良性肥胖对2型糖尿病、心血管事件和死亡的影响——大庆糖尿病预防23年随访研究  

Long-term effects of metabolically healthy obesity on the risks of diabetes,cardiovascular disease events and its mortality over 23 years in the China Daqing diabetes prevention study

作　　者：李肖珏 王金平[2] 何思垚 沈晓霞[1] 王慧[1] 钱鑫[1] 冯新星[1] 王宣[1] 巩秋红[1] 安雅莉[1] 张波[3] 赵芳[3] 黎辉[2] 李光伟[1] 陈燕燕[1] Li Xiaojue;Wang Jinping;He Siyao;Shen Xiaoxia;Wang Hui;Qian Xin;Feng Xinxing;Wang Xuan;Gong Qiuhong;An Yali;Zhang Bo;Zhao Fang;Li Hui;Li Guangwei;Chen Yanyan(State Key Laboratory of Cardiovascular Disease,Center of Endocrinology and Cardiology,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Cardiology,Daqing Oilfield General Hospital,Daqing 163000,China;Department of Endocrinology,China-Japan Friendship Hospital,Beijing 100029,China)

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,阜外医院内分泌与心血管病代谢中心,心血管疾病国家重点实验室,北京100037 [2]大庆油田总医院心内科,163000 [3]中日友好医院内分泌科,北京100029

出　　处：《中华内分泌代谢杂志》2020年第3期207-212,共6页Chinese Journal of Endocrinology and Metabolism

基　　金：CDC/WHO的健康促进合作协议项目(U58/CCU424123-01-02)。

摘　　要：目的探讨良性肥胖对2型糖尿病、心血管事件和死亡等长期临床结局的影响。方法1986年纳入大庆市经口服葡萄糖耐量试验诊断的糖耐量正常者519名和新诊断2型糖尿病者630例,之后评估23年随访的长期临床结局。良性肥胖即超重肥胖而无代谢异常(定义为无糖尿病、高血压和高脂血症)。最终纳入682例受试者(糖耐量正常者350名和新诊断2型糖尿病者332例),根据基线状态分为正常体重无代谢异常组(211例)、超重肥胖无代谢异常组(58例)、超重肥胖伴高血压组(81例)、超重肥胖伴2型糖尿病组(109例)、超重肥胖伴高血压和2型糖尿病组(223例)。比较各组2型糖尿病、心血管事件和死亡发病率。结果23年后随访,超重肥胖无代谢异常组心血管事件和死亡发病风险与正常体重无代谢异常组相比无差异,但是其2型糖尿病发病率为正常体重无代谢异常组的2倍(24.1%、12.5/1000人年对10.9%、5.2/1000人年,P=0.01)。多因素回归分析调整了年龄、性别、吸烟史的影响后,这种差别依然存在[风险比(HR)=2.42,95%CI 1.24~4.74,P=0.01]。超重肥胖伴高血压组、超重肥胖伴2型糖尿病组及超重肥胖伴高血压和2型糖尿病组的全因死亡、心血管事件和死亡的发病风险均高于正常体重无代谢异常组,并依次递增(P<0.05)。结论良性肥胖人群长期心血管病风险和死亡与正常组无差异,但其2型糖尿病发病率显著增加。肥胖合并其他代谢紊乱人群的2型糖尿病、心血管事件和死亡的发病风险增加更甚。Objective To investigate the long-term effects of metabolically healthy obesity on the risks of type 2 diabetes,cardiovascular disease events,and its mortality over a 23-year follow-up.Methods Based on the results of an oral glucose tolerance test,there were 519 participants with normal glucose tolerance and 630 with newly diagnosed type 2 diabetes enrolled in 1986 and then given to assess the long-term clinical outcomes during the 23-year follow-up in Daqing.Metabolically healthy obesity was defined as the overweight and obese individuals with no metabolic abnormalities(diabetes,hypertension,hyperlipidemia).Finally,we identified 682 participants(350 with normal glucose tolerance and 332 with newly diagnosed diabetes).They were divided into five groups:211 individuals with metabolically healthy normal weight(MHNW group),58 with metabolically healthy overweight and obesity(MHO group),81,109,223 were metabolically unhealthy overweight and obesity with hypertension(MUHO group),type 2 diabetes(MUDO group),hypertension and diabetes(MUHDO group).Incidences of type 2 diabetes,morbidity and mortality of cardiovascular disease were compared among these groups.Results Over 23 years,instead of the morbidity and mortality of cardiovascular disease,the incidence of type 2 diabetes in MHO group was two times higher than in MHNW group(24.1%,12.5/1000 person years vs 10.9%,5.2/1000 person years,P=0.01),with an age,sex,and smoking history-adjusted hazard ratio(HR)of 2.42(95%CI 1.24-4.74,P=0.01).The morbidity and mortality of cardiovascular disease in the groups of overweight and obesity with metabolically unhealthy were higher than in MHNW group,and increased across the subjects with MUHO,MUDO,MUHDO(P<0.05).Conclusion Compared with metabolically healthy normal weight participants,the metabolically healthy obese group was at increased risk of type 2 diabetes but not cardiovascular disease events and its mortality.On the contrary,the overweight and obese groups with metabolic abnormalities had significant higher incidence of type 2

关 键 词：良性肥胖 糖尿病 2型 死亡 心血管事件 

分 类 号：R587[医药卫生—内分泌] R589[医药卫生—内科学]