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Article(id=1241102733697151968, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102730337505325, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202401307, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1705507200000, receivedDateStr=2024-01-18, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773831550287, onlineDateStr=2026-03-18, pubDate=1721836800000, pubDateStr=2024-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773831550287, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773831550287, creator=13701087609, updateTime=1773831550287, updator=13701087609, issue=Issue{id=1241102730337505325, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='14', pageStart='2497', pageEnd='2688', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773831549486, creator=13701087609, updateTime=1773831697291, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241103350322745680, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102730337505325, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241103350322745681, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102730337505325, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2628, endPage=2633, ext={EN=ArticleExt(id=1241102735014163446, articleId=1241102733697151968, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association between blood lipid, lipid ratios and glucose metabolism disorders, columnId=1228016573156360233, journalTitle=Modern Preventive Medicine, columnName=Disease Control and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the association between blood lipid, lipid ratios and glucose metabolism disorders, and to explore the dose-response relationship between lipid ratios and glucose metabolism disorders.

Methods

During July 2022 to March 2023, a total of 7 527 residents aged 35 and above in Changzhou were selected. basic information, blood pressure, fasting plasma glucose and blood lipid of the subjectswere collected. Binary logistic regression was used to explore the correlation between prediabetes, diabetes and blood lipid, lipid ratios, respectively. The dose–response relationship was evaluated by restricted cubic spline analysis. ResultsOur results showed that TC, LDL-C, TC/HDL-C, TG/HDL-C, LDL-C/HDL-C and non-HDL-C/HDL-C were risk factors for both prediabetes and diabetes (P<0.05), and HDL-C was a protective factor for both prediabetes and diabetes (P<0.05). The dose-response relationships between TC/HDL-C, TG/HDL-C, LDL-C/HDL-C, non‐HDL-C/HDL-C and glucose metabolism disorders were statistically significant, and the cutoff values were 3.78, 1.07, 2.10 and 2.77, respectively.

Conclusion

TC/HDL-C, TG/HDL-C, LDL-C/HDL-C and non‐HDL-C /HDL-C increase the risk of prediabetes and diabetes, which may be useful indicators to identify future glucose metabolism disorders.

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目的

探索血脂参数、脂质比值与糖代谢异常的关联性以及脂质比值与糖代谢异常的剂量反应关系。

方法

选取2022年7月至2023年3月，35岁及以上的常州市常住居民7 527人作为研究对象，收集其基本信息、血压、空腹血糖、血脂四项等资料，采用logistic回归探索影响糖尿病前期、糖尿病与血脂参数、脂质比值的关联强度，采用三次立方样条函数来分析脂质比值与糖代谢异常潜在的剂量反应关系。

结果

本研究发现TC、LDL-C、TC/HDL-C、TG/HDL-C、LDL-C/HDL-C、non‐HDL‐C/HDL-C升高是糖尿病前期和糖尿病的危险因素（P<0.05），HDL-C升高是糖尿病前期和糖尿病的保护因素（P<0.05）。TC/HDL-C、TG/HDL-C、LDL-C/HDL-C、non‐HDL‐C/HDL-C与糖代谢异常之间存在剂量反应关系，截断值分别为3.78、1.07、2.10、2.77。

结论

TC/HDL-C、TG/HDL-C、LDL-C/HDL-C、non‐HDL‐C/HDL-C升高会增加糖尿病前期和糖尿病的患病风险，对糖代谢异常有预测作用。

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徐文超，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=nRyTYt711VWkd0RBY9Ro6Q==, magXml=r489jKfsCTZ6cZKth0fkTQ==, pdfUrl=null, pdf=g30syx7XoOv9RTM5yDuCUw==, pdfFileSize=673930, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=1FvnBTYCZWQLu882+vq3mA==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=2Q6wVnFfChzML54qFPXERw==, mapNumber=null, authorCompany=null, fund=null, authors=

计叶（1995—），女，硕士，主管医师，研究方向：糖尿病流行病学

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注：A：TC/HDL-C与糖代谢异常的关系；C：TG/HDL-C与糖代谢异常的关系；C：LDD-C/HDL-C与糖代谢异常的关系；D：Non-HDL-C/HDL-C与糖代谢异常的关系；实线为脂质比值的OR值，虚线为OR值的95%可信区间。

