三酰甘油/高密度脂蛋白胆固醇比值与糖尿病并发症的关系研究进展

doi:10.12114/j.issn.1007-9572.2021.00.419

摘要/Abstract

摘要： 糖尿病作为重要公共健康问题，严重影响人们生活质量，给社会经济带来严重负担，特别是糖尿病并发症。血脂异常在糖尿病人群中患病率逐年上升，脂代谢异常在糖尿病并发症的发生及发展中占有重要的地位，逐渐被人们重视，尤其是三酰甘油（TG）/高密度脂蛋白胆固醇（HDL-C）比值，是目前临床研究热点问题，根据目前研究发现，TG/HDL-C比值在糖尿病并发症的发生、发展中起到重要作用。本文就TG/HDL-C比值与糖尿病并发症的关系情况做一综述，发现TG/HDL-C比值与糖尿病并发症有关，与微血管并发症及大血管并发症均有联系，但是，仅从目前研究中，TG/HDL-L比值与糖尿病具体并发症的切值没有统一的标准，还需进一步研究。

关键词: 糖尿病并发症, 脂代谢异常, 三酰甘油/高密度脂蛋白胆固醇比值, 综述

Abstract: As an important public health issue，diabetes and its associated complications seriously affect the patients' quality of life，and impose a serious burden on society and economy.Increasing dyslipidemia prevalence in diabetics and the key role of abnormal lipid metabolism in the development of diabetic complications have attracted increasing attentions.Among the research topics of lipid with diabetes，triglyceride/high-density lipoprotein cholesterol（TG/HDL-C）ratio and diabetes is a clinical focus.Available studies have found that TG/HDL-C ratio plays a vital role in the development of diabetes.We reviewed recent advances in the relationship between TG/HDL-C ratio and diabetic complications. it is found that there is a correlation between TG/HDL-C ratio and diabetic complications，whether it is microvascular complications and macrovascular complications. However，only from the current research，there is no unified standard between TG/HDL-ratio and diabetes specific complications，and further research is needed.

Key words: Diabetic complications, Abnormal lipid metabolism, Triglyceride / high density lipoprotein cholesterol ratio, Review

姚伟列,颜雅青,欧典强,等. 三酰甘油/高密度脂蛋白胆固醇比值与糖尿病并发症的关系研究进展[J]. 中国全科医学, 2021, 24(17): 2224-2229. DOI: 10.12114/j.issn.1007-9572.2021.00.419.
YAO Weilie,YAN Yaqing,OU Dianqiang, et al. Recent Advances in the Relationship between Plasma Triglyceride/High-density Lipoprotein Cholesterol Ratio and Diabetic Complications　[J]. Chinese General Practice, 2021, 24(17): 2224-2229. DOI: 10.12114/j.issn.1007-9572.2021.00.419.

