空腹血糖水平与肝硬化发病关系的前瞻性研究  

Prospective study of the association between fasting glucose concentrations and liver cirrhosis risk

作　　者：尹梁宇[1] 陈汶[2] 崔剑锋[2] 刘彬[2] 阴建[2] 范金虎[2] 陈凤[2] 刘新伏[2] 付春静[1] 代兴碧[1] 

机构地区：[1]重庆医科大学公共卫生与管理学院,400016 [2]中国医学科学院肿瘤医院、肿瘤研究所

出　　处：《中华肝脏病杂志》2012年第5期381-385,共5页Chinese Journal of Hepatology

摘　　要：目的探讨中国人群中空腹血糖水平与肝硬化发病风险的关系。方法基于河南省某县食管癌营养干预试验队列完成了一项巢式病例对照研究。利用全自动生物化学分析仪及酶联免疫法检测了310例肝硬化个体与620例对照者的基线空腹血糖以及3项肝炎病毒学标志物（HBsAg、抗-HBc与抗-HCV）水平，并从调查问卷收集了研究对象相关特征信息。使用两独立样本t检验比较了基线特征与研究因素中的连续性变量在病例组和对照组之间的分布差异，而分类变量的比较则使用了爿。检验。使用多重线性回归模型对各项研究因素与血糖连续性变量的依存关系进行探索用于筛选潜在的混杂因素。在多重线性回归模型中提示与血糖浓度有关的因素以及考虑可疑的混杂因素均被纳入Logistic回归模型中作为调整以分析血糖水平与及肝硬化的联系，模型中血糖最低浓度组被定义为参考水平，对回归模型统计学意义的评价使用了似然比检验。结果病例组与对照组血糖浓度分别为（4．5土1．8）mmol／L与（4．2±2．1）mmol／L，两者比较，差异有统计学意义（t=-2．414，P〈0．05）；第5组中的研究对象与第1组即参考水平相比肝硬化发病风险升高，OR=1．672；并且血糖水平的升高与疾病发病风险的增加具有线性相关关系（P〈0．05）。在对可能的混杂因素包括性别、年龄、HBsAg、抗-HCV以及饮酒情况进行调整之后，高浓度组肝硬化疾病风险的增加仍具有统计学意义（OR=1．96，P〈0．05）。结论提示较高的空腹血糖水平可能作为肝硬化一项独立的危险因素，与肝硬化发病风险升高相关。Objective To investigate the association between concentration levels of fasting serum glucose and liver cirrhosis. Methods A nested case-control study was carried out based on the sample cohort from the Nutrition Intervention Trials previously conducted in one country in Henan province. Using an automatic biochemical analysis system and enzyme-linked immunoassay, baseline serum samples from 310 liver cirrhosis patients and 620 healthy controls were tested for fasting glucose concentration, hepatitis B surface antigen （HBsAg）, hepatitis B core antibody （anti-HBc）, and hepatitis C virus antibody （anti-HCV）. Baseline demographic information was collected by questionnaire. The serum glucose values were divided into quintiles and applied to a logistic regression model to estimate odds ratios （ORs） and 95% confidence intervals （95% CIs）. Results The mean fasting blood glucose level was significantly higher in cases （4.5± 1.8 mmol/L） than in controls （4.2±2.1 mmol/L） （t = -2.414, P=0.016）. The individuals in the highest quintile had a significantly higher risk of disease than those in the lowest quintile [OR = 1.672 （1.080, 2.588）]. Moreover, increase in glucose level was accompanied by increased risk, and the relation showed statistically significant linearity （P= 0.002）. The statistical significance of risk remained after adjustment for potential confounders, including sex, age, HBsAg, anti-HBc, and residence running water status [OR = 1.96 （1.216, 3.157）, P = 0.001 ]. Conclusion Elevated serum fasting glucose concentration was an independent risk factor of cirrhosis.

关 键 词：肝硬化 血糖 病例对照研究 

分 类 号：R575.2[医药卫生—消化系统]