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Article(id=1241329574894694883, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202501238, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1736697600000, receivedDateStr=2025-01-13, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773885633443, onlineDateStr=2026-03-19, pubDate=1752076800000, pubDateStr=2025-07-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773885633443, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773885633443, creator=13701087609, updateTime=1773885633443, updator=13701087609, issue=Issue{id=1241329570129956900, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='13', pageStart='2305', pageEnd='2496', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773885632307, creator=13701087609, updateTime=1773885763730, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241330121425080472, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241330121425080473, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2491, endPage=2496, ext={EN=ArticleExt(id=1241329575242822124, articleId=1241329574894694883, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association between Alpha-1-acid glycoprotein and prediabetes in adults, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the association between alpha-1-acid glycoprotein (AGP) and prediabetes prevalence in US adults.

Methods

We analyzed data from 2 926 participants (age ≥18 years) in the National Health and Nutrition Examination Survey (2017-2023). Participants were classified into prediabetes and non-prediabetes groups. AGP levels were measured and analyzed both as continuous and quartile-categorized variables. Weighted logistic regression models were employed to assess this relationship after adjusting for covariates.

Results

The prediabetes group showed significantly higher AGP levels (0.79±0.02) versus controls (0.78±0.01; P<0.001). In fully adjusted models, each unit increase in AGP was associated with 7.8% higher prediabetes risk (OR=1.08, 95%CI:1.453-1.842). Quartile analysis revealed progressively increasing risks from Q2 to Q4 versus Q1 (all P<0.05). Subgroup analyses showed stronger associations in females (OR=1.01,95%CI:1.095-2.778, P=0.043) and younger adults (18-39 years; OR=1.22, 95%CI:1.182-7.965, P=0.008).

Conclusion

Elevated AGP levels are consistently associated with increased prediabetes risk, suggesting its potential as a novel biomarker for early risk identification.

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目的

评估α-1-酸性糖蛋白（Alpha-1-acid glycoprotein，AGP）与美国成年人糖尿病前期患病率之间的关系。

方法

收集2017—2023年美国国家健康与营养检查调查（NHANES）数据库年龄≥18岁的受试者相关数据，分为糖尿病前期组和非糖尿病前期组，并收集AGP及相关协变量情况；参与者根据AGP四分位数分四组，采用加权单因素分析、加权多元回归分析、亚组分析来检验AGP与糖尿病前期的关系。

结果

共纳入2 926名受试者，其中206例报告是糖尿病前期（7.04%）。糖尿病前期组AGP水平为（0.79±0.02），高于对照组的（0.78±0.01），差异有统计学意义（P<0.001）。加权多因素logistic回归分析结果显示，AGP连续变量与糖尿病前期呈正相关，且在完全调整协变量后的模型3中，AGP每增加1个单位与糖尿病前期发病率增加7.8%（OR=1.08，95%CI 1.453～1.842）相关；且AGP转换为四分位数的分类变量时也得到一致结果，与Q1组相比，Q2、Q3、Q4组未调整模型（model 1）、微调整（model 2）和完全调整模型（model 3）糖尿病前期患病风险均不同程度增加（OR均>1，P均<0.05）。亚组分析显示，AGP水平与高风险糖尿病前期的正相关性在女性模型3（OR=1.01, 95%CI:1.095～2.778, P=0.043）、18～39岁（OR=1.22，95%CI：1.182～7.965, P= 0.008）中更为显著；AGP分类变量回归模型1～3中，不同性别、不同年龄段人群Q4组糖尿病前期风险也呈增加趋势。

结论

无论是作为连续变量还是分类变量，高AGP水平都与糖尿病前期风险增加相关，AGP可能是识别糖尿病前期早期风险人群的新效指标。

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马西文，E-mail:
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贾晓艳（1990—），女，硕士，主治医师，研究方向：老年心血管及内分泌方向

