Predictive value of atherogenic index of plasma and apolipoprotein A1 for the development of diabetic nephropathy in elderly patients with type 2 diabetes

MEN Hengtong; WANG Zhaopeng; YANG Meili; LYU Chunfeng; WANG Shanshan

doi:10.13431/j.cnki.immunol.j.20260008

Abstract：Objective To analyze the predictive value of atherogenic index of plasma(AIP)and apolipoprotein A1(ApoA1)for the development of diabetic kidney disease(DKD)in elderly patients with type 2 diabetes mellitus(T2DM).Methods Elderly patients with T2DM admitted from January 2018 to January 2020 were selected as the research subjects.After a 5-year follow-up,patients with DKD were included in the DKD group,and those without DKD were included in the T2DM group.The general data at admission and the levels of AIP and serum ApoA1 were compared between the two groups,and the influencing factors of the development of DKD in elderly T2DM patients were analyzed.The dose-response relationship between AIP,serum ApoA1 at admission and the risk of DKD in elderly T2DM patients was analyzed,and the predictive value of AIP and serum ApoA1 at admission for the development of DKD in elderly T2DM patients was analyzed.Based on the conventional influencing factors,a logistic regression(LR)model 1 was constructed,and a LR model 2 was constructed by combining AIP,serum ApoA1 at admission with the conventional influencing factors,to compare the predictive values of the two models.Results The proportion of T2DM duration≥10 years,glycated hemoglobin A1c(HbAlc),and blood urea nitrogen(BUN)levels at admission in the DKD group were higher than those in the T2DM group,showing significant differences(P<0.01).The AIP at admission in the DKD group was higher than that in the T2DM group,while the serum ApoA1 level was lower than that in the T2DM group,showing significant differences(P<0.01).The results of multivariate logistic regression analysis showed that T2DM duration,HbAlc,BUN,AIP,and serum ApoA1 at admission were all independent influencing factors for the development of DKD in elderly T2DM patients(P<0.05,P<0.01).The restricted cubic spline model analysis showed that after correcting for T2DM duration,HbAlc,and BUN at admission,AIP at admission was non-linearly positively correlated with the risk of DKD in elderly T2DM patients,while serum ApoA1 at admission was non-linearly negatively correlated with the risk of DKD in elderly T2DM patients(P<0.05).When AIP was>0.23,the risk of DKD in elderly T2DM patients increased with the increase of AIP,and when serum ApoA1 was<1.26 g/L,the risk of DKD in elderly T2DM patients increased with the decrease of serum ApoA1.The receiver operating characteristic(ROC)curve analysis showed that the area under the ROC curve of LR model 2 for predicting the development of DKD in elderly T2DM patients was significantly larger than that of LR model 1(P<0.05).Conclusion AIP,and serum ApoA1 are related to the occurrence of DKD in elderly T2DM patients.A predictive model combining AIP and ApoA1 with conventional risk factors demonstrates significantly improved predictive value for the development of DKD in elderly T2DM patients,providing a reference for clinical diagnosis and treatment.