, figureFileSmall=4XRu86bjsFnRsfDsDWofAA==, figureFileBig=1FvnBTYCZWQLu882+vq3mA==, tableContent=null), ArticleFig(id=1241102739728560388, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102733697151968, language=EN, label=Table 1, caption=

Demographic characteristics of three groups

, figureFileSmall=null, figureFileBig=null, tableContent=
特征非糖尿病
(n=4 918)		糖尿病前期
(n=1 105)		糖尿病
(n=1 504)		P值F/χ2
　　　　　　
年龄(,岁)55.41±9.6658.37±8.3561.19±8.26<0.001240.805
性别<0.00161.241
男55.41±9.6658.37±8.3561.19±8.26
女
婚姻状况0.2894.979
未婚1 717(34.91)441(39.91)690(45.88)
已婚3 201(65.09)664(60.09)814(54.12)
分居/离异/丧偶<0.001141.489
文化程度37(0.75)7(0.63)5(0.33)
小学及以下4 566(92.84)1 018(92.13)1 390(92.42)
初中315(6.41)80(7.24)109(7.25)
高中/中专<0.001157.069
大专及以上782(15.90)176(15.93)405(26.93)
职业类型2 331(47.40)504(45.61)694(46.14)
农民1 185(24.10)316(28.60)310(20.61)
工人620(12.60)109(9.86)95(6.32)
行政/专技/服务业<0.00184.997
退休/家务801(16.29)160(14.48)346(23.01)
其他743(15.11)115(10.41)172(11.43)
家庭年总收入（万元）808(16.43)147(13.30)127(8.44)
<2万2 202(44.77)623(56.38)787(52.33)
3~5万364(7.40)60(5.43)72(4.79)
6~10万
>10万684(13.91)159(14.39)314(20.88)
吸烟史1 427(29.02)381(34.48)497(33.05)<0.00144.089
否1 692(34.40)374(33.85)438(29.12)
是1 115(22.67)191(17.28)255(16.95)
饮酒史0.00212.423
否3 646(74.14)793(71.76)983(65.36)
是1 272(25.86)312(28.24)521(34.64)
BMI(kg/m2)<0.001107.071
正常体重3 710(75.44)779(70.50)1 103(73.34)
超重1 208(24.56)326(29.50)401(26.66)
肥胖<0.001304.5
腰臀比2 502(50.87)418(37.83)596(39.63)
非中心性肥胖1 847(37.56)492(44.52)684(45.48)
中心性肥胖569(11.57)195(17.65)224(14.89)
高血压<0.00196.863
否2 255(45.85)350(31.67)331(22.01)
是2 663(54.15)755(68.33)1 173(77.99)
糖尿病家族史<0.001556.806
无3 591(73.02)688(62.26)930(61.84)
有1 327(26.98)417(37.74)574(38.16)
TC(mmol/L)5.13(4.58,5.82)5.22(4.71,5.88)5.15(4.52,5.84)0.00212.494
TG(mmol/L)1.37(0.97,2.03)1.59(1.12,2.34)1.69(1.16,2.50)<0.001154.335
HDL-C(mmol/L)1.42(1.21,1.65)1.33(1.14,1.54)1.28(1.10,1.50)<0.001227.154
LDL-C(mmol/L)2.80(2.37,3.27)2.98(2.54,3.41)2.82(2.35,3.29)<0.00153.123
non-HDL-C(mmol/L)3.69(3.15,4.32)3.86(3.34,4.49)3.86(3.22,4.48)<0.00148.267
TC/HDL-C3.63(3.08,4.27)3.90(3.36,4.52)3.99(3.40,4.64)<0.001199.714
TG/HDL-C0.96(0.62,1.61)1.18(0.77,1.93)1.32(0.83,2.14)<0.001226.877
LDL-C/HDL-C2.01(1.61,2.43)2.21(1.82,2.65)2.20(1.81,2.61)<0.001174.716
non-HDL-C/HDL-C2.63(2.08,3.27)2.90(2.36,3.52)2.99(2.40,3.64)<0.001199.714
FPG(mmol/L)5.31(4.99,5.64)6.46(6.25,6.81)8.36(7.14,9.89)<0.0014897.015
), ArticleFig(id=1241102739825029390, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102733697151968, language=CN, label=表1, caption=