参考文献

［1］SAEEDI P，PETERSOHN I，SALPEA P，et al．Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045：results from the International Diabetes Federation Diabetes Atlas，9th edition［J］．Diabetes Res Clin Pract，2019，157：107843．DOI：10.1016/j.diabres.2019.107843.
［2］BROWNLEE M.The pathobiology of diabetic complications：a unifying mechanism［J］．Diabetes，2005，54（6）：1615-1625．DOI：10.2337/diabetes.54.6.1615.
［3］PANTOJA-TORRES B，TORO-HUAMANCHUMO C J，URRUNAGA-PASTOR D，et al．High triglycerides to HDL-cholesterol ratio is associated with insulin resistance in normal-weight healthy adults［J］．Diabetes Metab Syndr，2019，13（1）：382-388．DOI：10.1016/j.dsx.2018.10.006.
［4］CHENG C，LIU Y，SUN X Z，et al．Dose-response association between the triglycerides：high-density lipoprotein cholesterol ratio and type 2 diabetes mellitus risk：the rural Chinese cohort study and meta-analysis［J］．J Diabetes，2019，11（3）：183-192．DOI：10.1111/1753-0407.12836.
［5］HAN T S，CHENG Y，TIAN S，et al．Changes in triglycerides and high-density lipoprotein cholesterol may precede peripheral insulin resistance，with 2-h insulin partially mediating this unidirectional relationship：a prospective cohort study［J］．Cardiovasc Diabetol，2016，15（1）：154．DOI：10.1186/s12933-016-0469-3.
［6］YOUNG K A，MATURU A，LORENZO C，et al．The triglyceride to high-density lipoprotein cholesterol（TG/HDL-C）ratio as a predictor of insulin resistance，β-cell function，and diabetes in Hispanics and African Americans［J］．J Diabetes Complications，2019，33（2）：118-122．DOI：10.1016/j.jdiacomp.2018.10.018.
［7］LEE M Y，HSIAO P J，HUANG J C，et al．Associations between triglyceride/high-density lipoprotein cholesterol ratio and micro-and macroangiopathies in type 2 diabetes mellitus［J］．Endocr Pract，2018，24（7）：615-621．DOI：10.4158/EP-2017-0254.
［8］JUNG U J，CHOI M S.Obesity and its metabolic complications：the role of adipokines and the relationship between obesity，inflammation，insulin resistance，dyslipidemia and nonalcoholic fatty liver disease［J］．Int J Mol Sci，2014，15（4）：6184-6223．DOI：10.3390/ijms15046184.
［9］LAM T K T，CARPENTIER A，LEWIS G F，et al．Mechanisms of the free fatty acid-induced increase in hepatic glucose production［J］．Am J Physiol-Endocrinol Metab，2003，284（5）：E863-873．DOI：10.1152/ajpendo.00033.2003.
［10］HIRAI F E，TIELSCH J M，KLEIN B E，et al．Ten-year change in vision-related quality of life in type 1 diabetes：Wisconsin epidemiologic study of diabetic retinopathy［J］．Ophthalmology，2011，118（2）：353-358．DOI：10.1016/j.ophtha.2010.06.022.
［11］XIE X W，XU L，JONAS J B，et al．Prevalence of diabetic retinopathy among subjects with known diabetes in China：the Beijing Eye Study［J］．Eur J Ophthalmol，2009，19（1）：91-99．DOI：10.1177/112067210901900114.
［12］SACKS F M，HERMANS M P，FIORETTO P，et al．Association between plasma triglycerides and high-density lipoprotein cholesterol and microvascular kidney disease and retinopathy in type 2 diabetes mellitus：a global case-control study in 13 countries［J］．Circulation，2014，129（9）：999-1008．DOI：10.1161/CIRCULATIONAHA.113.002529.
［13］The ACCORD Study Group and ACCORD Eye Study Group.Effects of medical therapies on retinopathy progression in type 2 diabetes［J］．N Engl J Med，2010，363（3）：233-244．DOI：10.1056/nejmoa1001288.
［14］RUSSO G T，GIANDALIA A，ROMEO E L，et al．HDL subclasses and the common CETP TaqIB variant predict the incidence of microangiopatic complications in type 2 diabetic women：a 9 years follow-up study［J］．Diabetes Res Clin Pract，2017，132：108-117．DOI：10.1016/j.diabres.2017.07.026.
