累积糖化血红蛋白及胰岛素剂量在1型糖尿病患者胰岛素抵抗相关代谢紊乱中的作用  

Role of cumulative hemoglobin A 1c levels and insulin doses in insulin resistance-related metabolic disorders in patients with type 1 diabetes

作　　者：石梅 张妍 范闻琦 陈艳[2] 谢雨婷[2] 邓超[2] 李霞[1] Shi Mei;Zhang Yan;Fan Wenqi;Chen Yan;Xie Yuting;Deng Chao;Li Xia(Department of Metabolism and Endocrinology,the Second Xiangya Hospital of Central South University,Key Laboratory of Diabetes Immunology,Ministry of Education,Changsha 410011,China;National Clinical Research Center for Metabolic Diseases,the Second Xiangya Hospital of Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院代谢内分泌科、糖尿病免疫学教育部重点实验室,长沙410011 [2]中南大学湘雅二医院、国家代谢性疾病临床医学研究中心,长沙410011

出　　处：《中华内科杂志》2025年第4期309-317,共9页Chinese Journal of Internal Medicine

基　　金：国家重点研发计划(2022YFC2010102);湖南省三诺糖尿病公益基金会(LYF2022039);中国博士后科学基金(2024M753697);国家资助博士后研究人员计划(GZC20233190);中南大学研究生创新项目(2024XQLH049)。

摘　　要：目的:探讨自起病以来累积糖化血红蛋白(HbA 1c)水平和胰岛素剂量在新发1型糖尿病(T1D)患者胰岛素抵抗(IR)相关代谢紊乱中的作用。方法:本研究为回顾性队列研究,纳入2015年11月至2023年3月就诊中南大学湘雅二医院的T1D患者。收集患者的临床资料,包括年龄、性别、病程、胰岛素剂量、体重指数、腰围、血压、HbA 1c、胰岛自身抗体及空腹血脂等。IR相关代谢紊乱包括超重/肥胖/中心性肥胖、高血压和血脂异常。通过Cox回归分析和聚类分析,评估累积HbA 1c和胰岛素剂量在IR相关代谢紊乱中的作用。结果:共纳入235例患者,其中男性97例(41.3%),女性138例(58.7%),中位年龄19.8(13.3,31.1)岁,中位随访时间为30.8(20.8,45.6)个月。在随访期间,41.6%(72/173)的患者出现IR相关代谢紊乱。多因素Cox回归分析显示,累积HbA 1c≥60 mmol/mol是任一IR相关代谢紊乱[HR(95%CI):1.739(1.067~2.835)]及甘油三酯异常[HR(95%CI):3.277(1.176~9.127)]的独立危险因素,而累积胰岛素剂量≥0.5 U·kg^(-1)·d^(-1)是超重/肥胖/中心性肥胖[HR(95%CI):2.374(1.059~5.323)]的独立危险因素。聚类分析进一步发现,具有高累积HbA 1c、高胰岛素剂量和青春期发病特征的患者,发生高血压(HR=2.460,95%CI 1.008~6.005)、超重/肥胖/中心性肥胖(HR=2.707,95%CI 1.062~6.900)、甘油三酯异常(HR=5.495,95%CI 1.842~16.391)、高密度脂蛋白胆固醇异常(HR=11.054,95%CI 4.107~29.751)及任一IR相关代谢紊乱(HR=5.833,95%CI 2.602~13.077)的风险显著增加。结论:累积HbA 1c水平和胰岛素剂量较高的T1D患者发生IR相关代谢紊乱的风险增加,提示在这一人群中迫切需要探索新的治疗干预措施。Objective:To examine the effect of cumulative hemoglobin A 1c(HbA 1c)levels and insulin dosage on insulin resistance(IR)-related metabolic disturbances in newly diagnosed patients with type 1 diabetes(T1D).Methods:This retrospective cohort study included T1D patients admitted to the Second Xiangya Hospital of Central South University from November 2015 to March 2023.Clinical data collected comprised age,sex,disease duration,insulin dosage,body mass index,waist circumference,blood pressure,HbA 1c levels,islet autoantibodies,and fasting blood lipid profiles.IR-related metabolic disturbances assessed were overweight,obesity,central obesity,hypertension,and dyslipidemia.Cox regression and cluster analyses were applied to assess the influence of cumulative HbA 1c and insulin dosage on these metabolic disturbances.Results:A total of 235 patients were included,with 97 males(41.3%)and 138 females(58.7%).The median age was 19.8(13.3,31.1)years,and the median follow-up duration was 30.8(20.8,45.6)months.During follow-up,41.6%(72/173)of patients developed IR-related metabolic disturbances.Multivariate Cox regression analysis revealed that a cumulative HbA 1c≥60 mmol/mol was an independent risk factor for any IR-related metabolic disturbance[HR(95%CI):1.739(1.067-2.835)]and for triglyceride abnormalities[HR(95%CI):3.277(1.176-9.127)].Additionally,a cumulative insulin dosage≥0.5 U·kg^(-1)·d^(-1) was identified as an independent risk factor for overweight,obesity,or central obesity[HR(95%CI):2.374(1.059-5.323)].Cluster analysis further identified that patients with higher levels of cumulative HbA 1c and insulin dosage,particularly those with adolescent-onset diabetes,had the highest likelihood of developing hypertension(HR=2.460,95%CI 1.008-6.005),overweight/obesity/central obesity(HR=2.707,95%CI 1.062-6.900),triglyceride abnormalities(HR=5.495,95%CI 1.842-16.391),high-density lipoprotein cholesterol abnormalities(HR=11.054,95%CI 4.107-29.751),and any IR-related metabolic disturbance(HR=5.833,95%CI 2.602-13.077).Conclusi

关 键 词：糖尿病 1型 血红蛋白A 糖基化 胰岛素抵抗 累积 胰岛素剂量 

分 类 号：R587.1[医药卫生—内分泌]