Cardiovasc Diabetol:内脏肥胖指数与偶发肾病和视网膜病变的关系:一项糖尿病人群的队列研究

2022-05-24 从医路漫漫 MedSci原创

腰围(WC)是内脏脂肪增加的主要临床指标,鉴于皮下脂肪和内脏脂肪的不同作用,它无法区分皮下脂肪和内脏脂肪块。

背景:约90%的糖尿病患者来自二型糖尿病,这已成为一个严重的全球公共卫生问题。据估计,到2030年,预计将有3.66亿人患有糖尿病,血管并发症已成为二型糖尿病的主要死亡原因。血管并发症严重影响患者的生活质量,并给医疗保健系统带来沉重的经济负担。腹部肥胖被认为是心脏代谢疾病、糖尿病和糖尿病并发症的重要危险因素之一。有趣的是,几项研究报告称,在血管并发症的发展中,脂肪组织的分布比总量更重要。X射线计算机断层扫描(CT)和磁共振成像(MRI)是检测腹部肥胖的精确方法。然而,这些方法昂贵、耗时并且需要辐射暴露,因此它们对于普通人群中的频繁临床使用和流行病学研究是不实用的。腰围(WC)是内脏脂肪增加的主要临床指标,鉴于皮下脂肪和内脏脂肪的不同作用,它无法区分皮下脂肪和内脏脂肪块。因此,已经建立了内脏脂肪指数的一些替代指标,包括内脏脂肪指数(VAI)和中国内脏脂肪指数(CVAI) 。先前的研究发现VAI和CVAI可以预测成年人患糖尿病的风险。然而,目前关于VAI和糖尿病并发症之间联系的证据是有限的。最近的一项研究报告了VAI和CVAI与糖尿病血管并发症的横断面相关性。然而,VAI和CVAI对糖尿病并发症发展的影响仍不清楚。

目的:因此,本研究旨在利用基于人群的队列研究VAI和CVAI与糖尿病肾病和视网膜病变发病率的纵向联系。

方法:来自北京健康管理队列的8 948名二型糖尿病参与者在2013年至2014年期间入选,并随访至2019年12月31日。通过尿白蛋白/肌酐比率和估计的肾小球滤过率来确定肾病;使用眼底照片诊断视网膜病变。

结果:平均年龄为53.35 (14.66)岁,其中男性6 154人(68.8%)。在中位数为4.82年的随访中,467名参与者发生肾病,90名参与者发生视网膜病变。VAI和CVAI水平增加一个标准差与肾病风险增加显著相关,校正风险比(HR)分别为1.127(95% CI 1.050-1.210)和1.165(95% CI 1.003-1.353)。相反,调整混杂因素后,VAI和CVAI水平与视网膜病变无关。

表1研究人群的基线特征

表2内脏脂肪指数与糖尿病肾病和视网膜病变的关系

图1校正年龄和性别后,基线VAI和CVAI与偶发肾病的剂量反应关系

图2预测糖尿病肾病发展的VAI和CVAI的时间依赖性ROC曲线

表3内脏肥胖指数的三分位数与糖尿病肾病和视网膜病变的关系

图3敏感性分析中VAI和CVAI与偶发肾病的关系

结论:在中国成年糖尿病患者中,VAI和CVAI与肾病的发展独立相关,但与视网膜病变无关。

原文出处:Wu Z,  Yu S,  Kang X, et al.Association of visceral adiposity index with incident nephropathy and retinopathy: a cohort study in the diabetic population.Cardiovasc Diabetol 2022 02 24;21(1)

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    2022-06-21 quxin068
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    2022-07-06 docwu2019
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    2022-05-24 zutt
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