三组人群基本特征比较

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特征非糖尿病
(n=4 918)		糖尿病前期
(n=1 105)		糖尿病
(n=1 504)		P值F/χ2
　　　　　　
年龄(,岁)55.41±9.6658.37±8.3561.19±8.26<0.001240.805
性别<0.00161.241
男55.41±9.6658.37±8.3561.19±8.26
女
婚姻状况0.2894.979
未婚1 717(34.91)441(39.91)690(45.88)
已婚3 201(65.09)664(60.09)814(54.12)
分居/离异/丧偶<0.001141.489
文化程度37(0.75)7(0.63)5(0.33)
小学及以下4 566(92.84)1 018(92.13)1 390(92.42)
初中315(6.41)80(7.24)109(7.25)
高中/中专<0.001157.069
大专及以上782(15.90)176(15.93)405(26.93)
职业类型2 331(47.40)504(45.61)694(46.14)
农民1 185(24.10)316(28.60)310(20.61)
工人620(12.60)109(9.86)95(6.32)
行政/专技/服务业<0.00184.997
退休/家务801(16.29)160(14.48)346(23.01)
其他743(15.11)115(10.41)172(11.43)
家庭年总收入（万元）808(16.43)147(13.30)127(8.44)
<2万2 202(44.77)623(56.38)787(52.33)
3~5万364(7.40)60(5.43)72(4.79)
6~10万
>10万684(13.91)159(14.39)314(20.88)
吸烟史1 427(29.02)381(34.48)497(33.05)<0.00144.089
否1 692(34.40)374(33.85)438(29.12)
是1 115(22.67)191(17.28)255(16.95)
饮酒史0.00212.423
否3 646(74.14)793(71.76)983(65.36)
是1 272(25.86)312(28.24)521(34.64)
BMI(kg/m2)<0.001107.071
正常体重3 710(75.44)779(70.50)1 103(73.34)
超重1 208(24.56)326(29.50)401(26.66)
肥胖<0.001304.5
腰臀比2 502(50.87)418(37.83)596(39.63)
非中心性肥胖1 847(37.56)492(44.52)684(45.48)
中心性肥胖569(11.57)195(17.65)224(14.89)
高血压<0.00196.863
否2 255(45.85)350(31.67)331(22.01)
是2 663(54.15)755(68.33)1 173(77.99)
糖尿病家族史<0.001556.806
无3 591(73.02)688(62.26)930(61.84)
有1 327(26.98)417(37.74)574(38.16)
TC(mmol/L)5.13(4.58,5.82)5.22(4.71,5.88)5.15(4.52,5.84)0.00212.494
TG(mmol/L)1.37(0.97,2.03)1.59(1.12,2.34)1.69(1.16,2.50)<0.001154.335
HDL-C(mmol/L)1.42(1.21,1.65)1.33(1.14,1.54)1.28(1.10,1.50)<0.001227.154
LDL-C(mmol/L)2.80(2.37,3.27)2.98(2.54,3.41)2.82(2.35,3.29)<0.00153.123
non-HDL-C(mmol/L)3.69(3.15,4.32)3.86(3.34,4.49)3.86(3.22,4.48)<0.00148.267
TC/HDL-C3.63(3.08,4.27)3.90(3.36,4.52)3.99(3.40,4.64)<0.001199.714
TG/HDL-C0.96(0.62,1.61)1.18(0.77,1.93)1.32(0.83,2.14)<0.001226.877
LDL-C/HDL-C2.01(1.61,2.43)2.21(1.82,2.65)2.20(1.81,2.61)<0.001174.716
non-HDL-C/HDL-C2.63(2.08,3.27)2.90(2.36,3.52)2.99(2.40,3.64)<0.001199.714
FPG(mmol/L)5.31(4.99,5.64)6.46(6.25,6.81)8.36(7.14,9.89)<0.0014897.015
), ArticleFig(id=1241102739925692694, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102733697151968, language=EN, label=Table 2, caption=

