上海郊区35~74岁中老年2型糖尿病患者脑血管病发生风险亚组分析  

Study on the risk for cerebrovascular disease among subtypes of middle-aged and elderly type 2 diabetes mellitus patients aged between 35‒74 years in Shanghai suburbs

作　　者：张成珺 肖秋 刘振球 索晨 张铁军[1,4,5] 赵根明 蒋艳峰[2,4] 徐珂琳 陈兴栋 ZHANG Chengjun;XIAO Qiu;LIU Zhenqiu;SUO Chen;ZHANG Tiejun;ZHAO Genming;JIANG Yanfeng;XU Kelin;CHEN Xingdong(Department of Epidemiology&Ministry of Education Key Laboratory of Public Health Safety,School of Public Health,Fudan University,Shanghai 200032,China;State Key Laboratory of Genetic Engineering,Human Phenome Institute,School of Life Sciences,Fudan University,Shanghai 200438,China;Shanghai Institute of Infectious Disease and Biosecurity,Shanghai 200032,China;Fudan University Taizhou Institute of Health Sciences,Taizhou,Jiangsu 225316,China;Yiwu Research Institute,Fudan University,Yiwu,Zhejiang 322000,China;Department of Biostatistics,School of Public Health,Fudan University,Shanghai 200032,China;State Key Laboratory of Genetic Engineering,Human Phenome Institute,Zhangjiang Fudan International Innovation Center,National Clinical Research Center for Aging and Medicine,Huashan Hospital,Fudan University,Shanghai 200438,China)

机构地区：[1]复旦大学公共卫生学院流行病学教研室,教育部公共卫生安全重点实验室,上海200032 [2]复旦大学遗传工程国家重点实验室,人类表型组研究院,生命科学学院,上海200438 [3]上海市重大传染病与生物安全研究院,上海200032 [4]复旦大学泰州健康科学研究院,江苏泰州225316 [5]复旦大学义乌研究院,浙江义乌322000 [6]复旦大学公共卫生学院生物统计学教研室,上海200032 [7]复旦大学遗传工程国家重点实验室,人类表型组研究院,张江复旦国际创新中心,华山医院国家老年疾病临床医学研究中心,上海200438

出　　处：《上海预防医学》2024年第12期1148-1156,共9页Shanghai Journal of Preventive Medicine

基　　金：国家自然科学基金(82304239,82204125);国家重点研发计划“精准医学研究”重点专项(2017YFC0907000);上海市自然科学基金(23ZR1414000);上海市公共卫生重点学科(2023—2025年)新三年行动计划(GWVI-11.1-23);复旦大学公共卫生学院-嘉定疾控中心公共卫生高质量发展重点学科(GWGZLXK-2023-02)。

摘　　要：【目的】在上海郊区35~74岁中老年2型糖尿病(T2DM)患者人群中划分亚组,比较各亚组的特点并分析各亚组新发脑血管病的风险,促进T2DM的个体化和精准化治疗。【方法】基于上海郊区自然人群队列和生物样本库(SSACB),选取2016—2019年完成基线调查的7792例T2DM患者作为研究对象,按照性别分层,使用k⁃means方法根据基线收集的糖尿病患者诊断年龄、体重指数、空腹血糖和甘油三酯/高密度脂蛋白胆固醇指数将T2DM患者聚类为各亚组,并随访至2023年3月31日。使用多因素Cox回归模型分析不同亚组与脑血管病事件发生风险的关联,敏感性分析中排除随访1年内发生脑血管病事件者。【结果】7792例T2DM患者中,男性为3615例,女性为4177例,按照性别分层,通过k⁃means聚类得到4个亚组:血糖控制不良亚组、严重胰岛素抵抗亚组、早发型亚组和晚发型亚组。中位随访时间为4.30年,随访期共观察到1960例患者(男性844例,女性1116例)发生脑血管病结局事件。调整吸烟、饮酒、每周锻炼情况、糖尿病家族史和糖尿病持续时间后,在男性患者中,以晚发型亚组为参照,早发型亚组、血糖控制不良亚组和严重胰岛素抵抗亚组的新发脑血管病风险均更低(HR=0.59,95%CI:0.48~0.73,P<0.001;HR=0.81,95%CI:0.65~1.00,P=0.046;HR=0.61,95%CI:0.50~0.75,P<0.001)。在女性患者中,以晚发型亚组为参照,早发型亚组、血糖控制不良亚组和严重胰岛素抵抗亚组的新发脑血管病风险均更低(HR=0.68,95%CI:0.57~0.80,P<0.001;HR=0.73,95%CI:0.60~0.89,P=0.002;HR=0.72,95%CI:0.61~0.85,P<0.001)。敏感性分析结果与主分析结果一致。【结论】在上海郊区的T2DM患者人群中,男女性患者均为晚发型亚组的新发脑血管病风险最高,T2DM的亚组分型有助于识别患者中脑血管病高风险人群。[Objective]To classify subtypes among middle-aged and elderly type 2 diabetes mellitus(T2DM)patients aged between 35‒74 years in Shanghai suburbs,to compare their characteristics and analyze incidence risk for cerebrovascular disease among these subtypes,so as to promote personalized and precise treatment of T2DM.[Methods]A total of 7792 patients with T2DM who completed a baseline survey from 2016 and 2019 were selected as the research subjects,based on the data from a natural population cohort and biobank in Shanghai suburbs.Patients were stratified by gender and clustered into subtypes using k-means method based on baseline parameters including the age at T2DM diagnosis,body mass index(BMI),fasting blood glucose,and triglyceride to high-density lipoprotein cholesterol ratio(TG/HDL-C).Patients were followed up until March 31,2023.Multivariate Cox regression models were used to analyze the association between subtypes and incidence risk for cerebrovascular disease,and those with cerebrovascular disease within 1 year of follow-up survey were excluded from sensitivity analysis.[Results]Among the 7792 patients with T2DM,3615 were males and 4177 were females.Stratified by gender,4 subgroups were identified through k-means clustering analysis,namely poor blood glucose control subgroup,severe insulin-resistant subgroup,younger onset subgroup,and older onset subgroup.The median follow-up time was 4.30 years,during which 1960 cerebrovascular disease events were observed(844 in males,1116 in females).After adjusting for smoking,alcohol consumption,weekly exercise,family history of diabetes mellitus,and duration of diabetes mellitus,among male patients,the incidence risk for cerebrovascular disease was lower in the younger onset subgroup(HR=0.59,95%CI:0.48‒0.73,P<0.001),poor blood glucose control subgroup(HR=0.81,95%CI:0.65‒1.00,P=0.046),and severe insulin-resistant subgroup(HR=0.61,95%CI:0.50‒0.75,P<0.001),compared to the older onset subgroup.While among female patients,the incidence risk for cerebrovascular disea

关 键 词：2型糖尿病 并发症 聚类 精细分型 脑血管病 

分 类 号：R181.3[医药卫生—流行病学]