生活方式干预对糖尿病前期人群心脑血管事件和死亡的影响大庆糖尿病预防长期随访研究  

Effect of lifestyle interventions on reduction of cardiovascular disease events and its mortality in pre-diabetic patients：long-term follow-up of Da Qing Diabetes Prevention Study

作　　者：陈燕燕[1] 王金平[2] 安雅莉[1] 巩秋红[1] 何一凡[3] 张波[3] 黎辉[2] 帅瑛[3] 唐欣然[1] 姜亚云[2] 洪靖[3] 杨文英[3] 胡英华[2] 李光伟[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院内分泌心血管病中心,北京100037 [2]大庆油田总医院(大庆市第一医院)心内科 [3]中日友好医院内分泌科,北京100029

出　　处：《中华内科杂志》2015年第1期13-17,共5页Chinese Journal of Internal Medicine

基　　金：卫生部与世界卫生组织合作研究基金（U58/CCU424123-01-02）;杨森科学研究委员会基金（JRCC2011）

摘　　要：目的 探讨糖尿病前期人群强化生活方式干预对心脑血管事件及死亡的长期影响.方法 1986年入选大庆市519例糖耐量正常（NGT）者和577例糖耐量减低（IGT）者.IGT者被随机分到对照组和饮食、运动或饮食加运动干预组进行6年生活方式干预.通过问卷和系统病历查阅,跟踪调查随后23年间首次心血管事件（心肌梗死、卒中）和死亡状况.结果 IGT未干预组心血管事件发生率和死亡率最高（44.44％及20.00％）,NGT组最低（29.59％及7.52％）,IGT干预组居二者之间（37.84％及12.53％）.多因素分析调整基线年龄、性别、BMI、血压、吸烟和既往心血管事件的影响后,IGT未干预组的心血管病死亡率和心血管事件发生率为NGT组的1.89和1.38倍（HR=1.89,95％CI1.11～3.22;HR =1.38,95％CI1.01～1.90）.而IGT干预组的心血管病死亡率和心血管事件发生率与正常对照组相比差异均无统计学意义（HR=1.39,95％CI0.89 ～2.18及HR=1.25,95％CI0.98～1.59）.结论 IGT者心血管事件和死亡风险均显著高于NGT人群.数年生活方式干预可以减少长期心脑血管事件发生率和心血管病死亡率.Objective To investigate if a six-year intensive lifestyle intervention in people with prediabetes lead to reduction of cardiovascular events and cardiovascular disease （CVD） mortality in subsequent 23 years.Methods Five hundreds and nineteen subjects with normal glucose tolerance （NGT） and 577 subjects with impaired glucose tolerance （IGT） in Da Qing city were recruited in the study in 1986.The IGT subjects randomly assigned to either the no-intervention group or one of three lifestyle intervention groups （diet,exercise,or diet plus exercise） to receive a 6-year lifestyle intervention.In 2009,the participants were followed up to assess the primary outcomes of cardiovascular events and CVD mortality by a questionnaire and medical records.Results Subjects in IGT no-intervention group had the highest incidences of cardiovascular events （44.44％） and CVD mortality （20.00％）,while those in NGT group had the lowest incidences of cardiovascular events （29.59％） and CVD mortality （7.52％） after 23-year follow-up.The incidences of cardiovascular events and CVD mortality in IGT intervention subjects were 37.84％ and 12.53％,respectively.The multivariable analyses showed that,after controlling of age,gender,BMI smoking,blood pressure and cardiovascular event at baseline,the CVD mortality and incidence of cardiovascular events in IGT no-intervention group was 1.89 （HR =1.89,95 ％ CI 1.11-3.22,P =0.02） and 1.38（HR =1.38,95％ CI 1.01-1.90,P =0.04） times of those in NGT group.However,the CVD mortality and incidence of cardiovascular events were not different in the IGT intervention group compared with those in the NGT group （HR =1.39,95 ％ CI 0.89-2.18,P =0.15 and HR =1.25,95％ CI 0.98-1.59,P =0.07,respectively）.Conclusions Subjects with IGT were at high risk for cardiovascular events and mortality.A six-year lifestyle intervention in this population can reduce both the incidence of cardiovascular event and CVD mortality.

关 键 词：糖尿病前期 心血管事件 死亡率 

分 类 号：R587.1[医药卫生—内分泌]