Risk of prediabetes and diabetes by blood lipid and lipid ratios

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糖尿病前期糖尿病
OR(95%CI)值P值OR(95%CI)值P值
血脂参数
TC1.03(1.03~1.04)0.0061.04(0.97~1.11)0.253
TG1.08(1.04~1.12)<0.0011.16(1.12~1.20)<0.001
HDL-C0.52(0.41~0.65)<0.0010.28(0.23~0.36)<0.001
LDL-C1.36(1.24~1.50)<0.0011.01(0.92~1.11)0.814
non-HDL-C1.19(1.11~1.27)<0.0011.18(1.10~1.26)<0.001
脂质比值
TC/HDL-C1.27(1.19~1.35)<0.0011.40(1.31~1.49)<0.001
TG/HDL-C1.07(1.03~1.11)<0.0011.14(1.11~1.18)<0.001
LDL-C/HDL-C1.62(1.46~1.79)<0.0011.49(1.35~1.64)<0.001
non-HDL-C/HDL-C1.27(1.19~1.35)<0.0011.40(1.31~1.49)<0.001
), ArticleFig(id=1241102740026356001, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102733697151968, language=CN, label=表2, caption=

血脂参数、脂质比值与糖代谢异常的关联

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糖尿病前期糖尿病
OR(95%CI)值P值OR(95%CI)值P值
血脂参数
TC1.03(1.03~1.04)0.0061.04(0.97~1.11)0.253
TG1.08(1.04~1.12)<0.0011.16(1.12~1.20)<0.001
HDL-C0.52(0.41~0.65)<0.0010.28(0.23~0.36)<0.001
LDL-C1.36(1.24~1.50)<0.0011.01(0.92~1.11)0.814
non-HDL-C1.19(1.11~1.27)<0.0011.18(1.10~1.26)<0.001
脂质比值
TC/HDL-C1.27(1.19~1.35)<0.0011.40(1.31~1.49)<0.001
TG/HDL-C1.07(1.03~1.11)<0.0011.14(1.11~1.18)<0.001
LDL-C/HDL-C1.62(1.46~1.79)<0.0011.49(1.35~1.64)<0.001
non-HDL-C/HDL-C1.27(1.19~1.35)<0.0011.40(1.31~1.49)<0.001
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血脂参数及脂质比值与糖代谢异常的关联研究
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计叶 2, 3 , 徐文超 1
现代预防医学 | 疾病预防控制 2024,51(14): 2628-2633
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现代预防医学 | 疾病预防控制 2024, 51(14): 2628-2633
血脂参数及脂质比值与糖代谢异常的关联研究
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计叶2, 3, 徐文超1
作者信息
  • 1.常州市疾病预防控制中心慢非传科，江苏 常州 213022
  • 2.江阴市疾病预防控制中心慢非传科
  • 3.江苏省现场流行病学培训项目

    • 计叶（1995—），女，硕士，主管医师，研究方向：糖尿病流行病学

通讯作者:

徐文超，E-mail：
Association between blood lipid, lipid ratios and glucose metabolism disorders
Ye JI2, 3, Wen-chao XU1
Affiliations
  • Changzhou Center for Disease Control and Prevention, Changzhou, Jiangsu 213022, China
出版时间: 2024-07-25 doi: 10.20043/j.cnki.MPM.202401307
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摘要
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目的

探索血脂参数、脂质比值与糖代谢异常的关联性以及脂质比值与糖代谢异常的剂量反应关系。

方法

选取2022年7月至2023年3月，35岁及以上的常州市常住居民7 527人作为研究对象，收集其基本信息、血压、空腹血糖、血脂四项等资料，采用logistic回归探索影响糖尿病前期、糖尿病与血脂参数、脂质比值的关联强度，采用三次立方样条函数来分析脂质比值与糖代谢异常潜在的剂量反应关系。

结果

本研究发现TC、LDL-C、TC/HDL-C、TG/HDL-C、LDL-C/HDL-C、non‐HDL‐C/HDL-C升高是糖尿病前期和糖尿病的危险因素（P<0.05），HDL-C升高是糖尿病前期和糖尿病的保护因素（P<0.05）。TC/HDL-C、TG/HDL-C、LDL-C/HDL-C、non‐HDL‐C/HDL-C与糖代谢异常之间存在剂量反应关系，截断值分别为3.78、1.07、2.10、2.77。

结论

TC/HDL-C、TG/HDL-C、LDL-C/HDL-C、non‐HDL‐C/HDL-C升高会增加糖尿病前期和糖尿病的患病风险，对糖代谢异常有预测作用。

糖尿病前期  /  糖尿病  /  血脂  /  脂质比值
Objective

To explore the association between blood lipid, lipid ratios and glucose metabolism disorders, and to explore the dose-response relationship between lipid ratios and glucose metabolism disorders.