［15］ZOPPINI G，NEGRI C，STOICO V，et al．Triglyceride-high-density lipoprotein cholesterol is associated with microvascular complications in type 2 diabetes mellitus［J］．Metabolism，2012，61（1）：22-29．DOI：10.1016/j.metabol.2011.05.004.
［16］YANG H，YOUNG D，GAO J，et al．Are blood lipids associated with microvascular complications among type 2 diabetes mellitus patients? A cross-sectional study in Shanghai，China［J］．Lipids Health Dis，2019，18（1）：18．DOI：10.1186/s12944-019-0970-2.
［17］ZHANG L X，LONG J Y，JIANG W S，et al．Trends in chronic kidney disease in China［J］．N Engl J Med，2016，375（9）：905-906．DOI：10.1056/nejmc1602469.
［18］JENKINS A J，LYONS T J，ZHENG D Y，et al．Lipoproteins in the DCCT/EDIC cohort：associations with diabetic nephropathy［J］．Kidney Int，2003，64（3）：817-828．DOI：10.1046/j.1523-1755.2003.00164.x.
［19］RUSSO G T，DE COSMO S，VIAZZI F，et al．Plasma triglycerides and HDL-C levels predict the development of diabetic kidney disease in subjects with type 2 diabetes：the AMD annals initiative［J］．Dia Care，2016，39（12）：2278-2287．DOI：10.2337/dc16-1246.
［20］YUN K J，KIM H J，KIM M K，et al．Risk factors for the development and progression of diabetic kidney disease in patients with type 2 diabetes mellitus and advanced diabetic retinopathy［J］．Diabetes Metab J，2016，40（6）：473-481．DOI：10.4093/dmj.2016.40.6.473.
［21］THOMAS M C，BROWNLEE M，SUSZTAK K，et al．Diabetic kidney disease［J］．Nat Rev Dis Primers，2015，1：15018．DOI：10.1038/nrdp.2015.18.
［22］DAVIS T M，TING R，BEST J D，et al．Effects of fenofibrate on renal function in patients with type 2 diabetes mellitus：the Fenofibrate Intervention and Event Lowering in Diabetes（FIELD）Study［J］．Diabetologia，2011，54（2）：280-290．DOI：10.1007/s00125-010-1951-1.
［23］RUSSO G T，HORVATH K V，DI BENEDETTO A，et al．Influence of menopause and cholesteryl ester transfer protein（CETP）TaqIB polymorphism on lipid profile and HDL subpopulations distribution in women with and without type 2 diabetes［J］．Atherosclerosis，2010，210（1）：294-301．DOI：10.1016/j.atherosclerosis.2009.11.011.
［24］BOOTH G L，KAPRAL M K，FUNG K，et al．Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people：a population-based retrospective cohort study［J］．Lancet，2006，368（9529）：29-36．DOI：10.1016/S0140-6736（06）68967-8.
［25］WEN J，HUANG Y，LU Y，et al．Associations of non-high-density lipoprotein cholesterol，triglycerides and the total cholesterol/HDL-c ratio with arterial stiffness independent of low-density lipoprotein cholesterol in a Chinese population［J］．Hypertens Res，2019，42（8）：1223-1230．DOI：10.1038/s41440-019-0251-5.
［26］YANG S H，DU Y，LI X L，et al．Triglyceride to high-density lipoprotein cholesterol ratio and cardiovascular events in diabetics with coronary artery disease［J］．Am J Med Sci，2017，354（2）：117-124．DOI：10.1016/j.amjms.2017.03.032.
［27］VEGA G L，BARLOW C E，GRUNDY S M，et al．Triglyceride-to-high-density-lipoprotein-cholesterol ratio is an index of heart disease mortality and of incidence of type 2 diabetes mellitus in men［J］．J Investig Med，2014，62（2）：345-349．DOI：10.2310/JIM.0000000000000044.
［28］MURGUIA-ROMERO M，JIMENEZ-FLORES J R，SIGRIST-FLORES S C，et al．Plasma triglyceride/HDL-cholesterol ratio，insulin resistance，and cardiometabolic risk in young adults［J］．J Lipid Res，2013，54（10）：2795-2799．DOI：10.1194/jlr.M040584.
［29］KIM J S，KIM W，WOO J S，et al．The predictive role of serum triglyceride to high-density lipoprotein cholesterol ratio according to renal function in patients with acute myocardial infarction［J］．PLoS One，2016，11（10）：e0165484．DOI：10.1371/journal.pone.0165484.
