC0907001

上海市高峰计划公共卫生与预防医学重点学科建设项目 17

详细信息
    通讯作者:

    赵琦,E-mail: zhaoqi@shmu.edu.cn

  • 中图分类号: R587.1; R181

The relationship between lipid accumulation product and the risk of diabetes

Funds: 

National Key Research and Development Program of China, Precision Medicine Project 2017YFC0907001

Key Discipline Construction Project for Public Health and Preventive Medicine of Shanghai Peak Plan 17

More Information
  • 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。
  • 图  1  不同LAP组别糖尿病患病率(%)

    Figure  1.  Prevalence of diabetes in different LAP groups (%)

    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 P
    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。
    下载: 导出CSV

    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 P 女性 χ2/Z P
    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
    下载: 导出CSV

    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 OR(95% CI)值 P OR(95% CI)值 P
    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
    下载: 导出CSV

    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 P
    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。
    下载: 导出CSV
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    [23] Nusrianto R, Ayundini G, Kristanti M, et al. Visceral adiposity index and lipid accumulation product as a predictor of type 2 diabetes mellitus: the Bogor cohort study of non-communicable diseases risk factors[J]. Diabetes Res Clin Pract, 2019, 155: 107798. DOI: 10.1016/j.diabres.2019.107798.
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出版历程
  • 收稿日期:  2021-06-04
  • 修回日期:  2021-08-30
  • 网络出版日期:  2022-02-10
  • 刊出日期:  2022-02-10

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