Methods

During July 2022 to March 2023, a total of 7 527 residents aged 35 and above in Changzhou were selected. basic information, blood pressure, fasting plasma glucose and blood lipid of the subjectswere collected. Binary logistic regression was used to explore the correlation between prediabetes, diabetes and blood lipid, lipid ratios, respectively. The dose–response relationship was evaluated by restricted cubic spline analysis. ResultsOur results showed that TC, LDL-C, TC/HDL-C, TG/HDL-C, LDL-C/HDL-C and non-HDL-C/HDL-C were risk factors for both prediabetes and diabetes (P<0.05), and HDL-C was a protective factor for both prediabetes and diabetes (P<0.05). The dose-response relationships between TC/HDL-C, TG/HDL-C, LDL-C/HDL-C, non‐HDL-C/HDL-C and glucose metabolism disorders were statistically significant, and the cutoff values were 3.78, 1.07, 2.10 and 2.77, respectively.

Conclusion

TC/HDL-C, TG/HDL-C, LDL-C/HDL-C and non‐HDL-C /HDL-C increase the risk of prediabetes and diabetes, which may be useful indicators to identify future glucose metabolism disorders.

Prediabetes  /  Diabetes  /  Blood lipid  /  Lipid ratios
计叶, 徐文超. 血脂参数及脂质比值与糖代谢异常的关联研究. 现代预防医学, 2024 , 51 (14) : 2628 -2633 . DOI: 10.20043/j.cnki.MPM.202401307
Ye JI, Wen-chao XU. Association between blood lipid, lipid ratios and glucose metabolism disorders[J]. Modern Preventive Medicine, 2024 , 51 (14) : 2628 -2633 . DOI: 10.20043/j.cnki.MPM.202401307
正文
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近年来，我国居民糖尿病的患病率持续上升，由于早期症状不明显,未诊断的糖尿病比例也居高不下[1]，糖尿病的疾病负担越来越大[2]，1990年江苏省2型糖尿病伤残调整寿命年为24.21万人年，2019年已增长为58.83万人年[3]，目前已成为阻碍社会高质量发展的严重公共卫生问题之一。糖代谢异常导致胰岛β细胞代偿能力逐渐减弱，从而打破机体的血糖稳态，从正常状态进展为糖尿病前期，最终发展为糖尿病[4]。糖尿病前期包括空腹血糖受损（impaired fasting glucose，IFG）、糖耐量减低（impaired glucose tolerance，IGT），分别依据空腹血糖（fasting plasma glucose，FPG）、糖化血红蛋白（glycosylated hemoglobin A1c，HbA1c）、糖负荷后2 h血糖（oral glucose tolerance test，OGTT 2h PG）判定。流行病学研究发现，吸烟、饮酒、肥胖、血脂异常、高血压、糖尿病家族史为糖尿病患病的危险因素[5-6]。