血清1,5-AG在2型糖尿病早期诊断中的应用价值-现代医学

血清1,5-AG在2型糖尿病早期诊断中的应用价值

单位：1. 永州市第四人民医院检验科, 湖南永州 425000;
2. 中南大学湘雅医院检验科, 湖南长沙 410008

分类号：R587.1

出版年·卷·期（页码）：2023·51·第九期（1220-1226）

摘要：

目的：检测糖尿病前期(p-T2DM)及2型糖尿病(T2DM)患者血清1,5-D-山梨醇(1,5-AG)水平，并探讨其作为T2DM早期诊断指标的应用价值。方法：选取2022年5月至9月在中南大学湘雅医院内分泌科和肾病内科住院的T2DM患者55例为T2DM组，其中男38例、女17例，平均年龄(55.13±8.44)岁；在内分泌科就诊的p-T2DM患者51例为p-T2DM组，其中男30例、女21例，平均年龄(55.18±10.02)岁；并按照年龄性别进行匹配后收集同期健康体检者51例为对照组，其中男33例、女18例，平均年龄(52.00±6.49)岁。收集各组临床资料，并测定各组患者血清1,5-AG水平进行统计分析。结果：1,5-AG在对照组[(142.73±53.51)mmol·L^-1]、p-T2DM组[(113.48±65.48)mmol·L^-1]及T2DM组[(49.88±56.31)mmol·L^-1]中水平逐渐降低，且各组两两比较差异均有统计学意义(均P＜0.05)；相关性分析结果表明，1,5-AG与体质指数(r=-0.184,P=0.021)、尿素(r=-0.177,P=0.028)、甘油三酯(r=-0.303,P＜0.001)、非高密度脂蛋白胆固醇(r=-0.185,P=0.025)、空腹血糖(r=-0.529,P＜0.001)及糖化血红蛋白(HbA1C)(r=-0.565,P＜0.001)显著负相关，与高密度脂蛋白胆固醇(HDL-C)(r=0.227,P=0.006)及高密度脂蛋白胆固醇-总胆固醇比值(r=0.244,P=0.003)显著正相关。多元线性回归显示总胆红素(TB)、直接胆红素(DB)、尿酸(UA)、HDL-C及餐后2 h血糖(2 h-BG)为血清1,5-AG的主要影响因素，线性回归方程为Y=-5.16X₁+14.66X₂+0.2X₃+82.37X₄-6.63X₅(Y=1,5-AG；X₁=TB；X₂=DB；X₃=UA；X₄=HDL；X₅=2h-BG)，该模型能解释血清1,5-AG变化水平的58.2%。Logistic回归分析表明1,5-AG水平降低、收缩压和HbA1C水平升高是p-T2DM向T2DM进展的独立危险因素(P＜0.05)。血清1,5-AG区分p-T2DM与T2DM的曲线下面积(AUC)为0.821(95%CI 0.727~0.915)，截断值为93.15 mmol·L^-1,敏感度为0.852，特异度为0.815。结论：血清1,5-AG水平降低是p-T2DM进展为T2DM的危险因素，对T2DM的早期诊断具有重要的临床意义。

Objective: To detect the level of serum 1,5-anhydroglucitol(1,5-AG) in patients with prediabetes(p-T2DM) and type 2 diabetes(T2DM), and to explore its application value as an early diagnostic indicator of T2DM.Methods: From May 2022 to September 2022,55 hospitalized patients with T2DM in the department of endocrinology and nephrology of Xiangya Hospital of Central South University were collected as T2DM group, including 38 males and 17 females, with an average age of(55.13±8.44) years old;51 patients with p-T2DM in the department of endocrinology were collected as p-T2DM group, including 30 males and 21 females, with an average age of(55.18±10.02) years old. After matching according to age and sex, 51 healthy subjects were collected as the control group, including 33 males and 18 females, with an average age of(52.00±6.49) years old. The clinical data of each group were collected, and the serum 1,5-AG levels of each group were measured for statistical analysis.Results: The levels of 1,5-AG in the control group [(142.73±53.51) mmol·L^-1], p-T2DM group[(113.48±65.48) mmol·L^-1] and T2DM group [(49.88±56.31) mmol·L^-1] decreased gradually, and the differences between the groups were statistically significant(all P<0.05). The results of correlation analysis show that 1,5-AG was negatively correlated with body mass index(r=-0.184, P= 0.021),urea(r=-0.177,P=0.028),triglyceride(r=-0.303,P<0.001), non-high-density lipoprotein cholesterol(r=-0.185,P=0.025), fasting blood glucose(r=-0.529,P<0.001) and glycosylated hemoglobin(HbA1C)(r=-0.565, P<0.001), and positively correlated with high-density lipoprotein cholesterol(HDL-C)(r=0.227,P=0.006) and HDL-C to total cholesterol ratio(r=0.244, P=0.003). Multiple linear regression showed that total bilirubin(TB), direct bilirubin(DB), uric acid(UA), HDL-C, and 2-hour post-meal blood glucose(2h-BG) were the main influencing factors for serum 1,5-AG.The linear regression equation was Y=-5.16X₁+14.66X₂+0.2X₃+82.37X₄-6.63X₅(Y=1,5-AG；X₁=TB；X₂=DB；X₃=UA；X₄=HDL-C；X₅=2h-BG), which explained 58.2% of the change in serum 1,5-AG level. Logistic regression analysis revealed that the decrease of 1,5-AG level, the increase of systolic blood pressure and HbA1C level were independent risk factors for the progression of p-T2DM to T2DM(P<0.05). Area under the curve(AUC) of serum 1, 5-AG to distinguish p-T2DM from T2DM was 0.821(95% CI 0.727-0.915), the cut-off value was 93.15 mmol·L^-1, the sensitivity was 0.852, and the specificity was 0.815. Conclusion: The decrease of serum 1,5-AG level is a risk factor for the progression of p-T2DM to T2DM, which has important clinical significance for the early diagnosis of T2DM.

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