摘要
目的探讨甘油三酯葡萄糖(Ty G)指数与T2DM合并肾功能不全(RI)患者出现早期肾衰竭(ERF)的相关性。方法选取2019年7月至2022年7月我院收治的T2DM合并RI患者141例,以2019年7月至2021年12月的94例为训练集,以2022年1月至2022年7月的47例为验证集,训练集分为单纯T2DM+RI组(n=48)和ERF组(n=46)。比较两组一般资料及生化指标,Logistic回归分析T2DM合并RI患者发生ERF的影响因素,限制性立方样条法(RCS)分析Ty G指数与ERF的剂量‑反应关系,建立回归方程预测模型并验证。受试者工作特征(ROC)曲线下面积(AUC)和校准曲线评价区分度与准确性。结果ERF组TC、TG、LDL‑C、HDL‑C、FPG、Ty G指数、Hb A_(1)c、血肌酐(Scr)、血尿酸、BUN、胱抑素、β2微球蛋白高于T2DM+RI组(P<0.05),总蛋白(TP)、白蛋白(Alb)、凝血酶原时间、e GFR低于T2DM+RI组(P<0.05)。Logistic回归分析显示,校正混杂因素后,与Q1组比较,Q2~Q4组ERF发生风险随Ty G指数升高而升高(P_(趋势)<0.001)。RCS分析显示,男、女性T2DM合并RI患者Ty G指数与ERF风险均不存在非线性剂量‑反应关系(P_(非线性)=0.738、0.664,P_(总趋势)<0.001)。T2DM合并RI患者发生ERF的预测模型为P=1-1/(1+e^(1.018+0.534×TyG指数+0.449×Scr+1.246×BUN+1.626×e^GFR+0.532×Hb A_(1)c-1.232×TP-0.782×Alb))。ROC曲线显示,模型预测前后AUC分别为0.883、0.872,敏感度分别为87.67%、88.18%,特异度分别为87.44%、87.18%,截断值分别为3.52、2.66。校准曲线分析显示,模型预测前后拟合度较好。结论TyG指数与ERF发生相关,基于此构建的预测模型对T2DM合并RI患者发生ERF具有一定预测能力。
Objective To explore the correlation between triglyceride glucose(TyG)index and early renal failure(ERF)in type 2 diabetes mellitus(T2DM)patients with renal insufficiency(RI).Methods A total of 141 patients with T2DM combined with RI admitted to our hospital from July 2019 to July 2022 were selected.Among them,94 cases from July 2019 to December 2021 were used as the training set,and 47 cases from January 2022 to July 2022 were used as the validation set.The training set was divided into the simple T2DM+RI group(n=48)and the ERFgroup(n=46).The general data and biochemical indicators of the two groups were compared.Logistic regression analysis was used to analyze the influencing factors of ERF in patients with T2DM combined with RI.The restricted cubic spline method(RCS)was used to analyze the dose-response relationship between the TyG index and ERF.A regression equation prediction model was established and verified.The area under the receiver operating characteristic(ROC)curve(AUC)and the calibration curve were used to evaluate the discrimination and accuracy.Results The total cholesterol,triglycerides,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,fasting plasma glucose(FPG),TyG index,hemoglobin A_(1)c(HbA_(1)c),serum creatinine(Scr),serum uric acid,serum urea nitrogen(BUN),cystatin,andβ2 microglobulin in the ERFgroup were higher than those in the T2DM+RI group(P<0.05),while total protein(TP),albumin(Alb),prothrombin time,and estimated glomerular filtration rate(eGFR)were lower than those in the T2DM+RI group(P<0.05).Logistic regression analysis revealed that after adjusting for confounding factors,compared with the Q1 group,the risk of ERF increased with the elevation of TyG index in the Q2 to Q4 groups(P_(for trend)<0.O01).RCS analysis showed that there was no non-linear dose-response relationship between the TyG index and the risk of ERF in male and female patients with T2DM and RI(P_(nonliear)=0.738,O.664,P_(total trend)<0.O01).The predictive model for the occurrence of ERF in patients with T2DM and RI was P=1-1/(1+e^(1.018+0.534×TyG index+0.449×Scr+1.246×BUN+1.626×eGFR+0.532×HbA_(1)c-1.232×TP-0.782×Alb)).The ROC curveS shOWed that the AUC before and after model predictions are 0.883 and 0.872 respectively,the sensitivity were 87.67%and 88.18%respectively,the specificity were 87.44%and 87.18%respectively,and the cut-off values were 3.52 and 2.66 respectively.The calibration curves analysis showed that the model prediction has good fit Conclusions The TyG index is correlated with the occurrence of ERF.Based on this,the constructed prediction model has certain predictive ability for the occurrence of ERF in patients with T2DM and RI.
作者
黄晓丹
刘淑婵
HUANG Xiaodan;LIU Shuchan(Departmentof Endocrinology,Puyang Oilfield General Hospital,Puyang 457001,China)
出处
《中国糖尿病杂志》
北大核心
2026年第3期202-207,共6页
Chinese Journal of Diabetes
关键词
糖尿病
2型
肾功能不全
早期肾衰竭
甘油三酯葡萄糖指数
相关性
Diabetes mellitus,type 2
Renal insufficiency
Early renalfailure
Triglyceride glucose index
Correlation