一项队列研究表明肥胖、高血压、血脂异常是糖尿病前期发病的危险因素[7]。血脂异常常伴有糖代谢异常，糖脂代谢紊乱可能会增加多种微血管和大血管并发症的风险，包括糖尿病视网膜病变、糖尿病肾病、心脑血管疾病等[8]。既往研究发现脂质比值TC/ HDL-C、TG/ HDL-C、LDL-C / HDL-C、non‐HDL‐C / HDL-C与糖尿病的发生发展有关，在天津市常住居民中调查发现脂质比值的升高与糖尿病、糖尿病前期的患病风险增加有关[9]，也有研究指出在传统血脂指标尚未出现异常时，脂质比值更早期的异常值能为糖尿病患者血管并发症的早诊早治提供依据[10]，然而少有研究报道脂质比值与糖代谢异常的剂量反应关系，提出脂质比值异常的具体截断值。本研究以“江苏省心脑血管疾病综合防控项目”的调查内容为基础，筛选出7 527名研究对象，应用logistic回归模型、三次立方样条函数来系统评价血脂参数、脂质比值与糖尿病前期、糖尿病的关联。
1　对象与方法
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1.1　研究对象
2022年7月至2023年3月，采用多阶段整群抽样的方法在江苏省常州市抽取天宁区、武进区作为项目点，每个区抽取3~4个街道开展筛查项目。遵循自愿参加原则对35岁及以上的常住居民展开调查。调查内容包括基本信息、体格测量以及空腹血糖血脂的检测。纳入标准：年龄满35周岁、空腹时间大于8小时；排除标准：信息不全、2周内服用调脂药物。最终7 527名社区居民完成所有调查项目，纳入本次研究。本研究经江苏省疾控中心伦理审查委员会审查（伦理批准号：JSJK2021-B005-01），研究对象均已在调查前签署知情同意书。
1.2　研究方法
资料收集主要来源于问卷调查、体格测量和实验室检测三部分。（1）问卷调查：采用省心脑血管项目的统一问卷，由培训合格的调查员以面访的形式开展调查。问卷内容主要包括：基本信息（年龄、性别、婚姻状况、文化程度、职业类型、家庭年总收入、糖尿病家族史等）、生活方式（吸烟、饮酒），疾病史及用药情况（糖尿病、高血压、血脂异常）等。（2）体格测量：身高、体重、腰围、臀围、血压等指标。（3）实验室检测：采集清晨至少空腹（无饮食和饮水）8小时的静脉血，检测指标为：空腹血糖、总胆固醇（total cholesterol，TC）、甘油三酯（triglyceride，TG）、高密度脂蛋白胆固醇（high-density lipoprotein cholesterol，HDL-C）、低密度脂蛋白胆固醇（low-density lipoprotein cholesterol，LDL-C）。
相关指标定义：（1）糖代谢异常：依据中国2型糖尿病防治指南[1]，将研究对象分为三组：非糖尿病组（FPG<5.6 mmol/L）,糖尿病前期组（IFG:5.6 mmol/L≤FPG<7.0 mmol/L），糖尿病组（既往已诊断为糖尿病或符合糖尿病诊断标准：FPG≥7.0 mmol/L）；本研究依据FPG进行分组。（2）高血压：既往已诊断为高血压或符合高血压诊断标准在未使用降压药物情况下，收缩压≥140 mmHg和（或）舒张压≥90 mmHg。（3）体质指数（body mass index，BMI）：正常体重BMI<24.0 kg/m2，超重24.0 kg/m2≤BMI<28.0 kg/m2，肥胖BMI≥28.0 kg/m2。（4）中心性肥胖[11]：男性腰臀比≥0.90，女性腰臀比≥0.85。（5）非高密度脂蛋白胆固醇（non‐HDL‐C）＝TC ‐ HDL‐C，脂质比值包括TC/HDL-C、TG/HDL-C、LDL-C/HDL-C、non‐HDL‐C/HDL-C。（6）吸烟：累计吸烟100支以上，饮酒：每周饮酒1次以上。
1.3　统计学方法
本研究的数据录入采用EpiData 3.0软件，双人双轨录入调查问卷的资料信息，数据比对核查确保准确性。统计分析软件包括R 4.3.1和SPSS 19.0软件，统计检验均设定为双侧概率检验，检验水准α=0.05。采用多分类logistic回归探索糖尿病前期、糖尿病与常规血脂、脂质比值的关联，用OR值及其95%可信区间（confidence interval, CI）描述关联强度。考虑到脂质比值与糖代谢异常的关联尚不明确，二者之间可能存在非线性关系，本研究在R中利用“rms”包的三次立方样条函数来分析脂质比值与糖代谢异常潜在的剂量反应关系[12]。
2　结果
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2.1　研究对象的基本特征
