2型糖尿病患者内脏脂肪指数(VAI)的性别差异

Gender Differences in Visceral Adiposity Index (VAI) among Patients with Type 2 Diabetes Mellitus

摘要: 目的：分析不同组别2型糖尿病(T2DM)患者内脏脂肪指数的差异，进一步阐明临床T2DM及合并靶器官损害的高危因素，为早期预防器官损害提供一定理论依据。方法：选取美国国家健康与营养调查(NHANSE)数据库2005~2020年所以符合条件的参与者纳入本研究，分别计算男女VAI。将VAI采用三分位法分为高VAI组、中VAI组、低VAI组，T2DM患者分为糖尿病周围神经病(DPN)、糖尿病视网膜病变(DR)、糖尿病肾病(DN)。采用SPSS26.0进行统计学分析，符合正态分布计量资料组间比较采用单因素方差分析，不符合正态分布的计量资料及计数资料组间比较采用Kruskal-Wallis H检验。采用多元logistic回归分析法，计算各靶器官损害发生风险OR值及95%CI，评估VAI与2型糖尿病靶器官损害的关系。结果：本研究共纳入1338例符合纳入与排除标准的2型糖尿病患者，其中男性764例(57%)，女性574例(43%)。女性患者糖化血红蛋白、VAI、BMI均高于男性(均P < 0.05)，年龄、教育水平、婚姻状况、舒张压、饮酒、糖尿病肾病患病率均低于男性患者(均P < 0.05)。在男性中，低VAI组(VAI ≤ 1.370) 255例；中VAI组(1.370 < VAI ≤ 2.561) 255例；高VAI组(VAI > 2.561) 254例。组间Kruskal-Wallis H检验显示，3组患者T2DM糖尿病周围神经病变(P = 0.997)、糖尿病视网膜病变(P = 0.49)、糖尿病肾病(P = 0.052)检出率无差异。在女性中，低VAI组(VAI ≤ 1.831) 192例；中VAI组(1.831 < VAI ≤ 3.046)191例；高VAI组(VAI > 3.046)191例。组间Kruskal-Wallis H检验显示，3组患者2型糖尿病周围神经病变(P = 0.022)、糖尿病肾病(P = 0.002)检出率存在差异，糖尿病视网膜病变(P = 0.868)检出率无差异。进一步两两比较，高VAI组2型糖尿病周围神经病变(P = 0.022)与低VAI组检出率存在差异。中VAI组及低VAI组之间各数据无差异。高VAI组糖尿病肾病(P = 0.002)与中VAI组、低VAI组检出率存在差异。女性中，以低VAI组为参照，logistic回归分析显示，高VAI是患者发生糖尿病周围神经病变(OR = 1.870, 95%CI = 0.965 − 1.180, P = 0008)、糖尿病肾病(OR = 1.951, 95%CI = 1.258 − 3.028, P = 0.003)的危险因素。结论：女性患者中，高水平的VAI指数与2型糖尿病患者周围神经病及糖尿病肾病发病率呈正相关。高水平的VAI指数是女性患者发生糖尿病周围神经病变及糖尿病肾病的关联因素。评估和管理VAI有助于筛查和防止2型糖尿病女患者的靶器官损伤。

Abstract: Objective: To analyze the differences in the Visceral Adiposity Index (VAI) among different groups of patients with type 2 diabetes mellitus (T2DM), and to further elucidate the high-risk factors for clinical T2DM and associated target organ damage, providing a theoretical basis for the early prevention of organ damage. Methods: Eligible participants from the National Health and Nutrition Examination Survey (NHANES) database (2005~2020) were included in this study. VAI was calculated separately for males and females. Participants were divided into high, medium, and low VAI groups using the tertile method. T2DM patients were categorized based on the presence of diabetic peripheral neuropathy (DPN), diabetic retinopathy (DR), and diabetic kidney disease (DKD). Statistical analysis was performed using SPSS 26.0. One-way ANOVA was used for normally distributed continuous data, and the Kruskal-Wallis H test was used for non-normally distributed continuous data and categorical data comparisons between groups. Multivariate logistic regression analysis was used to calculate the odds ratios (OR) and 95% confidence intervals (CI) for the risk of each target organ damage, assessing the relationship between VAI and target organ damage in T2DM. Results: A total of 1,338 T2DM patients meeting the inclusion and exclusion criteria were enrolled, comprising 764 males (57%) and 574 females (43%). Female patients had higher levels of glycated hemoglobin (HbA1c), VAI, and BMI than males (all P < 0.05), while age, education level, marital status, diastolic blood pressure, alcohol consumption, and prevalence of DKD were lower than in male patients (all P < 0.05). In males: The low VAI group (VAI ≤ 1.370) had 255 cases; the medium VAI group (1.370 < VAI ≤ 2.561) had 255 cases; the high VAI group (VAI > 2.561) had 254 cases. The Kruskal-Wallis H test showed no significant differences in the detection rates of DPN (P = 0.997), DR (P = 0.49), or DKD (P = 0.052) among the three groups. In females: The low VAI group (VAI ≤ 1.831) had 192 cases; the medium VAI group (1.831 < VAI ≤ 3.046) had 191 cases; the high VAI group (VAI > 3.046) had 191 cases. The Kruskal-Wallis H test showed significant differences in the detection rates of DPN (P = 0.022) and DKD (P = 0.002) among the three groups, but no difference for DR (P = 0.868). Further pairwise comparisons revealed that the high VAI group had a significantly different detection rate for DPN compared to the low VAI group (P = 0.022). The high VAI group had a significantly different detection rate for DKD compared to both the medium and low VAI groups (P = 0.002). No differences were found between the medium and low VAI groups for any data. In females, using the low VAI group as reference, logistic regression analysis showed that high VAI was a risk factor for developing DPN (OR = 0.535, 95%CI = 0.337 − 0.848, P = 0.008) and DKD (OR = 1.951, 95%CI = 1.258 − 3.028, P = 0.003). Conclusion: Among female patients, a high VAI is positively correlated with the incidence of diabetic peripheral neuropathy and diabetic kidney disease in T2DM patients. A high VAI is a risk factor for DPN and DKD in female patients. Assessing and managing VAI may help screen for and prevent target organ damage in female patients with T2DM.