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Animal,2016, 10(5): 812-820., articleTitle=α 1-acid glycoprotein inhibits lipogenesis in neonatal swine adipose tissue, refAbstract=null)], funds=[Fund(id=1241329763139252498, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574894694883, awardId=2024YLZDJH 252, language=CN, fundingSource=郑州市医疗卫生领域科技创新指导计划项目(2024YLZDJH 252), fundOrder=null, country=null), Fund(id=1241329763248304408, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574894694883, awardId=242102310159, language=CN, fundingSource=河南省科技攻关计划项目(242102310159), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241329757229478914, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574894694883, xref=1., ext=[AuthorCompanyExt(id=1241329757242060802, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574894694883, companyId=1241329757229478914, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Geriatrics, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan 450007, China), AuthorCompanyExt(id=1241329757246255106, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574894694883, companyId=1241329757229478914, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.郑州大学附属郑州中心医院病案管理科，河南 郑州 450007)]), AuthorCompany(id=1241329757351112717, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574894694883, xref=2., ext=[AuthorCompanyExt(id=1241329757359501327, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574894694883, companyId=1241329757351112717, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.新乡医学院第一临床医学院)]), AuthorCompany(id=1241329757485330455, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574894694883, xref=3., ext=[AuthorCompanyExt(id=1241329757497913367, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574894694883, companyId=1241329757485330455, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.郑州大学附属郑州中心医院检验科)]), AuthorCompany(id=1241329757581799455, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574894694883, xref=4., ext=[AuthorCompanyExt(id=1241329757594382368, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574894694883, companyId=1241329757581799455, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=4.郑州大学附属郑州中心医院老年医学科，河南 郑州 450007)])], figs=[ArticleFig(id=1241329762111647955, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574894694883, language=EN, label=Figure 1, caption=Flow chart of inclusion and exclusion of study subjects, figureFileSmall=+OKFG8XhckBAFhCJoI31kQ==, figureFileBig=KLWs+IMSIt+PxvngYzZBkQ==, tableContent=null), ArticleFig(id=1241329762229088473, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574894694883, language=CN, label=图1, caption=研究对象纳入排除流程图, figureFileSmall=+OKFG8XhckBAFhCJoI31kQ==, figureFileBig=KLWs+IMSIt+PxvngYzZBkQ==, tableContent=null), ArticleFig(id=1241329762367500515, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574894694883, language=EN, label=Table 1, caption=

Baseline characteristics of the study population［（），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
指标非糖尿病前期
（n=2 720）		糖尿病前期
（n=206）		P值
年龄（岁）33.85±0.2733.89±1.030.125
年龄分层（岁）0.063
18～391 875（68.94）131（63.35）
40～60845（31.06）75（36.65）
AGP（g/L）0.78±0.010.79±0.02<0.001
性别0.299
男性1 154 （42.42）93 （45.24）
女性1 566 （57.58）113 （54.76）
种族<0.001
墨西哥裔美国人274 （10.08）22 （10.74）
其他西班牙裔297 （10.91）22 （10.52）
非西班牙裔白人1 457 （53.55）115 （55.66）
非西班牙裔黑人335 （12.31）17 （8.3）
非西班牙裔亚洲人202 （7.42）14 （6.91）
其他种族156 （5.73）16 （7.87）
婚姻0.051
已婚或与伴侣同住1 590 （58.47）117 （56.64）
丧偶或离婚或分居328 （12.05）27 （13.04）
未婚802 （29.48）62 （30.32）
教育<0.001
9年级以下75 （2.75）2 （0.91）
9～12年级170 （6.24）10 （4.86）
高中或美国高中同等学力证书570 （20.97）64 （31.17）
大学855 （31.42）57 （27.43）
大学以上学历1 051 （38.63）73 （35.64）
贫困收入比2.84±0.052.79±0.20<0.001
BMI（kg/m2）29.82±0.2529.11±0.78<0.001
腰围（cm）95.79±0.5495.53±2.02<0.001
臀围（cm）109.79±0.47107.95±1.46<0.001
SBP（mm Hg）110.34±0.37108.94±1.320.260
DBP（mm Hg）72.24±0.3271.73±0.91<0.001
吸烟状态<0.001
从不831 （30.55）61 （29.61）
曾吸1 478 （54.33）106 （51.39）
当前仍吸411 （15.12）39 （18.99）
饮酒史0.002
从不261 （9.6）16 （7.67）
轻中度692 （25.44）66 （31.82）
重度1 767 （64.96）125 （60.51）
病史
高血压370 （13.59）23 （11.28）<0.001
高胆固醇血症714 （26.25）57 （27.77）0.112
冠心病172 （6.32）13 （6.13）0.107
CHF159 （5.86）12 （6.01）0.072
低剂量阿司匹林0.094
无2 289 （84.16）141 （68.54）
有431 （15.84）65 （31.46）
实验室指标
WBC（×109/L）7.39±0.067.65±0.27<0.001
RBC（×1012/L）4.53±0.014.51±0.04<0.001
HGB（g/L）13.19±0.0413.18±0.11<0.001
HbA1c（%）5.33±0.055.42±0.03<0.001
葡萄糖（mmol/L）5.38±0.125.63±0.06<0.001
INS（μm/mol）10.53±0.9113.67±0.73<0.001
胆固醇（mmol/L）4.73±0.034.84±0.15<0.001
甘油三酯（mmol/L）0.99±0.031.39±0.44<0.001
LDL（mmol/L）2.75±0.052.75±0.16<0.001
HDL（mmol/L）1.47±0.011.41±0.03<0.001
TyG8.28±0.048.39±0.220.273
), ArticleFig(id=1241329762493329645, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574894694883, language=CN, label=表1, caption=

