贵阳城区新诊断糖尿病前期人群3年自然转归及影响因素分析  

Outcomes of newly diagnosed prediabetes and its risk factors in Guiyang:a 3-year follow-up study

作　　者：何茜 张巧[1] 彭年春 胡颖 李红 陈正益 刘若一 徐淑静 张淼 时立新 He Xi;Zhang Qiao;Peng Nianchun;Hu Ying;Li Hong;Chen Zhengyi;Liu Ruoyi;Xu Shujing;Zhang Miao;Shi Lixin(Department of Endocrinology and Metabolism,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,China;Department of Endocrinology,Guizhou Provincial People′s Hospital,Guiyang 550002,China)

机构地区：[1]贵州医科大学附属医院内分泌科,贵阳550004 [2]贵州省人民医院内分泌科,贵阳550002

出　　处：《中华内分泌代谢杂志》2021年第7期618-623,共6页Chinese Journal of Endocrinology and Metabolism

基　　金：国家重点研发计划精准医学专项(2016YFC0901203);国家卫生和计划生育委员会公益性行业科研专项(201502007);2016年贵州省临床重点专科培育项目(医政)(SZD-2016-01)。

摘　　要：目的分析贵阳城区40岁及以上新诊断糖尿病前期人群3年自然转归情况及影响因素。方法2011年5月至2011年8月采用整群抽样方法对贵阳市云岩区某社区40岁以上常住居民10015人进行问卷调查、体格检查,并采集血样测定空腹血糖、糖负荷后2 h血糖、血脂及HbA1C等。于2014年对该人群进行随访,最终2530名基线新诊断糖尿病前期且随访资料完整者被纳入分析。结果研究人群中糖尿病3年累积发病率为14.3%,空腹血糖受损(IFG)+糖耐量受损(IGT)人群发生糖尿病的风险显著高于单纯IFG及单纯IGT(P<0.01)。空腹血糖、糖负荷后2 h血糖及HbA1C为糖尿病前期人群进展为糖尿病的独立危险因素(OR=1.836,95%CI 1.374~2.454;OR=1.398,95%CI 1.261~1.550;OR=2.526,95%CI 1.804~3.538,均P<0.01),以及逆转为正常糖耐量(NGT)的抑制因素(OR=0.511,95%CI 0.409~0.638;OR=0.715,95%CI 0.661~0.774;OR=0.638,95%CI 0.500~0.816,均P<0.01);高密度脂蛋白胆固醇为糖尿病前期逆转为NGT的促进因素(OR=1.306,95%CI 1.017~1.678,P=0.036)。根据HbA1C三分位分组,HbA1C≥6.3%的人群进展为糖尿病的可能性是HbA1C≤5.9%人群的2.398倍(95%CI 1.733~3.322,P<0.01)。根据体重指数(BMI)随访前后的变化(ΔBMI=随访BMI-基线BMI)三分位分组,ΔBMI最高组发生糖尿病的风险是最低组的2.402倍(95%CI 1.859~3.105,P<0.01);进一步以ΔBMI较小三分位数为切点,同时采用1∶1倾向性评分匹配,将研究对象分为体重下降显著及不显著2组,3年随访时,体重下降显著组糖尿病的患病风险较体重下降不显著组降低了40.4%(RR=0.596,95%CI 0.463~0.766,P<0.01)。结论IFG+IGT人群发生糖尿病的风险显著高于单纯IFG及单纯IGT;基线空腹血糖、糖负荷后2 h血糖及HbA1C为糖尿病的独立危险因素,高密度脂蛋白胆固醇为逆转为NGT的促进因素;减轻体重可显著降低糖尿病前期人群进展为糖尿病的风险。Objective To investigate the outcomes and influencing factors of newly diagnosed prediabetic subjects aged 40 years and above in Guiyang.Methods A total of 10015 residents aged 40 years and above were recruited from the Yunyan community,Guiyang,from May to August 2011.Physical examination,laboratory measurements,and questionnaires were conducted.The follow-up survey was conducted in July 2014.A total of 2530 newly diagnosed prediabetic subjects at baseline were included in the analysis.Results The 3-year cumulative morbidity of diabetes mellitus was 14.3%,and the risk of diabetes mellitus in combined impaired fasting glucose(IFG)and impaired glucose tolerance(IGT)groups was significantly higher than that in isolated IFG(i-IFG)or isolated IGT(i-IGT)group(P<0.01).High baseline fasting plasma glucose,2 h plasma glucose,and HbA1C levels were the independent risk factors for the development of diabetes(OR=1.836,95%CI 1.374-2.454;OR=1.398,95%CI 1.261-1.550;OR=2.526,95%CI 1.804-3.538,all P<0.01)and the inhibitory factors for reversion to normal glucose tolerance(OR=0.511,95%CI 0.409-0.638;OR=0.715,95%CI 0.661-0.774;OR=0.638,95%CI 0.500-0.816,all P<0.01).High level of high density lipoprotein-cholesterol(HDL-C)was an promoting factor for reversion to normal glucose tolerance(OR=1.306,95%CI 1.017-1.678,P=0.036).Subjects in the highest tertile of baseline HbA1C level and body mass index(BMI)change before and after follow-up(ΔBMI=follow-up BMI minus baseline BMI)had a higher risk of diabetes mellitus than those in the lowest tertile(OR=2.398,95%CI 1.733-3.322;OR=2.402,95%CI 1.859-3.105,both P<0.01).The risk of diabetes mellitus in the significant weight loss group was reduced by 40.4%compared with the non-significant weight loss group when the subjects were divided into two groups according to the cutoff of the lower tertile ofΔBMI(RR=0.596,95%CI 0.463-0.766,P<0.01).Conclusion The risk of diabetes mellitus in combined IFG/IGT group was significantly higher than that in i-IFG or i-IGT group.High baseline fasting plasma glu

关 键 词：糖尿病前期 糖尿病 正常糖耐量 影响因素 

分 类 号：R587.1[医药卫生—内分泌]