脂质蓄积指数与糖尿病前期患者转归糖尿病的相关性研究

Lipid accumulation product for prediction the outcome of prediabetes：a 5-year prospective study

摘要:

目的：通过队列研究分析脂质蓄积指数（lipid accumulation product，LAP）与糖尿病前期对象5年转归糖尿病的相关性；并比较LAP、体质指数（body mass index，BMI）、腰围（waist circumference，WC）、腰臀比（waist-to-hip ratio，WHR）预测糖尿病前期对象随访5年转归糖尿病的能力。方法：选取2011年4月至11月参与泸州地区2型糖尿病患者肿瘤发生风险的流行病学调查研究中基线调查确诊为糖尿病前期人群1 125人，将研究对象按LAP的四分位数分为4组（Q1，Q2，Q3，Q4），进行为期5年的随访，并观察转归糖尿病的情况。通过单因素及多因素logistic回归分析 LAP对糖尿病前期对象转归糖尿病的影响，并计算受试者工作特征（receiver operating characteristic，ROC）曲线下面积，比较 LAP、BMI、WC、WHR 4个肥胖指标预测糖尿病前期对象转归糖尿病的能力。结果：完成随访的1 064人中，转归为糖尿病者237人；4组对象转归糖尿病的比较结果显示，Q4组（92人）＞Q3组（69人）＞Q2组（48人）＞Q1组（28人），差异有统计学意义（χ2=49.308，P=0.000）；logistic回归分析结果显示，在未调整任何变量及调整年龄、性别、身高、收缩压、甘油三酯、高密度脂蛋白胆固醇、吸烟、饮茶后，Q3、Q4组的糖尿病前期对象较Q1、Q2组的研究对象转归糖尿病的风险更高；ROC曲线下面积结果显示，在4个不同肥胖指标中，LAP（曲线下面积0.651，P=0.000）大于BMI、WC及WHR曲线下面积，说明LAP相较于BMI、WC及WHR对预测糖尿病前期对象转归糖尿病有较好的价值。结论：LAP是影响糖尿病前期对象转归糖尿病的危险因素，LAP或可成为评估糖尿病前期转归糖尿病的预测因子。随着LAP增高，糖尿病前期对象转归为糖尿病的风险增高；LAP用于预测糖尿病前期对象5年转归糖尿病的能力优于BMI、WC及WHR。

Abstract:

Objective：To investigated the predictive value of the lipid accumulation product（LAP） for prediabetes development of diabetes and compared its predictive power with various anthropometric indices. Methods：The participants in this study were selected from the epidemiological study of cancer risk of Chinese patients with type 2 diabetes mellitus in Luzhou area. A total of 1 125 participants with prediabetes were selected from the baseline survey. The subjects were divided into four groups（Q1，Q2，Q3，Q4） according to the quartiles of the LAP and followed for five years. We assessed the predictive power of adiposity indices by performing univariate and multivariate binary logistic regression analysis and calculating the area under the receiver operating characteristic（ROC） curve according to their quartiles. Results：Of the 1 064 participants who completed the follow-up，237 were diabetic. The comparison of the four groups of subjects into diabetes showed that Q4 group（92 cases）>Q3 group（69 cases）>Q2 group（48 cases）>Q1 group（28 cases），the difference was statistically significant（χ2=49.308，P=0.000）. Logistic regression analysis showed that after adjusting for any variables and adjusting for age，gender，height，systolic blood pressure，TG，HDL-C，smoking and tea consumption，individuals in higher LAP quartiles at baseline were more likely to develop diabetes than those in lower LAP quartiles. The area under the ROC curve for LAP was significantly greater than that of other adiposity indices，indicating that LAP，compared with BMI，waist circumference（WC） and waist-to-hip ratio（WHR），had a better value in predicting the outcome of predia－betic subjects to diabetes. Conclusion：LAP was strongly asso－ciated with an increased risk of diabetes in prediabetes，and the association was numerical-dependent. LAP may be a predictor of the pro-gression from prediabetes to diabetes. Our data demonstrate that the LAP was a better predictor of diabetes than the BMI，waist circumference and waist-to-hip ratio in prediabetes.