根据糖尿病前期分组加权的研究人群基线特征［（），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
指标非糖尿病前期
（n=2 720）		糖尿病前期
（n=206）		P值
年龄（岁）33.85±0.2733.89±1.030.125
年龄分层（岁）0.063
18～391 875（68.94）131（63.35）
40～60845（31.06）75（36.65）
AGP（g/L）0.78±0.010.79±0.02<0.001
性别0.299
男性1 154 （42.42）93 （45.24）
女性1 566 （57.58）113 （54.76）
种族<0.001
墨西哥裔美国人274 （10.08）22 （10.74）
其他西班牙裔297 （10.91）22 （10.52）
非西班牙裔白人1 457 （53.55）115 （55.66）
非西班牙裔黑人335 （12.31）17 （8.3）
非西班牙裔亚洲人202 （7.42）14 （6.91）
其他种族156 （5.73）16 （7.87）
婚姻0.051
已婚或与伴侣同住1 590 （58.47）117 （56.64）
丧偶或离婚或分居328 （12.05）27 （13.04）
未婚802 （29.48）62 （30.32）
教育<0.001
9年级以下75 （2.75）2 （0.91）
9～12年级170 （6.24）10 （4.86）
高中或美国高中同等学力证书570 （20.97）64 （31.17）
大学855 （31.42）57 （27.43）
大学以上学历1 051 （38.63）73 （35.64）
贫困收入比2.84±0.052.79±0.20<0.001
BMI（kg/m2）29.82±0.2529.11±0.78<0.001
腰围（cm）95.79±0.5495.53±2.02<0.001
臀围（cm）109.79±0.47107.95±1.46<0.001
SBP（mm Hg）110.34±0.37108.94±1.320.260
DBP（mm Hg）72.24±0.3271.73±0.91<0.001
吸烟状态<0.001
从不831 （30.55）61 （29.61）
曾吸1 478 （54.33）106 （51.39）
当前仍吸411 （15.12）39 （18.99）
饮酒史0.002
从不261 （9.6）16 （7.67）
轻中度692 （25.44）66 （31.82）
重度1 767 （64.96）125 （60.51）
病史
高血压370 （13.59）23 （11.28）<0.001
高胆固醇血症714 （26.25）57 （27.77）0.112
冠心病172 （6.32）13 （6.13）0.107
CHF159 （5.86）12 （6.01）0.072
低剂量阿司匹林0.094
无2 289 （84.16）141 （68.54）
有431 （15.84）65 （31.46）
实验室指标
WBC（×109/L）7.39±0.067.65±0.27<0.001
RBC（×1012/L）4.53±0.014.51±0.04<0.001
HGB（g/L）13.19±0.0413.18±0.11<0.001
HbA1c（%）5.33±0.055.42±0.03<0.001
葡萄糖（mmol/L）5.38±0.125.63±0.06<0.001
INS（μm/mol）10.53±0.9113.67±0.73<0.001
胆固醇（mmol/L）4.73±0.034.84±0.15<0.001
甘油三酯（mmol/L）0.99±0.031.39±0.44<0.001
LDL（mmol/L）2.75±0.052.75±0.16<0.001
HDL（mmol/L）1.47±0.011.41±0.03<0.001
TyG8.28±0.048.39±0.220.273
), ArticleFig(id=1241329762619158769, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574894694883, language=EN, label=Table 2, caption=

Association analysis between AGP and prediabetes

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型 2模型 3
OR 值（95%CI）P值OR值 （95%CI）P值OR 值（95%CI）P值
AGP［M（P25，P75）］1.10（1.410～1.822）0.0161.08（1.378～1.855）0.0171.08（1.453～1.842）0.018
AGP（四分位数）
Q1referencereferencereference
Q21.06（1.778～3.140）0.0211.05（1.753～3.184）0.0231.01 （1.319～10.698）0.049
Q31.07（1.359～1.668）0.0241.06（1.340～1.698）0.0281.03（1.061～13.440）0.040
Q41.10（1.758～2.965）0.0131.08（1.720～3.021）0.0151.06 （1.499～7.469）0.034
), ArticleFig(id=1241329762732404982, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574894694883, language=CN, label=表2, caption=

AGP与糖尿病前期的关联性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型 2模型 3
OR 值（95%CI）P值OR值 （95%CI）P值OR 值（95%CI）P值
AGP［M（P25，P75）］1.10（1.410～1.822）0.0161.08（1.378～1.855）0.0171.08（1.453～1.842）0.018
AGP（四分位数）
Q1referencereferencereference
Q21.06（1.778～3.140）0.0211.05（1.753～3.184）0.0231.01 （1.319～10.698）0.049
Q31.07（1.359～1.668）0.0241.06（1.340～1.698）0.0281.03（1.061～13.440）0.040
Q41.10（1.758～2.965）0.0131.08（1.720～3.021）0.0151.06 （1.499～7.469）0.034
), ArticleFig(id=1241329762828873980, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574894694883, language=EN, label=Table 3, caption=