本研究共纳入7 527名常住居民，其中非糖尿病组4 918人，糖尿病前期组1 105人，糖尿病组1 504人。符合正态分布的连续性变量用均数±标准差表示，偏态分布的连续性变量用中位数（四分位数间距）表示，分类变量的描述采用频数和百分比，组间比较用χ2检验和非参数检验。三组人群在年龄、性别、吸烟史、饮酒史、BMI、糖尿病家族史等一般特征中存在统计学差异（P<0.05）。糖尿病组中合并高血压574人，在三组人群占比最多（38.2%，P<0.001）。血脂参数TC、TG、HDL-C、LDL-C、non-HDL-C，脂质比值TC/HDL-C、TG/HDL-C、LDL-C/HDL-C、non‐HDL‐C/HDL-C与糖代谢异常的关联均有统计学意义（P<0.05），具体内容见表1。
2.2　血脂参数、脂质比值与糖代谢异常的关联
以非糖尿病组为参照，在多分类logistics回归模型中调整年龄、性别、家庭年总收入、吸烟史、饮酒史、BMI、糖尿病家族史、高血压等变量，结果发现TC（OR=1.03）、TG（OR=1.08）、LDL-C（OR=1.36）、non-HDL-C（OR=1.19）是糖尿病前期的危险因素（P<0.05），TG（OR=1.16）、non-HDL-C（OR=1.18）是糖尿病的危险因素（P<0.001），HDL-C则是糖尿病前期（OR=0.52）、糖尿病（OR=0.28）的保护因素（P<0.001）。
脂质比值TC/HDL-C、TG/HDL-C、LDL-C/HDL-C、non‐HDL‐C/HDL-C是糖尿病前期的危险因素（P<0.001）；TC/HDL-C、TG/HDL-C、LDL-C/HDL-C、non‐HDL‐C/HDL-C升高，糖尿病的患病风险分别增加40%（OR=1.40，95%CI=1.31~1.49）、14%（OR=1.14，95%CI=1.11~1.18）、49%（OR=1.49，95%CI=1.35~1.64）、40%（OR=1.40，95%CI=1.31~1.49）。（见表2）
2.3　脂质比值和糖代谢异常的剂量反应关系
纳入年龄、性别、BMI、吸烟、饮酒、高血压、糖尿病家族史等协变量，将TC/HDL-C、TG/HDL-C、LDL-C/HDL-C、non‐HDL‐C/HDL-C进行对数转换，脂质比值与糖代谢异常的剂量反应关系见图1，随着脂质比值增大，糖代谢异常的发生风险也增大。2.29<TC/HDL-C<3.78时，该比值是糖代谢异常的保护因素，TC/HDL-C≥3.78时，该比值是糖代谢异常的危险因素；TG/HDL-C≥1.07时，该比值是糖代谢异常的危险因素；1.11<LDL-C/HDL-C<2.10时，该比值是糖代谢异常的保护因素，LDL-C/HDL-C≥2.10时，该比值是糖代谢异常的危险因素；1.29<non-HDL-C/HDL-C<2.77时，该比值是糖代谢异常的保护因素，non-HDL-C/HDL-C≥2.77时，该比值是糖代谢异常的危险因素。
3　讨论
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由于人口老龄化、生活方式和膳食结构的改变，血脂异常和糖尿病的患病率逐年增加。脂毒性、炎症反应和内质网应激是可能诱发胰岛素抵抗（insulin resistance，IR）的三种机制，过量的脂质堆积会改变细胞稳态、激活生成脂肪和血糖的细胞信号通路, 进一步加重糖脂代谢紊乱[13]。糖尿病前期的危险因素与糖尿病基本相同，一项基于英国生物银行的研究发现糖尿病前期与血压、吸烟、non-HDL-C相关[14]。本研究中同样发现TC、TG、LDL-C、non-HDL-C是糖尿病前期的危险因素，TG、non-HDL-C是糖尿病的危险因素，TC、LDL-C与糖尿病的关联无统计学意义，而其他研究中对照组TC、LDL-C水平低于糖尿病组[15]，结果存在差异可能与研究对象的选择有关。由于缺乏研究对象具体用药情况的信息，因此无法排除药物对关联的潜在影响。本研究发现高水平HDL-C是糖尿病前期和糖尿病患病的保护因素，HDL-C的升高能有效改善脂质代谢，并促进内质网-高尔基转运稳态的恢复，减少内质网应激反应对胰岛β细胞的损伤[16]。
