生殖因素与女性2型糖尿病发病风险的队列研究  

Cohort study on reproductive factors and risk of type 2 diabetes mellitus in women

作　　者：郭梦然 汤旭磊[2] 车红霞 关聪会[2] 赵楠[2] 傅松波[2] 刘丽娟[2] 闵行 叶月 许晓双 甄东户[2] Guo Meng-Ran;Tang Xu-Lei;Che Hong-Xia;Guan Cong-Hui;Zhao Nan;Fu Song-Bo;Liu Li-Juan;Min Hang;Ye Yue;Xu Xiao-Shuang;Zhen Dong-Hu(The First Clinical Medical College of Lanzhou University,Lanzhou 730030,China;Department of Endocrinology,the First Hospital of Lanzhou University,Lanzhou 730030,China;Department of Endocrinology,the Third People's Hospital of Gansu Province,Lanzhou 730030,China)

机构地区：[1]兰州大学第一临床医学院,兰州730030 [2]兰州大学第一医院内分泌科,兰州730030 [3]甘肃省第三人民医院内分泌科,兰州730030

出　　处：《解放军医学杂志》2021年第12期1196-1204,共9页Medical Journal of Chinese People's Liberation Army

基　　金：国家标准化代谢性疾病管理中心专项研究基金(2018-mmczxjj-3);甘肃省自然科学基金(21JR1RA096);甘肃省内分泌疾病临床医学研究中心项目(20JR10FA667)。

摘　　要：目的探讨孕次、产次、流产、哺乳、初潮年龄、绝经年龄、生育年限等生殖因素与女性2型糖尿病(T2DM)发病风险之间的关系。方法采用队列研究REACTION研究中兰州地区的资料,于2011年5月开始对兰州市天庆嘉园社区、张广社区和五泉山社区三个社区年龄为40~75岁的女性居民进行流行病学调查,通过调查问卷确定生殖史、月经史。纳入调查资料完整的7094名女性,其中基线糖耐量正常2963名,随访5年内结局事件T2DM的发生情况;采用logistic回归分析和Cox风险回归模型探讨生殖因素与女性T2DM发病风险的关系。结果较高孕次、产次女性T2DM的发病风险明显增加,尤其是孕次、产次超过3次时,T2DM发病风险增加约1.6倍,且产次对女性T2DM的影响更明显(孕次2、3、≥4次的HR分别为1.08、1.26、1.60,95%CI分别为0.68~1.72、1.07~1.99、1.01~2.45,P=0.000;产次2、3、≥4次的HR分别为1.21、1.60、1.65,95%CI分别为1.08~1.69、1.09~2.78、1.11~2.43,P=0.000)。是否流产并不影响女性T2DM的发病情况,雌激素累积水平(初潮年龄、绝经年龄、生育年限)与女性T2DM也无相关性。哺乳是女性T2DM较好的保护因素,母乳喂养女性T2DM的发病风险降低约30%(HR=0.70,95%CI 0.46~0.96,P=0.001)。结论孕次、产次是女性T2DM的危险因素,随着孕次、产次增加,T2DM发病风险明显增高;而哺乳是女性T2DM的保护因素,可降低女性T2DM的发病风险。Objective To explore the relationship between the reproductive factors(such as the number of pregnancy,number of birth,abortion,lactation,menarche age,menopausal age and childbearing years)and female type 2 diabetes mellitus(T2DM).Methods Based on the data of cohort study REACTION in Lanzhou,an epidemiological investigation was performed among residents aged 40-75 years in Tianqingjiayuan,Zhangguang and Wuquanshan communities of Lanzhou City in May 2011.Reproductive history and menstrual history were determined by questionnaire.A total of 7094 women were with complete investigation data,including 2963 with normal baseline glucose tolerance who were followed up for 5 years for the occurrence of outcome event T2DM;Logistic regression and Cox risk regression analysis were employed to explore the relation between reproductive related factors and female T2DM.Results The risk of T2DM obviously increased in women with more gestational number and parturient times,especially when the gestational number and parturient times were more than 3,the risk of T2DM increased about 1.6 times,and the impact of parturient times was more significant on female T2DM(Pregnancy number 2,3,≥4,HR:1.08,1.26,1.60;95%CI 0.68-1.72,1.07-1.99,1.01-2.45;P=0.000.Parturient times 2,3,≥4,HR:1.21,1.60,1.65;95%CI 1.08-1.69,1.09-2.78,1.11-2.43;P=0.000).Abortions did not affect the incidence of female T2DM,and there was no correlation between the cumulative level of estrogen(menarche age,menopause age,childbearing years)and female T2DM.In addition,lactation was a better protective factor for women from T2DM,and may reduced the risk of female T2DM by about 30%(HR=0.70,95%CI 0.46-0.96,P=0.001).Conclusions Pregnancy and parturient times were the risk factors of T2DM in women.With the increase of pregnancy and parturient times,the risk of T2DM increased significantly;Lactation is the protective factor of female T2DM.

关 键 词：糖尿病 2型 孕次 产次 流产 哺乳 女性 队列研究 

分 类 号：R587.1[医药卫生—内分泌]