健康体检队列人群γ-谷氨酰转移酶发展轨迹与新发2型糖尿病的相关性研究  

Correlation between gamma-glutamyl transpeptidase development track and new-onset type 2 diabetes mellitus in a health examination cohort

作　　者：白云瑞 苗鑫蕾 唐桂敏 葛旭红 胡洁怡 王露[1] 冷松[1] Bai Yunrui;Miao Xinlei;Tang Guimin;Ge Xuhong;Hu Jieyi;Wang Lu;Leng Song(Health Management Center,Second Affiliated Hospital of Dalian Medical University,Dalian 116023,China)

机构地区：[1]大连医科大学附属第二医院健康管理中心,大连116023

出　　处：《中华糖尿病杂志》2023年第6期533-539,共7页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：大连医科大学附属第二医院“1+X”计划项目(2022DXDL01)。

摘　　要：目的研究健康体检队列人群γ-谷氨酰转移酶(GGT)的发展轨迹,探讨其与新发2型糖尿病(T2DM)的相关性。方法本研究为队列研究。回顾性选取于2015年1月1日至2020年1月1日在大连医科大学附属第二医院健康管理中心体检的符合队列入组标准的1566人作为研究对象。收集一般资料及实验室检查指标,包括性别、年龄、体重指数、收缩压、舒张压、GGT、肌酐、尿酸、总胆固醇、甘油三酯、空腹血糖、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)等。构建目标人群4年GGT水平发展的组基轨迹模型,确定其GGT发展轨迹的组数和趋势。采用Kaplan-Meier曲线分析各轨迹组T2DM的累积发病率,并用LogRank检验比较GGT轨迹组T2DM累积发病率的差异。应用Cox比例风险回归模型分析GGT轨迹组T2DM的发病风险,并通过补充失访人群和去除随访第1年发病人群,对主要结果进行敏感性分析。结果确定3个亚组人群GGT的变化轨迹,分别标记为GGT低水平组(734名,46.87%)、GGT中水平组(657名,41.95%)和GGT高水平组(175名,11.18%),其中GGT低/中水平组人群的GGT均值在4年随访内逐渐上升,而GGT高水平组则呈现先升高再下降又上升的趋势,但始终大于基线均值,总体呈上升态势。随访4年后,该队列T2DM的发病密度为18.32/1000人年,GGT低、中、高水平组的发病密度分别为13.51/1000人年、19.12/1000人年和36.14/1000人年。各GGT轨迹组T2DM的4年累积发病率随着随访时间的延长而逐渐上升,且GGT高水平组的累积发病率最高(χ^(2)=15.579,P<0.001)。Cox回归分析结果显示,在调整性别、年龄、体重指数、肌酐、尿酸、收缩压、舒张压、总胆固醇、甘油三酯、空腹血糖、HDL-C和LDL-C后,GGT高水平组T2DM的发病风险为GGT低水平组的2.594倍(HR=2.594,95%CI 1.112~6.048,P=0.027)。敏感性分析结果显示,GGT高水平组的发病风险仍高于低水平组(P<0.05)。结论健康体�Objective To investigate the development trajectory ofγ-glutamyl transpeptidase(GGT)in a health examination cohort and its correlation with new-onset type 2 diabetes mellitus(T2DM).Methods From January 1,2015 to January 1,2020,1566 people who met the team′s inclusion criteria at the Health Management Center of the Second Affiliated Hospital of Dalian Medical University were retrospectively selected.General data and laboratory test indicators were collected,including sex,age,body mass index,systolic blood pressure,diastolic blood pressure,GGT,serum creatinine,uric acid,cholesterol,triglycerides,fasting plasma glucose,high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C).A group-based trajectory model for the 4-year GGT level development of the target population was constructed,and the number of groups and the trend of GGT development trajectory of the target population were determined.Kaplan-Meier curves were used to show the cumulative incidence of T2DM in each trajectory group,and the LogRank test was used to compare the cumulative incidence of T2DM in different GGT trajectory groups.Cox proportional hazards regression model was used to analyze the risk of T2DM in different GGT trajectory groups,and sensitivity analysis was performed to analyze the primary outcome by supplementing lost to follow-up population and removing the onset population in the first year of follow-up.Results The change trajectories of GGT were determined in three subgroups,which were labeled as low level GGT group(734 cases,46.87%),medium level GGT group(657 cases,41.95%)and high level GGT group(175 cases,11.18%).The average GGT of the low/medium level GGT group increased gradually during the 4-year follow-up.However,the GGT high level group showed a trend of first increasing,then decreasing and then increasing,but it was always more than the baseline mean,and showed an overall upward trend.After 4 years of follow-up,the prevalence of T2DM in this cohort was 18.32/1000 person-years,and the incidence r

关 键 词：糖尿病 2型 Γ-谷氨酰转移酶 健康体检队列 轨迹模型 

分 类 号：R587.1[医药卫生—内分泌]