Correlation analysis of AGP and pre-diabetes in different genders and ages

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2模型3
OR 值（95%CI）P值OR值 （95%CI）P值OR 值（95%CI）P值
性别
男性
AGP 连续变量1.06（1.298～4.472）0.0381.02（1.276～4.505）0.0780.1201.01（1.192～6.425）
AGP（Q1）reference referencereference
Q21.01（1.378～3.804）0.0581.01（1.372～3.852）0.0621.00（1.291～4.239）0.079
Q31.02（1.293～2.914）0.0281.03（1.290～2.908）0.0291.02（1.200～2.662）0.032
Q41.08（1.299～3.184）0.0211.06（1.287～3.235）0.0251.12（1.208～4.069）0.026
女性
AGP 连续变量1.06（1.299～1.613）0.0361.05（1.256～1.660）0.0390.0431.01（1.095～2.778）
AGP（Q1）reference referencereference
Q21.04（1.183～1.577）0.0381.02（1.170～1.602）0.0461.02（1.107～3.314）0.055
Q31.08（1.061～4.880）0.0351.04（1.056～5.157）0.0361.03（1.022～6.423）0.045
Q41.09（1.859～3.749）0.0121.10（1.808～4.018）0.0151.12（1.624～4.740）0.019
年龄（岁）
18～39
AGP 连续变量1.08（1.357～2.044）0.0231.08（1.336～2.157）0.0341.22（1.182～7.965）0.008
AGP（Q1）referencereferencereference
Q21.08（1.352～1.773）0.0181.07（1.341～1.850）0.0141.08（1.385～2.409）0.016
Q31.08（1.821～3.449）0.0151.07（1.803～3.686）0.0131.10（1.781～4.699）0.011
Q41.16（1.946～4.067）0.0071.18（1.937～4.192）0.0041.20（1.913～4.075）<0.001
40～60
AGP 连续变量1.08（1.210～3.4190.0301.08（1.175～3.841）1.08（1.119～5.529）0.044
AGP（Q1）referencereferencereference
Q21.05（1.289～3.781）0.0461.02（1.286～3.629）0.0781.01（1.177～3.294）0.087
Q31.07（1.361～4.478）0.0391.05（1.314～4.448）0.0501.05（1.169～3.698）0.056
Q41.09（1.176～2.997）0.0231.08（1.165～3.109）0.0261.07（1.184～4.907）0.029
), ArticleFig(id=1241329762937925892, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574894694883, language=CN, label=表3, caption=

不同性别、年龄AGP与糖尿病前期的相关性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2模型3
OR 值（95%CI）P值OR值 （95%CI）P值OR 值（95%CI）P值
性别
男性
AGP 连续变量1.06（1.298～4.472）0.0381.02（1.276～4.505）0.0780.1201.01（1.192～6.425）
AGP（Q1）reference referencereference
Q21.01（1.378～3.804）0.0581.01（1.372～3.852）0.0621.00（1.291～4.239）0.079
Q31.02（1.293～2.914）0.0281.03（1.290～2.908）0.0291.02（1.200～2.662）0.032
Q41.08（1.299～3.184）0.0211.06（1.287～3.235）0.0251.12（1.208～4.069）0.026
女性
AGP 连续变量1.06（1.299～1.613）0.0361.05（1.256～1.660）0.0390.0431.01（1.095～2.778）
AGP（Q1）reference referencereference
Q21.04（1.183～1.577）0.0381.02（1.170～1.602）0.0461.02（1.107～3.314）0.055
Q31.08（1.061～4.880）0.0351.04（1.056～5.157）0.0361.03（1.022～6.423）0.045
Q41.09（1.859～3.749）0.0121.10（1.808～4.018）0.0151.12（1.624～4.740）0.019
年龄（岁）
18～39
AGP 连续变量1.08（1.357～2.044）0.0231.08（1.336～2.157）0.0341.22（1.182～7.965）0.008
AGP（Q1）referencereferencereference
Q21.08（1.352～1.773）0.0181.07（1.341～1.850）0.0141.08（1.385～2.409）0.016
Q31.08（1.821～3.449）0.0151.07（1.803～3.686）0.0131.10（1.781～4.699）0.011
Q41.16（1.946～4.067）0.0071.18（1.937～4.192）0.0041.20（1.913～4.075）<0.001
40～60
AGP 连续变量1.08（1.210～3.4190.0301.08（1.175～3.841）1.08（1.119～5.529）0.044
AGP（Q1）referencereferencereference
Q21.05（1.289～3.781）0.0461.02（1.286～3.629）0.0781.01（1.177～3.294）0.087
Q31.07（1.361～4.478）0.0391.05（1.314～4.448）0.0501.05（1.169～3.698）0.056
Q41.09（1.176～2.997）0.0231.08（1.165～3.109）0.0261.07（1.184～4.907）0.029
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α-1-酸性糖蛋白与成人糖尿病前期的相关性分析
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贾晓艳 1 , 连瑞佳 2 , 马保东 3 , 马西文 4
现代预防医学 | 临床与预防 2025,52(13): 2491-2496
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现代预防医学 | 临床与预防 2025, 52(13): 2491-2496
α-1-酸性糖蛋白与成人糖尿病前期的相关性分析
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贾晓艳1, 连瑞佳2, 马保东3, 马西文4
作者信息
  • 1.郑州大学附属郑州中心医院病案管理科，河南 郑州 450007
  • 2.新乡医学院第一临床医学院
  • 3.郑州大学附属郑州中心医院检验科
  • 4.郑州大学附属郑州中心医院老年医学科，河南 郑州 450007

