大庆糖尿病前期人群糖耐量改善对心血管事件和死亡率的影响——一项20年随访研究  

Improving glucose intolerance linked with the reduction of cardiovascular disease events and mortality in a Da Qing population with pre-diabetes--a 20 year follow-up study

作　　者：王金平[1] 张波[2] 姜亚云[1] 帅英[2] 安雅莉[2] 黎辉[1] 李春勤[1] 王瑶[2] 巩秋红[2] 张景玲[1] 李宏亮[2] 胡英华[1] 杨文英[2] 李光伟[2] 

机构地区：[1]大庆油田总医院(大庆市第一医院)心内科,163001 [2]北京中日友好医院内分泌科,100029

出　　处：《中华内分泌代谢杂志》2010年第1期6-9,共4页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的探讨糖尿病前期人群中改善或减缓糖耐量恶化是否可能降低心血管事件和死亡率。方法1986年大庆市577例糖耐量受损者被随机分到对照组和3个干预组（饮食、运动和饮食加运动组）进行6年（1986～1992）生活方式干预后又随访14年。本研究将全部受试者按1992年生活干预结束时糖负荷后2h血糖（2hPG）分为4组（Quartiles，2hPG均值分别为6．17、9．00、12．07和16．96mmol／L），分析血糖水平高低与随访期间心血管事件及死亡率有无相关。结果20年随访中共有142例死亡，68例死于心血管疾病（CVD）。有首次CVD事件211次（145次脑卒中、66次心梗）。从血糖水平最高到血糖最低的4组中全因死亡（17．8、12．7、10．9和9．7／1000人年）、CVD死亡（9．1、5．9、6．1和4．9／1000人年）、CVD事件（30．4、24．0、18．8和19．7／1000人年）和脑卒中（26．6、18．5、16．3和18．1／1000人年）发生率明显依次递减。多因素分析调整基线年龄、性别、体重指数、血压、吸烟和干预分组的影响后，强化生活方式干预结束时（1992年）2hPG升高5mmol／L可使全因死亡（HR1．335，P=0．005）、CVD事件（HR1．227，P=0．012）和脑卒中（HR1．213，P=0．026）发生率显著升高。结论在糖尿病前期人群，如果生活干预的强度足以改善或减缓该人群糖耐量的恶化，就可能降低心血管事件和死亡率。Objective To investigate if improving or slowing the progression of glucose intolerance might be linked with the reduction of cardiovascular disease（CVD） events and mortality in a Da Qing population with prediabetes. Methods In 19Z6,577 subjects with impaired glucose tolerance in 33 clinics in Daqing city were randomly assigned to either the control group or one of three lifestyle intervention groups（ diet, exercise, or diet plus exercise） to receive a 6 year lifestyle intervention. All the participants were followed for 14 years （ 1993-2006 ）after completion of the 6 year active interventions to assess the long-term effect of the interventions. In this post-hoe analysis, the participants were stratified into four subgroups （quartiles）based on their 2 h plasma glucose （2hPG） level after glucose loading at the end of the active intervention, in order to analyze the impact of plasma glucose level on CVD events and mortality. Results During the 20-year follow-up,there were a total of 142 deaths（68 of which were attributed to CVD）and 211 first CVD events（ 145 strokes and 66 myocardial infarctions）. From the highest to the lowest levels of 2hPG in the 4 quartiles, the all-cause mortality （ 17.8,12.7,10.9, and 9.7/1 000 personyears）, CVD mortality（9.1,5.9,6.1, and 4.9/1 000 person-years）and the incidence of first CVD events （30.4, 24.0,18.8, and 19.7/1 000 person-years） showed a clear trend of decline. In multivariate analyses, controlled for age, sex, body mass index, smoking habit, blood pressure, and intervention methods at baseline, the results showed that the 5 mmol/L elevation of 2hPG level after glucose loading in 1992 significantly increased the all-cause mortality （ HR 1. 335, P = 0. 005 ）, the incidences of first CVD events （ HR 1. 227, P = 0.012） and stroke （ HR 1.213, P= 0. 026）. Conclusion In pre-diabetes population, if the lifestyle interventions are substantially efficacious in improving glucose intolerance, the CVD risk and mortality will be reduced.

关 键 词：糖尿病前期 改善 糖耐量受损 心血管事件 死亡率 

分 类 号：R587.1[医药卫生—内分泌]