2型糖尿病患者体脂分布与糖尿病肾脏病及其临床表型的关系OA

Objective To investigate the relationships between body fat distribution indices and diabetic kidney dis-ease(DKD)and its clinical phenotypes in patients with type 2 diabetes mellitus(T2DM).Methods A retrospective study was conducted involving 1,112 patients with T2DM.General clinical data and laboratory parameters were collected via the electronic medical records system.Multifrequency bioelectrical impedance analysis was used to determine the body fat mass(BFM),body fat percentage(PBF),visceral fat area(VFA),waist-to-hip ratio(WHR),upper limb fat-to-total fat mass ratio(AF/TF),lower limb fat-to-total fat mass ratio(LF/TF),limb-to-total fat mass ratio(Limb/TF),and trunk-to-total fat mass ratio(Trunk/TF).Diabetic kidney disease(DKD)was diagnosed based on the urine albumin-to-creati-nine ratio(UACR)and estimated glomerular filtration rate(eGFR),with patients further classified into albuminuric and impaired filtration subtypes.Based on the quartiles of each body fat distribution indicator,we categorised indicators from low to high as Q1,Q2,Q3 and Q4.Multiple linear regression was used to analyse the correlation between body fat distri-bution indicators and renal function parameters;a restricted cubic spline(RCS)model was employed to analyse the dose-response relationship between body fat distribution indicators and the risk of DKD;and multivariate Logistic regres-sion was used to analyse the relationships between different levels of body fat distribution and DKD and its clinical pheno-types.Results Among 1,112 patients with T2DM,318 developed DKD,yielding an incidence rate of 28.6%;of these,304 presented with albuminuric DKD and 68 with impaired filtration function.Results of multiple linear regression analysis showed that WHR,PBF and Trunk/TF were all positively correlated with eGFR(all P<0.05),whilst none of the body fat distribution indices showed a statistically significant correlation with the log-transformed UACR(all P>0.05).Re-sults from the RCS model analysis showed that WHR exhibited an approximately'U-shaped'non-linear relationship with the risk of DKD(overall P=0.010,non-linearity P=0.003).Results from multivariate Logistic regression analysis indi-cated that,compared with WHR Q2,WHR Q1,Q3 and Q4 were all independently associated with an increased risk of DKD(OR=1.69,1.54 and 1.66,respectively;all P<0.05);compared with LF/TF Q1,LF/TF Q2 was independently associat-ed with a reduced risk of DKD(OR=0.62,P<0.05).Clinical phenotype analysis revealed that,compared with WHR Q2,both WHR Q1 and Q3 were independently associated with an increased risk of albuminuria(OR=1.83 and 1.62,respec-tively;both P<0.05);compared with LF/TF Q1,LF/TF Q2 was independently associated with a reduced risk of albumin-uria(OR=0.60,P<0.05);compared with Trunk/TF Q1,both Trunk/TF Q2 and Q3 were independently associated with a reduced risk of impaired filtration function(OR=0.42 and 0.45,respectively;both P<0.05).Conclusions Body fat distribution in patients with T2DM is associated with DKD and its clinical phenotypes in a non-linear and phenotypically heterogeneous manner.WHR exhibits an approximate'U-shaped'relationship with the risk of DKD;LF/TF at the Q2 lev-el is associated with reduced risks of DKD and albuminuric DKD;Trunk/TF at the Q2 and Q3 levels is associated with a re-duced risk of DKD with impaired filtration function.