    • 贾晓艳（1990—），女，硕士，主治医师，研究方向：老年心血管及内分泌方向

通讯作者:

马西文，E-mail:
Association between Alpha-1-acid glycoprotein and prediabetes in adults
Xiao-yan JIA1, Rui-jia LIAN2, Bao-dong MA3, Xi-wen MA4
Affiliations
  • Department of Geriatrics, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan 450007, China
出版时间: 2025-07-10 doi: 10.20043/j.cnki.MPM.202501238
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摘要
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目的

评估α-1-酸性糖蛋白（Alpha-1-acid glycoprotein，AGP）与美国成年人糖尿病前期患病率之间的关系。

方法

收集2017—2023年美国国家健康与营养检查调查（NHANES）数据库年龄≥18岁的受试者相关数据，分为糖尿病前期组和非糖尿病前期组，并收集AGP及相关协变量情况；参与者根据AGP四分位数分四组，采用加权单因素分析、加权多元回归分析、亚组分析来检验AGP与糖尿病前期的关系。

结果

共纳入2 926名受试者，其中206例报告是糖尿病前期（7.04%）。糖尿病前期组AGP水平为（0.79±0.02），高于对照组的（0.78±0.01），差异有统计学意义（P<0.001）。加权多因素logistic回归分析结果显示，AGP连续变量与糖尿病前期呈正相关，且在完全调整协变量后的模型3中，AGP每增加1个单位与糖尿病前期发病率增加7.8%（OR=1.08，95%CI 1.453～1.842）相关；且AGP转换为四分位数的分类变量时也得到一致结果，与Q1组相比，Q2、Q3、Q4组未调整模型（model 1）、微调整（model 2）和完全调整模型（model 3）糖尿病前期患病风险均不同程度增加（OR均>1，P均<0.05）。亚组分析显示，AGP水平与高风险糖尿病前期的正相关性在女性模型3（OR=1.01, 95%CI:1.095～2.778, P=0.043）、18～39岁（OR=1.22，95%CI：1.182～7.965, P= 0.008）中更为显著；AGP分类变量回归模型1～3中，不同性别、不同年龄段人群Q4组糖尿病前期风险也呈增加趋势。

结论

无论是作为连续变量还是分类变量，高AGP水平都与糖尿病前期风险增加相关，AGP可能是识别糖尿病前期早期风险人群的新效指标。

α-1-酸性糖蛋白  /  糖尿病前期  /  NHANES数据库  /  横断面研究
Objective

To investigate the association between alpha-1-acid glycoprotein (AGP) and prediabetes prevalence in US adults.

Methods

We analyzed data from 2 926 participants (age ≥18 years) in the National Health and Nutrition Examination Survey (2017-2023). Participants were classified into prediabetes and non-prediabetes groups. AGP levels were measured and analyzed both as continuous and quartile-categorized variables. Weighted logistic regression models were employed to assess this relationship after adjusting for covariates.

Results

The prediabetes group showed significantly higher AGP levels (0.79±0.02) versus controls (0.78±0.01; P<0.001). In fully adjusted models, each unit increase in AGP was associated with 7.8% higher prediabetes risk (OR=1.08, 95%CI:1.453-1.842). Quartile analysis revealed progressively increasing risks from Q2 to Q4 versus Q1 (all P<0.05). Subgroup analyses showed stronger associations in females (OR=1.01,95%CI:1.095-2.778, P=0.043) and younger adults (18-39 years; OR=1.22, 95%CI:1.182-7.965, P=0.008).

Conclusion

Elevated AGP levels are consistently associated with increased prediabetes risk, suggesting its potential as a novel biomarker for early risk identification.

