重庆地区HIV感染者2型糖尿病发病及风险因素的巢式病例对照研究  

Incidence and risk factors of type 2 diabetes mellitus among people living with HIV in Chongqing:a nested case-control study

作　　者：王登萍 齐苗苗 田景伟 朱科阳 鲁雁秋 陈耀凯 WANG Dengping;QI Miaomiao;TIAN Jingwei;ZHU Keyang;LU Yanqiu;CHEN Yaokai(School of Public Health,Zunyi Medical University,Zunyi 563006,Guizhou,China;Chongqing Public Health Medical Center,Chongqing 400036,China)

机构地区：[1]遵义医科大学公共卫生学院,贵州遵义563006 [2]重庆市公共卫生医疗救治中心,重庆400036

出　　处：《中国艾滋病性病》2025年第3期267-272,共6页Chinese Journal of Aids & STD

基　　金：重庆市艾滋病专病医学研究中心建设项目;重庆市疾病预防控制与公共卫生研究中心建设项目;重庆市首批公共卫生重点学科建设项目;2022年度技术创新与应用发展专项重点项目(CSTB2022TIAD-KPX0180)。

摘　　要：目的探讨重庆地区HIV感染人群2型糖尿病(T2DM)发病率及风险因素。方法采用巢式病例对照研究的方法。首先建立HIV感染者基线队列,然后对基线队列进行随访,随访期间发生T2DM的患者进入病例组,同时在基线队列中选择尚未发展成T2DM的HIV感染者,以年龄(±5岁)和性别为匹配条件进行1∶4匹配,确立对照组。采用单因素和多因素分析方法,分析两组患者中相关因素的差异。结果2016年1月1日至2017年12月31日,共有1002例符合纳入标准的HIV感染者进入基线队列。6年随访期间,基线队列中共发生T2DM新发病例90例,累积发病率为8.98%。与对照组(360例)相比,病例组(90例)TG[1.37(1.01,2.09)mmol/L vs.2.07(1.28,3.18)mmol/L]、LDL-C[2.71(2.28,3.21)mmol/Lvs.3.07(2.47,3.52)mmol/L]、尿酸[302.00(253.00,360.00)mmol/Lvs.341.00(278.50,384.50)mmol/L]、空腹血糖水平[5.81(5.45,6.19)mmol/L vs.6.30(5.87,6.67)mmol/L]和空腹血糖受损(IFG)比例(7.78%vs.45.56%)均显著增高。多因素分析显示,TG升高(≥2.3 mmol/L)、LDL-C升高(≥3.4 mmol/L)、IFG(6.1~7.0 mmol/L)和HIV感染时间>1年的HIV感染者T2DM发病风险显著增加[HR分别为3.82(95%CI:1.60~9.08),2.56(95%CI:1.04~6.30),5.28(95%CI:2.43~11.47)和2.82(95%CI:1.12~7.14)。结论重庆地区HIV感染人群T2DM发病率较高,脂质代谢异常和IFG是其风险因素。Objective To investigate the incidence and risk factors of type 2 diabetes mellitus(T2DM) in people living with HIV in Chongqing. Methods A nested case-control study was conducted. A baseline cohort was first established and followed up. During this follow-up period, participants diagnosed with T2DM were stratified into the case group, while controls were selected at a ratio of 1:4 from those who had not developed T2DM and matched based on age (±5 years) and sex. Univariate and multivariate analyses were performed to assess differences in related factors between the two groups. Results A total of 1 002 participants were enrolled into the baseline cohort from January 1, 2016, to December 31, 2017. During the 6-year follow-up period, 90 incident cases of T2DM occurred, with a cumulative incidence of 8.98%. Compared to the control group(360 cases), the case group(90 cases) had significantly higher levels of triglycerides [TG, 1.37(1.01, 2.09) mmol/L vs. 2.07(1.28, 3.18) mmol/L], low-density lipoprotein cholesterol [LDL-C, 2.71(2.28, 3.21) mmol/L vs. 3.07 (2.47, 3.52) mmol/L], uric acid [302.00(253.00, 360.00) mmol/L vs 341.00(278.50, 384.50) mmol/L], fasting blood glucose [FBG, 5.81(5.45, 6.19) mmol/L vs 6.30(5.87, 6.67) mmol/L], and a higher proportion of patients with impaired fasting glucose(IFG, 7.78% vs. 45.56%). Multivariate analysis showed that HIV-infected individuals with elevated TG levels(≥2.3 mmol/L), elevated LDL-C levels(≥3.4 mmol/L), IFG(6.1-7.0 mmol/L), and HIV infection duration of more than 1 year had a significantly increased risk of developing T2DM, with hazard ratios(HR) of 3.82(95%CI: 1.60-9.08), 2.56(95%CI: 1.04-6.30), 5.28(95%CI: 2.43-11.47), and 2.82(95%CI: 1.12-7.14), respectively. Conclusions The incidence of T2DM among people living with HIV in Chongqing was high. Abnormal lipid profiles and impaired fasting blood glucose levels were risk factors for T2DM development in this population.

关 键 词：艾滋病 2型糖尿病 巢式病例对照研究 发病率 风险因素 

分 类 号：R373.9[医药卫生—病原生物学] R512.91[医药卫生—基础医学]