空腹血糖长期变异性与2型糖尿病患者心血管疾病死亡风险的前瞻性队列研究  

A prospective cohort study on the long-term fasting blood glucose variability and risk of mortality among patients with type 2 diabetes

作　　者：官昊宇 覃玉[2] 俞浩[2] 崔岚[2] 陆艳[3] 程亭亭 顾淑君[5] 沈冲[1] 周金意[2] 武鸣 苏健[2] GUAN Haoyu;QIN Yu;YU Hao;CUI Lan;LU Yan;CHENG Tingting;GU Shujun;SHEN Chong;ZHOU Jinyi;WU Ming;SU Jian(School of Public Health,Nanjing Medical University,Nanjing,Jiangsu Province 211166,China;不详)

机构地区：[1]南京医科大学公共卫生学院流行病与卫生统计学系,江苏省南京211166 [2]江苏省疾病预防控制中心慢性非传染病防制所,江苏省南京210009 [3]苏州市疾病预防控制中心慢性非传染病防制科 [4]苏州高新区(虎丘区)疾病预防控制中心急性传染病防制科 [5]常熟市疾病预防控制中心慢性非传染病防制科

出　　处：《中国慢性病预防与控制》2023年第10期721-726,731,共7页Chinese Journal of Prevention and Control of Chronic Diseases

基　　金：江苏省领军人才与创新团队项目(K201105);江苏省第五期“333工程”科研项目(BRA2020090);江苏省卫生健委2020年度医学科研项目(M2020085)。

摘　　要：目的探讨空腹血糖(FPG)长期变异性与2型糖尿病(T2DM)患者心血管疾病(CVD)死亡风险的关联,为T2DM患者的治疗和管理提供科学依据。方法于2013年12月—2014年1月,采用整群随机抽样方法选取江苏省常熟市14个乡镇(街道),在每个乡镇(街道)中招募已纳入国家基本公共卫生服务管理的T2DM患者作为研究对象,基线调查包括问卷调查、体格检查和实验室检测,共10246名T2DM患者完成基线调查,并于2020年进行随访调查。2013年和2020年的FPG值通过基线调查和随访调查获取,2014—2019年的FPG值来源于常熟市基本公共卫生服务平台的年度健康体检数据。基于至少3次FPG测量数据计算FPG长期变异性指标,包括FPG标准差(SD)、变异系数(CV)、平均真实变异(ARV)和独立于均值的变异系数(VIM)。采用Stata 16.0软件进行方差分析、Kruskal-Wallis H检验和χ^(2)检验,利用Cox比例风险回归模型估计SD、CV、ARV、VIM与T2DM患者CVD死亡风险的关联,并根据年龄、性别以及糖尿病用药史进行分层分析。结果共7174名患者纳入分析。截至2021年12月31日,研究人群中位随访时间为8.00年,随访期间共306人死于CVD。Cox回归分析显示,FPG的SD、CV、ARV和VIM每增加1个标准差,CVD死亡风险分别增加19%(HR=1.19,95%CI:1.06~1.34),13%(HR=1.13,95%CI:1.01~1.27),17%(HR=1.17,95%CI:1.04~1.31)和16%(HR=1.16,95%CI:1.04~1.30)。分层分析显示,在单用降糖药患者中,FPG长期变异性指标与CVD死亡风险呈正相关(SD:HR=1.20,95%CI:1.04~1.39;CV:HR=1.15,95%CI:1.00~1.32;ARV:HR=1.21,95%CI:1.06~1.39;VIM:HR=1.19,95%CI:1.04~1.35),但未见FPG长期变异性指标与CVD死亡风险在未用药、单用胰岛素和联合用药的T2DM患者中存在关联。在≥65岁的患者中,SD(HR=1.16,95%CI:1.02~1.32)、ARV(HR=1.24,95%CI:1.09~1.40)和VIM(HR=1.15,95%CI:1.02~1.30)与CVD死亡风险呈正相关,未见FPG变异性指标与CVD死亡风险在<65岁的患者中有统计学意义。此外,在男性中VIMObjective To explore the correlation between long-term fasting plasma glucose(FPG)variability and the risk of cardiovascular disease(CVD)mortality in patients with type 2 diabetes mellitus(T2DM),and provide the scientific basis for the treatment and management of patients with T2DM.Methods From December 2013 to January 2014,the whole-group random sampling method was used to select the T2DM patients included in management of national basic public health services from 14 townships(streets)in Changshu city of Jiangsu Province as the subjects.The baseline investigation was performed with the questionnaires,physical examinations and laboratory tests,and a total of 10246 T2DM patients completed the baseline investigation and were followed up in 2020.FPG values in 2013 and 2020 were obtained by baseline and follow-up investigations,and the FPG values in 2014-2019 were obtained from Changshu basic public health service platform.Long-term FPG variability metrics,including FPG standard deviation(SD),coefficient of variation(CV),average real variability(ARV),and variability independent of mean(VIM)were calculated based on data from 3 FPG measurements at least.Analysis of variance,Kruskal-Wallis H test and χ^(2) test were used to analyze the data.Cox proportional risk regression model was used to estimate the correlation between SD,CV,ARV or VIM and the risk of CVD mortality in T2DM patients,the stratified analysis was conducted according to age,sex and history of diabetes medication.The used software was State 16.0.Results In the study,7174 cases were included for analysis.As of December 31,2021,following up duration of subjects was 8.00 years,and 306 cases dead from CVD.Cox regression analysis showed that when SD,CV,ARV,and VIM increased one SD,the death risk of CVD increased 19%(HR=1.19,95%CI:1.06-1.34),13%(HR=1.13,95%CI:1.01-1.27),17%(HR=1.17,95%CI:1.04-1.31)and 16%(HR=1.16,95%CI:1.04-1.30),respectively.Stratified analysis showed that the FPG long-term variability indexes correlated positively to the risk of CVD death i

关 键 词：空腹血糖变异性 心血管疾病 糖尿病 2型 前瞻性队列研究 

分 类 号：R587.1[医药卫生—内分泌]