［30］GERHARD-HERMAN M D，GORNIK H L，BARRETT C，et al．2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease：executive summary：a report of the American college of cardiology/American heart association task force on clinical practice guidelines［J］．Circulation，2017，135（12）：e686-725．DOI：10.1161/CIR.0000000000000470.
［31］NEWMAN A B，SISCOVICK D S，MANOLIO T A，et al．Ankle-arm index as a marker of atherosclerosis in the cardiovascular health study.cardiovascular heart study（CHS）collaborative research group［J］．Circulation，1993，88（3）：837-845．DOI：10.1161/01.cir.88.3.837.
［32］DURAN E K，ADAY A W，COOK N R，et al．Triglyceride-rich lipoprotein cholesterol，small dense LDL cholesterol，and incident cardiovascular disease［J］．J Am Coll Cardiol，2020，75（17）：2122-2135．DOI：10.1016/j.jacc.2020.02.059.
［33］TOTH P P，PHILIP S，HULL M，et al．Hypertriglyceridemia is associated with an increased risk of peripheral arterial revascularization in high-risk statin-treated patients：a large administrative retrospective analysis［J］．Clin Cardiol，2019，42（10）：908-913．DOI：10.1002/clc.23241.
［34］RIDKER P M，STAMPFER M J，RIFAI N.Novel risk factors for systemic atherosclerosis：a comparison of C-reactive protein，fibrinogen，homocysteine，lipoprotein（a），and standard cholesterol screening as predictors of peripheral arterial disease［J］．JAMA，2001，285（19）：2481-2485．DOI：10.1001/jama.285.19.2481.
［35］MEADE T，ZUHRIE R，COOK C，et al．Bezafibrate in men with lower extremity arterial disease：randomised controlled trial［J］．BMJ，2002，325（7373）：1139．DOI：10.1136/bmj.325.7373.1139.
［36］HIRAYAMA S，MIIDA T.Small dense LDL：an emerging risk factor for cardiovascular disease［J］．Clin Chimica Acta，2012，414：215-224．DOI：10.1016/j.cca.2012.09.010.
［37］ZHEN Q N，YAO N，CHEN X J，et al．Total body adiposity，triglycerides，and leg fat are independent risk factors for diabetic peripheral neuropathy in Chinese patients with type 2 diabetes mellitus［J］．Endocr Pract，2019，25（3）：270-278．DOI：10.4158/EP-2018-0459.
［38］CALLAGHAN B C，CHENG H T，STABLES C L，et al．Diabetic neuropathy：clinical manifestations and current treatments［J］．Lancet Neurol，2012，11（6）：521-534．DOI：10.1016/S1474-4422（12）70065-0.
［39］VAN ACKER K，BOUHASSIRA D，DE BACQUER D，et al．Prevalence and impact on quality of life of peripheral neuropathy with or without neuropathic pain in type 1 and type 2 diabetic patients attending hospital outpatients clinics［J］．Diabetes Metab，2009，35（3）：206-213．DOI：10.1016/j.diabet.2008.11.004.
［40］SMITH A G，SINGLETON J R.Obesity and hyperlipidemia are risk factors for early diabetic neuropathy［J］．J Diabetes Complications，2013，27（5）：436-442．DOI：10.1016/j.jdiacomp.2013.04.003.
［41］李东风，章秋.三酰甘油/高密度脂蛋白胆固醇比值对老年糖尿病患者周围神经病变的预测价值研究［J］．中国全科医学，2020，23（29）：3690-3694.
［42］PADILLA A，DESCORBETH M，ALMEYDA A L，et al．Hyperglycemia magnifies Schwann cell dysfunction and cell death triggered by PA-induced lipotoxicity［J］．Brain Res，2011，1370：64-79．DOI：10.1016/j.brainres.2010.11.013.
［43］MCCALL K D，HOLLIDAY D，DICKERSON E，et al．Phenylmethimazole blocks palmitate-mediated induction of inflammatory cytokine pathways in 3T3L1 adipocytes and RAW 264.7 macrophages［J］．J Endocrinol，2010，207（3）：343-353．DOI：10.1677/JOE-09-0370.
［44］VINCENT A M，CALLAGHAN B C，SMITH A L，et al．Diabetic neuropathy：cellular mechanisms as therapeutic targets［J］．Nat Rev Neurol，2011，7（10）：573-583．DOI：10.1038/nrneurol.2011.137.

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