糖化血红蛋白、空腹及服糖后2小时胰岛素水平与高血压发病风险的前瞻性研究  

Associations between glycated hemoglobin, fasting insulin, insulin 2 hours after oral glucose tolerance test and incident hypertension in a prospective cohort study

作　　者：王艺颖 余杨文[1] 吴延莉 苏旭 周婕[1] 赵否曦 李雪娇 刘涛[1] WANG Yi-ying;YU Yang-wen;WU Yan-li;SU Xu;ZHOU Jie;ZHAO Fou-xi;LI Xue-jiao;LIU Tao(Guizhou Center for Disease Control and Prevention,Guiyang,Guizhou 550004,China;不详)

机构地区：[1]贵州省疾病预防控制中心,贵州贵阳550004 [2]贵州医科大学公共卫生与健康学院,环境污染与疾病监控教育部重点实验室

出　　处：《现代预防医学》2022年第9期1547-1553,共7页Modern Preventive Medicine

基　　金：贵州省科技计划项目(黔科合支撑[2018]2819);贵州省卫生健康委科学技术基金项目(gzwjkj2020-1-197)。

摘　　要：目的 探讨糖化血红蛋白(Glycosylated hemoglobin, HbA1c)、空腹胰岛素(Fasting insulin, INS)及服糖后2小时胰岛素(Insulin 2 hours after oral glucose tolerance test, INS-2H)与高血压发病的风险。方法 本研究采用全人群多阶段整群随机抽样方法,抽取了贵州省12个区(县)的48个乡镇共9 280人进行调查,排除基线HbA1c、INS及INS-2H缺失及有高血压病史者,最终纳入1 684例进入分析。中位随访6.23年。采用Cox生存回归分析HbA1c、INS及INS-2H与高血压发病的相关性。PAF及Survival计算人群归因危险百分比。结果 HbA1c和INS-2H每升高一个单位,高血压发病风险分别增加31.5%和1.1%。HbA1c高水平组发病风险是低水平组的2.87倍。相比第一分位组,INS-2H第四分位组发病风险增加73.6%。HbA1c水平控制在6.3 mmol/L及以下可降低人群8.6%的发病。INS-2H水平分别控制在8.81 mIU/L、15.60 mIU/L、24.30 mIU/L以下,可降低人群22.6%、11.9%和6.8%的发病。年龄>42岁组的人群中,HbA1c高水平组发病风险是低水平组的2.84倍;INS-2H第二、三、四分位组发病风险分别是第一分位组的2.001倍、2.145倍和2.145倍。男性人群中,HbA1c高水平组发病风险是低水平组的2.760倍;INS-2H第三、四分位组发病风险是第一分位组的1.828倍和2.116倍。结论 HbA1c及INS-2H是高血压发病的危险因素,在年龄>42岁和男性人群更为敏感。控制HbA1c及INS-2H能有效降低人群高血压发病。Objective To investigate the relationship between glycosylated hemoglobin(HbA1 c), fasting insulin(INS), and insulin 2 hours after oral glucose tolerance test administration(INS-2 H) and the risk of hypertension. Methods In this study, a total of 9 280 people were selected from 48 towns in 12 districts(counties) of Guizhou Province using a population-wide multi-stage cluster random sampling method. Excluded the deficiency of HbA1 c, INS, and INS-2 H at baseline, finally included 1 684 cases into the analysis, with a median follow-up of 6.23 years. The correlation of HbA1 c, INS, and INS-2 H with hypertension was analyzed by Cox survival regression. PAF and Survival were used to calculate the percentage of population attributable risk. Results For each unit increase of HbA1 c and INS-2 H, the risk of hypertension increased by 31.5% and 1.1%, respectively. The risk of hypertension in the high level group was 2.87 times higher than that of low levels group. The risk of hypertension in the fourth quartile of INS-2 H increased by 73.6% compared with the first quartile. Control HbA1 c level at 6.3 mmol/L or below can reduce the morbidity of the population by 8.6%. INS-2 H levels below 8.81 mIU/L, 15.60 mIU/L, and 24.30 mIU/L can reduce the morbidity of 22.6%, 11.9%, and 6.8% of the population, respectively. In patients aged >42 years, The risk of hypertension in the high-level group was 2.84 times higher than that of low levels group. The risk of hypertension in the second, third, and quartile groups of INS-2 H were 2.001, 2.145, and 2.145 times higher than that in the first quartile group, respectively. In men, the risk of hypertension in high-level group was 2.76 times higher than that of low levels group. The risk of hypertension in the third and quartile groups of INS-2 H was 1.828 and 2.116 times higher than in the first quartile group. Conclusion HbA1 c and INS-2 H are independent risk factors for hypertension, and the age > 42 years and male are more sensitive. Controlling HbA1 c and INS-2 H can effectively redu

关 键 词：高血压 糖化血红蛋白 空腹胰岛素水平 服糖后2小时胰岛素水平 发病风险 

分 类 号：R544.1[医药卫生—心血管疾病]