甘油三酯与2型糖尿病关系的回顾性队列研究

A retrospective cohort study on the relationship between triglyceride and type 2 diabetes mellitus

摘要:

目的：探究中国人群中甘油三酯（triglyceride，TG）与2型糖尿病（type 2 diabetes mellitus，T2DM）发病风险之间的关系。方法：本研究是一项回顾性队列研究。有211 833名参与者被纳入研究，并在5年内完成至少2次随访。采用Cox比例风险回归模型，以评估连续性变量TG及TG三分组与T2DM风险之间的独立关系，对潜在的混杂因素进行校准。本研究使用广义加性模型来识别其是否存在非线性关系，并采用基于最大似然法的原理通过递归实验自动计算阈值效应的临界点。结果：Cox比例风险回归模型中调整各种可能存在影响的因素后，显示TG可作为T2DM事件发生的危险因素（HR=1.20，95%CI=1.15~1.24，P<0.001）。TG与T2DM发病风险之间存在非线性关系。用分段线性回归模型计算TG的拐点为1.27 mmol/L（对数似然比检验P<0.001）。在临界点左侧，TG与T2DM发病率呈显著正相关（HR=2.30，95%CI=1.89~2.79，P<0.001）。在临界点右侧，TG与T2DM发病风险的关系趋于饱和（HR=1.08，95%CI=1.03~1.13，P<0.001）。结论：中国人群中TG可作为T2DM事件发生的危险因素，且TG水平与T2DM事件发生存在非线性关系与阈值饱和效应。

Abstract:

Objective：To explore the relationship between triglyceride（TG） and the risk of type 2 diabetes mellitus（T2DM） in Chinese population. Methods：This study was a retrospective cohort study. A total of 211 833 participants were included in the study and completed at least two follow-up visits within 5 years. The Cox proportional hazard regression model was used to evaluate the independent relationship between the continuous variables TG and TG tri-groups and the T2DM risk，and to calibrate the potential confounding factors. This study used a generalized additive model to identify whether there was a nonlinear relationship，and used the principle based on the maximum likelihood method to automatically calculate the critical point of the threshold effect through recursive experiments. Results：The Cox proportional hazard regression model adjusted for various possible influencing factors，showing that TG could be used as a risk factor for T2DM events（HR=1.20，95%CI=1.15-1.24，P<0.001）. There was a non-linear relationship between TG and the risk of T2DM. The inflection point of TG calculated by piecewise linear regression model was 1.27 mmol/L（P<0.001 for log-likelihood ratio test）. On the left side of the critical point，TG was significantly positively correlated with the incidence of T2DM（HR=2.30，95%CI=1.89-2.79，P<0.001）. On the right side of the critical point，the relationship between TG and the risk of T2DM tended to be saturated（HR=1.08，95%CI=1.03-1.13，P<0.001）. Conclusion：TG can be used as a risk factor for the occur－rence of T2DM events in the Chinese population，and there is a non-linear relationship and a threshold saturation effect between TG levels and the occurrence of T2DM events.