累积空腹血糖暴露对心脑血管事件的影响  

Association of cumulative fasting blood glucose exposure and risk of cardiovascular and cerebrovascular events

作　　者：刘婷婷[1] 王希柱[1] 宋巧凤[1] 刘爱娟[2] 杜悦 吴寿岭[4] 周文华[1] LIU Ting-ting;WANG Xi-zhu;SONG Qiao-feng;LIU Ai-juan;DU Yue;WU Shou-ling;ZHOU Wen-hua(Department of Cardiology,Tangshan People's Hospital,Tangshan,Hebei 063001,China;Office of Doctor-Patient Relationship,Tangshan People's Hospital,Tangshan,Hebei 063001,China;Medical Record Management Section,Tangshan People's Hospital,Tangshan,Hebei 063001,China;Department of Cardiology,Kailuan General Hospital)

机构地区：[1]唐山市人民医院心内科,河北唐山063001 [2]唐山市人民医院医患办,河北唐山063001 [3]唐山市人民医院病案管理科,河北唐山063001 [4]开滦总医院心内科

出　　处：《中华高血压杂志》2022年第3期244-252,共9页Chinese Journal of Hypertension

摘　　要：目的探讨累积空腹血糖暴露(cumFBG)对心脑血管事件的影响。方法采用前瞻性队列研究方法,以连续参加2006-2007、2008-2009、2010-2011年3次健康体检的开滦集团职工为观察对象,排除心肌梗死、脑卒中、心力衰竭患者,最终纳入统计分析52980例。以观察对象完成第3次健康体检时间为随访起点,以发生心脑血管事件为终点事件,随访终止时间为发生心脑血管事件、全因死亡或末次随访时间(2017年12月31日)。按cumFBG四分位分组,用Kaplan-Meier法计算各组心脑血管事件累积发病率,并用Log-rank检验比较各组心脑血管事件累积发病率的差异;采用Cox比例风险模型分析cumFBG对心脑血管事件的影响。结果随访(6.76±1.03)年,cumFBG第1至第4四分位组心脑血管事件发病密度分别为3.42/千人年、4.57/千人年、5.68/千人年和9.53/千人年,且随着cumFBG增加,心脑血管事件、脑卒中、缺血性脑卒中累积发病率均呈上升趋势,经Log-rank检验及组间两两比较,差异有统计学意义(均P<0.01)。Cox比例风险模型显示校正年龄、性别、体质量指数(BMI)、是否高血压、基线空腹血糖等混杂因素后,与第1四分位组比较,第2、3、4四分位组发生心脑血管事件的HR(95%CI)为0.88(0.76~1.02)、1.00(0.87~1.14)、1.23(1.08~1.40);发生脑卒中的HR(95%CI)分别为1.19(1.01~1.41)、1.23(1.04~1.44)、1.47(1.25~1.73);发生缺血性脑卒中的HR(95%CI)分别为1.18(0.99~1.42)、1.24(1.04~1.48)、1.53(1.29~1.82);且随着cumFBG四分位数增加,心脑血管事件、脑卒中、缺血性脑卒中发生风险逐渐增加(χ^(2)=20.03,21.52,23.60,P<0.01);发生心肌梗死及出血性脑卒中的HR值(95%CI)无统计学意义(P>0.05)。自然样条函数分析显示,cumFBG与心脑血管事件、脑卒中、缺血性脑卒中风险呈非线性相关。结论高cumFBG是心脑血管事件、脑卒中、缺血性脑卒中的危险因素。Objective To investigate the association of cumulative fasting blood glucose exposure(cumFBG)and risk of cardiovascular and cerebrovascular events.Methods A prospective cohort study was condected.Participants who had three consecutive medical examinations during 2006-2007,2008-2009,and 2010-2011 were recruited.Patients with myocardial infarction,stroke and heart failure were excluded.Finally 52980 participants were included for analysis.The follow-up observation began at the time of the third medical examination,and ended up with the occurrence of cardiovascular and cerebrovascular events,all-cause death or the last investigation(2017-12-31).The participants were grouped according to the cumFBG quartiles.The cumulative incidence of cardiovascular and cerebrovascular events was calculated using Kaplan-Meier survival analysis and was compared between groups using Log-rank test.Cox proportional hazards model was used to analyze the effect of cumFBG on cardiovascular and cerebrovascular events.Results During the follow-up of(6.76±1.03)years,the incidence density of cardiovascular and cerebrovascular events was 3.42,4.57,5.68,and 9.53 per 1000 person-years in the first to the fourth quartile group,respectively.The incidences of cardiovascular and cerebrovascular events,stroke and ischemic stroke were all increased significantly(P<0.01)with the increment of cumFBG via Log-rank test and pairwise comparisons.Cox proportional hazards model showed that,after adjusting for potential confounding factors(age,gender,body mas index,hypertension,baseline fasting blood glucose),compared with the first quartile group,the HR(95%CI)of cardiovascular and cerebrovascular events in the second,third and fourth quartile groups were 0.88(0.76-1.02),1.00(0.87-1.14)and 1.23(1.08-1.40),respectively;the HR(95%CI)of stroke were 1.19(1.01-1.41),1.23(1.04-1.44)and 1.47(1.25-1.73),respectively;the HR(95%CI)of ischemic stroke were 1.18(0.99-1.42),1.24(1.04-1.48)and 1.53(1.29-1.82),respectively.Moreover,the risk of cardiovascular and cerebrovascul

关 键 词：累积空腹血糖 心脑血管事件 危险因素 

分 类 号：R54[医药卫生—心血管疾病] R743[医药卫生—内科学]