Alpha-1-acid glycoprotein  /  Prediabetes  /  NHANES database  /  Cross-sectional study
贾晓艳, 连瑞佳, 马保东, 马西文. α-1-酸性糖蛋白与成人糖尿病前期的相关性分析. 现代预防医学, 2025 , 52 (13) : 2491 -2496 . DOI: 10.20043/j.cnki.MPM.202501238
Xiao-yan JIA, Rui-jia LIAN, Bao-dong MA, Xi-wen MA. Association between Alpha-1-acid glycoprotein and prediabetes in adults[J]. Modern Preventive Medicine, 2025 , 52 (13) : 2491 -2496 . DOI: 10.20043/j.cnki.MPM.202501238
正文
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糖尿病前期是糖尿病发病前的过渡阶段，包括空腹血糖受损（impaired fasting glucose，IFG）、糖耐量减低（impaired glucose tolerance，IGT）以及两者的混合状态（IFG+IGT），是在正常血糖与糖尿病之间的中间高血糖状态[1]。按照美国糖尿病协会2023标准[2]，据中国流行病学调查结果，2015—2017年抽样调查显示我国糖尿病前期患病率达35.2%[3]。在全球范围内，人口老龄化、城市化进程加快、生活方式改变、超重或肥胖及高甘油三酯血症的患病率增加等均促使糖尿病前期的发病率也逐年上升[4-5]。糖尿病前期不仅预示着发生糖尿病的风险增加，还与心血管疾病、微血管病变、肿瘤、痴呆、抑郁等疾病的风险增加相关。糖尿病前期个体每年约有 5%～10%进展为糖尿病，且其全因死亡、心血管疾病复合终点事件、冠心病、卒中的相对风险较血糖正常人群均有所增加[6-7]。因此，糖尿病前期已成为重要的公共卫生问题，受到广泛关注和研究。
α-1-酸性糖蛋白（Alpha-1-acid glycoprotein，AGP）是在肝脏中合成，在结构上属于分泌蛋白质的脂质运载蛋白超家族，也是一种敏感的急性期反应物。既往有研究发现尿AGP水平与慢性心力衰竭患者的心衰严重程度相关[8]；也有研究显示AGP可能为急性心肌梗死炎症、预后的重要指标[9]。AGP可能通过调控炎症通路影响糖代谢，既往Sun等[10]发现AGP通过瘦素受体信号调节能量稳态，而Lee等[11]证实AGP可减轻脂肪组织炎症并改善胰岛素敏感性。总之，AGP的N-糖基化在许多疾病中都会发生改变，有些改变似乎是疾病特有的，因此具有很大的诊断和预后潜力，但目前尚无关于AGP与糖尿病前期的研究，鉴于糖尿病前期常伴有炎症反应和代谢异常，且AGP在炎症和代谢中的双重潜在作用，我们推测AGP可能与糖尿病前期的发生发展相关，可能作为早期预测标志物，故本研究基于美国国家健康与营养检查调查（National Health and Nutrition Examination Survey，NHANES）数据库数据，探索AGP与糖尿病前期之间的相关性。
1　资料与方法
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1.1　数据来源与研究对象
该项横断面研究数据来源于NHANES数据库。本研究提取了NHANES 2017—2023中27 493名研究人群数据。纳入标准：（1）年龄≥18岁；（2）有AGP数据。排除标准：（1）年龄<18岁；（2）AGP为空值；（3）怀孕；（4）糖尿病患者；（5）缺失值。最终2 926名参与者纳入研究。见图1。
1.2　定义
糖尿病前期定义依据受访者根据临床医师建议自报。即数据来源于糖尿病问卷数据文件（变量前缀DIQ_L），该问卷提供糖尿病、糖尿病前期、胰岛素和/或口服降糖药使用的个人访谈数据。糖尿病前期数据来源于条目DIO_160，即是否曾被医生或其他健康专家告知有以下任何情况：“前驱糖尿病、空腹血糖受损、糖耐量受损、边缘型糖尿病或血糖高于正常水平，但还没有高到被称为糖尿病或糖型糖尿病的程度？”即考虑为糖尿病前期。其他实验室相关指标：甘油三酯葡萄糖指数。
1.3　协变量
本研究选择与糖尿病前期相关的因素，并进行了协变量调整。本研究协变量包括性别、年龄、种族、教育程度、家庭收入与贫困的比率、身体质量指数（body mass index, BMI）、吸烟状况、饮酒情况、活动情况、并发症/病史（高血压、冠心病、高胆固醇、充血性心力衰竭等）和TyG。
本文将年龄分层分为18～39岁、40～60岁。吸烟分为从不、曾经及当前吸烟。饮酒分为从不、轻中度饮酒、重度饮酒。运动分为久坐行为、适度运动、活跃运动。
1.4　研究分组