TC/HDL-C、TG/HDL-C、LDL-C/HDL-C、non‐HDL‐C/HDL-C均是糖尿病前期、糖尿病患病的危险因素（P<0.05）。如能早期识别糖尿病前期患者，经药物治疗、饮食控制、适量运动等，可以显著降低糖尿病微血管病变、心肌梗死和死亡的风险[17]。近几年的研究证明TC/HDL-C、TG/HDL-C、LDL-C/HDL-C对于糖尿病的预测价值优于常规血脂参数[18]，脂质比值的敏感度和特异度均优于常规血脂参数[19]。脂肪毒性与非脂肪组织（如心肌、胰腺、骨骼肌、肝脏和肾脏）的异位脂质沉积和胰岛素抵抗存在相关性，进而诱导发生多种并发症[20]。本研究结果显示TC/HDL-C、TG/HDL-C、LDL-C/HDL-C、non‐HDL‐C/HDL-C与糖代谢异常之间存在剂量反应关系，截断值分别为3.78、1.07、2.10、2.77，表明脂质比值在预测糖代谢异常风险上可能是较为灵敏的指标，提示糖尿病患者临床治疗应注意控制血脂水平。高水平的TG和低水平的HDL-C作为两个关键指标，其比值比单一指标的预测作用更强，Nur Zati Iwani的研究发现TG/HDL-C能独立预测胰岛素抵抗[21]，其机制可能是由脂质相关基因的遗传变异引起的TG水平升高和HDL-C水平降低与胰岛素抵抗有关[22]。一项在美国开展的研究表明，TG/HDL-C>1.06时，发生胰岛素抵抗的风险增加[23]，这与本研究的结论相差不大。TC/HDL-C、TG/HDL-C与糖代谢异常的关联可能与C反应蛋白介导的炎症反应有关[24]。Wu等人的队列研究同样利用RCS分析发现LDL-C/HDL-C比值与颈动脉斑块的形成呈非线性关系，其中患有糖尿病和血脂异常的老年男性是亟需防控的高危人群[25]。然而，目前的基础研究尚无法解释脂质比值的潜在机制。
本研究存在一些局限性，作为病例对照研究，无法论证因果关系；未考虑运动、饮食等变量分析其对结果的影响；虽然既往研究也有根据FPG划分糖代谢状态[9]，但缺乏OGTT 2h PG和HbA1c等指标，可能会影响糖尿病和糖尿病前期的患病率，也无法论证脂质比值与胰岛素抵抗的相关性；作为横断面研究，样本选择较为局限，可能需要多中心队列研究对结果进一步论证。
综上所述，本研究发现TC、LDL-C、TC/HDL-C、TG/HDL-C、LDL-C/HDL-C、non-HDL-C/HDL-C升高是糖尿病前期和糖尿病的危险因素，HDL-C升高是糖尿病前期和糖尿病的保护因素。TC/HDL-C、TG/HDL-C、LDL-C/HDL-C、non-HDL-C/HDL-C与糖代谢异常之间存在剂量反应关系，但其生理病理机制尚不明确。糖脂代谢异常及相关并发症已成为目前的重大公共卫生问题，吸烟酗酒、不健康的饮食习惯、缺乏体力活动、均是可改变且能降低发病风险的危险因素，做好三级预防，加强健康宣教和生活方式干预是慢病防控的重点内容。
基金
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  • 国家自然科学基金(82003495)
  • 南京医科大学常州医学中心临床研究项目(CMCC202212)
  • 南京医科常州公共卫生高等研究院开放课题重点项目(CPHM202304)
  • 常州市“十四五”卫生健康高层次人才培养工程—拔尖人才(2022CZBJ097)
  • 江苏省卫生健康委科研项目(Yl2023002)
  • 江阴市卫生健康委科研项目(Q202214)
文献
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2024年第51卷第14期
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doi: 10.20043/j.cnki.MPM.202401307
  • 接收时间：2024-01-18
  • 首发时间：2026-03-18
  • 出版时间：2024-07-25
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  • 收稿日期：2024-01-18
基金
国家自然科学基金(82003495)
南京医科大学常州医学中心临床研究项目(CMCC202212)
南京医科常州公共卫生高等研究院开放课题重点项目(CPHM202304)
常州市“十四五”卫生健康高层次人才培养工程—拔尖人才(2022CZBJ097)
江苏省卫生健康委科研项目(Yl2023002)
江阴市卫生健康委科研项目(Q202214)
作者信息
    1.常州市疾病预防控制中心慢非传科，江苏 常州 213022
    2.江阴市疾病预防控制中心慢非传科
    3.江苏省现场流行病学培训项目

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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