肾功能状态和体质指数与江苏省社区2型糖尿病患者死亡风险的交互作用研究

李梦夏; 何家镠; 俞浩; 范习康; 杨婕; 覃玉; 沈冲; 陆艳; 潘恩春; 陶然; 张永青; 苏健

Abstract

李梦夏,何家镠,俞浩,范习康,杨婕,覃玉,沈冲,陆艳,潘恩春,陶然,张永青,苏健.肾功能状态和体质指数与江苏省社区2型糖尿病患者死亡风险的交互作用研究[J].Chinese journal of Epidemiology,2025,46(1):50-56

肾功能状态和体质指数与江苏省社区2型糖尿病患者死亡风险的交互作用研究

Interaction between renal function and body mass index on all-cause mortality risk in patients with type 2 diabetes mellitus in communities in Jiangsu Province

Received:May 08, 2024

DOI：10.3760/cma.j.cn112338-20240508-00247

KeyWord: 糖尿病 2型肾功能异常体质指数交互作用死亡风险

English Key Word: Diabetes mellitus type 2 Renal dysfunction Body mass index Interaction Risk of mortality

FundProject:江苏省卫生健康委员会医学科研项目（M2020085，H2023022）；苏州市科技局民生科技-科技示范工程项目（SS202010）

Author Name	Affiliation	E-mail
Li Mengxia	Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
He Jialiu	School of Public Health, Southeast University, Nanjing 210009, China
Yu Hao	Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Fan Xikang	Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Yang Jie	Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Qin Yu	Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Shen Chong	School of Public Health, Nanjing Medical University, Nanjing 211166, China
Lu Yan	Suzhou Prefectural Center for Disease Control and Prevention, Suzhou 215003, China
Pan Enchun	Huai'an Prefectural Center for Disease Control and Prevention, Huai'an 223001, China
Tao Ran	Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Zhang Yongqing	Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Su Jian	Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China	sujiangx@163.com

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Abstract:

目的探讨江苏省社区2型糖尿病（T2DM）患者中肾功能状态和体质指数（BMI）之间的交互作用及其联合作用与全因死亡风险的关联。方法研究对象来自2013年12月至2014年1月开展的江苏省社区糖尿病综合干预及应用研究项目，并随访至2023年9月30日，共纳入20 025名研究对象。采用Cox比例风险回归模型分析肾功能状态与T2DM患者死亡风险的关联，并探讨肾功能状态与BMI在T2DM患者死亡风险的交互作用和联合作用。结果累计随访198 370人年，死亡4 459名。Cox比例风险回归模型显示，与肾功能正常者相比，肾功能异常者死亡风险升高71%（HR=1.71，95%CI：1.59~1.84），且在各BMI亚组中，肾功能异常均与T2DM患者全因死亡风险升高相关。似然比检验表明，肾功能状态和BMI之间存在交互作用（交互P=0.030）。联合作用分析显示，以肾功能正常且BMI正常的T2DM患者为参照，肾功能正常且超重或肥胖的T2DM患者死亡风险降低，低体重者死亡风险升高，以肾功能异常且低体重者死亡风险最高（HR=2.78，95%CI：1.87~4.14）。结论肾功能状态与BMI在T2DM患者死亡风险中存在交互作用，肾功能异常且低体重者死亡风险显著升高。

English Abstract:

Objective To investigate the association of the interaction and combined effect of renal function and body mass index (BMI) with the risk for all-cause death in patients with type 2 diabetes mellitus (T2DM) in communities of Jiangsu Province. Methods The study subjects were from the Comprehensive Research Project of Diabetes Prevention and Control conducted in Jiangsu from December 2013 to January 2014, and follow up was conducted for them until September 30, 2023. A total of 20 025 subjects were included in the study. Cox proportional hazards regression model was used to analyze the association of renal function with risk for death in T2DM patients, and the association of interaction between renal function and BMI and their combined effect with all-cause death risk in T2DM patients. Results In the follow up for 198 370 person-years, a total of 4 459 deaths were recorded. Cox proportional hazards regression model analysis showed that renal dysfunction was associated with 71% risk of all-cause mortality in all T2DM patients [hazard ratio (HR) =1.71, 95%CI: 1.59-1.84], as well as in all BMI subgroups. Likelihood ratio test indicated an interaction between renal function and BMI (interaction for P=0.030). Compared with patients with normal renal function and normal BMI, those with normal renal function and over weight or obesity had a lower risk of all-cause mortality, and those with renal dysfunction and low weight had the highest risk for death (HR=2.78, 95%CI: 1.87-4.14). Conclusions There is association of interaction between renal function and BMI with all-cause mortality in T2DM patients. T2DM patients with renal dysfunction and low body weight had significant higher risk for death.

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