根据是否为糖尿病前期，分为糖尿病前期组（n=206）和非糖尿病前期组（n=2 720）。将所有受试者根据AGP四分位数分为：Q1组（AGP<0.618g/L, n=729）、Q2组（0.618g/L≤AGP≤0.780g/L, n=733）、Q3组（0.780g/L≤AGP≤ 0.948g/L, n=730）、Q4组（AGP>0.948g/L, n=734）。分别将年龄、性别、作为亚组，使用逻辑回归模型进行亚组分析，探寻AGP与糖尿病前期之间的关系。
1.5　统计分析
所有数据使用R4.2.2和STATA 18.0进行分析。为确保结果的可靠性，采用NHANES官网推荐的方法进行加权分析数据，呈现的均值、标准差、百分比以及P值均为纳入wtmec2yr（调查权重）变量后换算得出[12]。计量资料用（加权平均数±标准差）表示，并进行方差齐性检验和进一步的Bonferroni检验，组间均数比较采用加权t检验；计数资料用加权百分比（%）表示，组间比较采用加权后χ2检验。由于研究在分析中使用抽样权重，因此使用基于设计的Wald关联检验，使用加权调查权重后均OR和95%CI表示，以AGP为连续和分类变量进行多因素logistic回归分析AGP与糖尿病前期的关系，并针对各种潜在混杂因素进行调整。模型1未调整。模型2根据年龄、性别和种族进行调整。模型 3在模型2基础上调整贫困收入比、学历、婚姻状况、吸烟、饮酒、运动、高血压、冠心病、充血性心力衰竭（CHF）、BMI、糖化血红蛋白（HbA1c）、葡萄糖、空腹胰岛素（INS）、胆固醇、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、TyG等协变量。然后分别将性别、年龄分层作为亚组，使用逻辑回归模型对潜在的混杂因素进行亚组分析，探寻AGP与糖尿病前期之间的关系。执行双侧检验，检验水准α=0.05。
2　结果
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2.1　基线特征
本研究最终纳入2 926名18岁以上受试者，加权后代表35 919 416名美国成年人。2 926名受试者中1 539名为男性（52.60%），1 387名为女性（47.40%），年龄19～49岁，平均年龄（33.75±9.25）岁。AGP平均值为（0.798±0.244）g/L，糖尿病前期患者206例，检出率为7.04%。
表1是基于糖尿病前期的加权人口基线特征。两组在种族、教育水平、吸烟状态、饮酒史、高血压病史、家庭收入、BMI、腰围、臀围、舒张压、白细胞、红细胞、血红蛋白、HbA1c、葡萄糖、INS、胆固醇、TG、HDL-C、LDL-C等差异具有统计学意义，与非糖尿病前期组相比，糖尿病前期组大学、大学及以上学历人员比例（P<0.001）和合并高血压病史比例（P<0.001）较低，当前仍吸烟人数（P<0.001）和轻中度饮酒人数比例（P=0.002）较高；此外糖尿病前期组GLu、INS、HbA1c、TC、TG和LDL-C的水平较高，HDL-C的水平较低（P<0.05或P<0.01）；此外，糖尿病前期组的AGP水平高于非糖尿病前期组（P<0.001）。
2.2　AGP与糖尿病前期关联分析
以是否发生糖尿病前期为因变量，分别以AGP连续或AGP的四分位分组为自变量，使用加权logistic回归模型探究其关联，见表2。总体而言，针对糖尿病前期，无论在连续变量模型还是分类变量模型下，AGP均与糖尿病前期的发生呈现正相关。在连续变量模型中，充分调整多种协变量模型3中，AGP每增加1个单位，糖尿病前期风险增加7.8%。同样地，在分类变量模型里，AGP水平越高（Q4组相较于Q1组），糖尿病前期患病率也越高；其模型3中，AGP最高的组（Q4）相较于Q1，糖尿病前期患病率增加了6.1%，且各模型中Q2、Q3、Q4组的P值均小于0.05，差异具有统计学意义。这表明AGP升高与糖尿病前期发生率增加之间存在稳定的关系。
2.3　亚组分析
对AGP与糖尿病前期进行亚组分析，结果显示，总体而言，AGP与不同性别（男性、女性）及不同阶段（年龄18～39岁、年龄40～60岁）人群糖尿病前期风险均相关（P<0.05），见表3。
在性别亚组分析中，男性和女性的AGP水平与糖尿病前期风险均呈正相关（P<0.05），但相关性在女性中更为显著。具体而言，女性人群中AGP每增加1个单位，糖尿病前期风险显著增加（P<0.05），完全调整模型3中，AGP连续变量每增加1个单位，糖尿病前期风险增加1.3%。在年龄亚组分析中，18～39岁和40～60岁年龄组的AGP水平升高均与糖尿病前期风险增加相关（P<0.05），且18～39岁年龄组的相关性更为突出；模型3中AGP每增加1个标准差，糖尿病前期风险增加21.8%；AGP分类变量模型3中，Q4组糖尿病前期发生风险是Q1组的1.20倍，表明年轻人群可能对AGP水平变化更为敏感。
3　讨论
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在糖尿病前期人群中，都不同程度存在胰岛素抵抗（insulin resistance，IR），若不干预，IR程度逐渐加重，30%～50%的患者5年内可能进展为2型糖尿病[13]，因此，早期识别糖尿病前期病变至关重要。本研究基于NHANES数据库，通过横断面分析AGP与糖尿病前期的关系，发现血清 AGP水平与糖尿病前期发生风险增加相关，且在年龄、性别亚组中结果一致。
目前，单独评估AGP和糖尿病前期之间关系的研究较少。既往研究显示，AGP与糖尿病风险相关，El-Beblawy等发现1型糖尿病儿童和青少年血清及尿AGP水平显著升高，是糖尿病微血管并发症的重要独立因素[14]。青年人中，高水平体脂百分比与血浆AGP升高有关[15]，提示肥胖与AGP升高及糖尿病存在联系。还有研究发现，AGP还可能是区分女性合并MS的超重/肥胖和代谢健康的生物标志物[16]；且MS组血清AGP水平更高[17]，并与MS相关临床危险因素密切相关[18]，这验证了AGP在调节代谢稳态的作用。ChinaMAP[19]研究发现，AGP是T2DM风险高频基因位点，并与空腹血糖升高正相关。本研究首次证实了 AGP对糖尿病前期的预测能力，提示其可能是糖尿病前期的前瞻性指标，具有重要意义。
尽管AGP升高与糖尿病前期风险增高的机制尚未完全明确，可能涉及以下方面。首先，糖尿病前期常伴有IR，而炎症是IR的重要因素，AGP作为急性时相反应蛋白，其水平升高可能反映体内炎症状态，间接与糖尿病前期风险相关；同时，AGP作为脂肪因子，可通过中枢和外周机制调节能量代谢和炎症[10]。其次，AGP能增加脂肪细胞对葡萄糖的摄取，减轻IR以及TNF-α介导的脂肪细胞脂解，改善葡萄糖和胰岛素耐受性，保护脂肪组织代谢功能[11]。再次，AGP可能通过抑制胰岛素介导的葡萄糖，进而抑制脂肪组织中脂肪生成[20]。最后，由于AGP主要由肝脏合成，肝脏在糖代谢和胰岛素作用中至关重要，肝脏功能异常可能影响AGP代谢，进而与糖尿病前期的发生有关。
本研究有一定优势。一方面，NHANES研究样本具有代表性，研究方案设计良好，质量控制严格，保证了结论的可靠性。另一方面，样本量充足，选取的是NHANES数据库近两个周期的数据集。此外，本研究调整了多种混杂变量，并进行了亚组分析，增强了结果的普遍性，支持AGP与糖尿病前期可能发生独立相关的结论。然而，本研究也存在局限性。一是横断面研究设计无法明确AGP与糖尿病前期的因果关系，需前瞻性研究来进一步探究因果关系。二是NHANES的调查数据基于问卷，糖尿病前期依据受访者自报，可能存在回忆偏差。另外，即使调整了比较完整的协变量，仍不能完全排除混杂效应。尽管存在这些局限性，本文首次揭示了AGP与糖尿病前期的关系，为将血清AGP作为糖尿病前期预测指标提供了临床依据。
综上所述，本研究首次揭示了血清AGP水平与糖尿病前期发生风险之前的正相关系，尤其是在女性和年轻人群中表现显著，提示AGP有潜力作为预测糖尿病前期发生风险的生物标志物。尽管存在局限性，但结果为将AGP作为糖尿病前期预测指标的临床应用提供了初步支持。未来研究方向应包括开展前瞻性队列研究和构建相关临床预测模型，以进一步明确AGP在糖尿病前期发展中的作用和影响。
基金
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  • 郑州市医疗卫生领域科技创新指导计划项目(2024YLZDJH 252)
  • 河南省科技攻关计划项目(242102310159)
文献
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2025年第52卷第13期
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doi: 10.20043/j.cnki.MPM.202501238
  • 接收时间：2025-01-13
  • 首发时间：2026-03-19
  • 出版时间：2025-07-10
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  • 收稿日期：2025-01-13
基金
郑州市医疗卫生领域科技创新指导计划项目(2024YLZDJH 252)
河南省科技攻关计划项目(242102310159)
作者信息
    1.郑州大学附属郑州中心医院病案管理科，河南 郑州 450007
    2.新乡医学院第一临床医学院
    3.郑州大学附属郑州中心医院检验科
    4.郑州大学附属郑州中心医院老年医学科，河南 郑州 450007

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2种不同金属材料的力学参数
科
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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