我国中年人群糖尿病和空腹血糖异常对心血管病发病的预测价值  

Predictive value of diabetes and impaired fasting glucose to incidence of cardiovascular disease in middle-aged Chinese

作　　者：周北凡[1] 刘小清[2] 武阳丰[1] 李义和[2] 李莹[1] 麦劲壮[2] 赵连成[1] 饶栩栩[2] 杨军[1] 郭成业[2] 张林峰[1] 石美玲[2] 于学海[3] 邓木兰[2] 田秀珍 连子斌[2] 

机构地区：[1]中国医学科学院中国协和医科大学阜外心血管病医院,100037 [2]广东省心血管病研究所 [3]首都钢铁公司职工医院 [4]北京石景山区慢性病防治研究所

出　　处：《中华心血管病杂志》2003年第3期226-230,共5页Chinese Journal of Cardiology

摘　　要：目的　采用前瞻性研究分析糖尿病在我国中年人群中是否心血管病发病的独立危险因素。方法　中国和美国心血管病和心肺疾病流行病学合作研究 1983～ 1984年在北京和广州工农人群 ( 35～ 5 4岁 )中用国际标准化的方法进行了心血管病危险因素基线调查。对 10 0 76人的队列按照统一的方案每 2年随访一轮到 1997年底 ,根据美国糖尿病协会空腹血糖的分类标准对于基线血糖水平进行分层 ,用Cox回归调整年龄和调整相关因素后 ,计算糖尿病和空腹血糖异常对于冠心病和脑卒中发病的相对危险。结果　在除外基线时有心肌梗死和脑卒中史资料完整的 9111人中 ,按照世界卫生组织MONICA方案的诊断标准 ,共计发生冠心病事件 72例 ,脑卒中事件 2 5 9例。心血管病的其他危险因素在空腹血糖异常组和糖尿病组高于正常组。经年龄调整和多因素调整后 ,糖尿病对冠心病和脑卒中发病的相对危险在女性 ( 3 78和 4 2 0 )和性别合并组 ( 3 2 2和 2 5 0 )显著高于血糖正常组 ,男性未达到统计学显著水平 ,空腹血糖异常组未见相对危险的增高。糖尿病对于冠心病和脑卒中发病的相对危险度仅低于高血压而高于血清总胆固醇和吸烟。结论　在我国中年人群中糖尿病是冠心病和脑卒中发病的重要危险因素之一。Objective To investigate whether diabetes is an independent risk factor for coronary heart disease and stroke in Chinese middle-aged cohort. Methods A cohort of Chinese workers and farmers of Beijing and Guangzhou was baseline surveyed in the fall of 1983-1984 using internationally standardized survey methods under the PRC-USA Collaborative study of Cardiovascular and Cardiopulmonary Epidemiology. From 1991, the cohort was followed-up according to an uniform protocol every two years till the end of 1997. The end points for events of coronary heart disease and stroke were diagnosed according to the MONICA criteria. Baseline fasting blood glucose was stratified according to the 1997 classification of fasting glucose by American Diabetes Association. Age adjusted and multiple risk factor adjusted relative risk of diabetes or impaired fasting glucose(IFG) to CHD or stroke were estimated using Cox regression model. Results There were 9 111 persons in the cohort free of the history of AMI and stroke with complete risk factor data. During 13-year follow-up, 72 cases of coronary events and 259 cases of stroke events emerged. The baseline levels of blood pressure, serum total cholesterol, BMI and smoking rate were higher in diabetes and IFG group compared with those in the normal glucose group. After adjusting for multiple risk factors, the relative risk of diabetes to incidence of coronary heart disease and stroke were 3.38 and 4.20 for women, 3.22 and 2.50 for sex combined group, significantly higher than that of the group with normal fasting glucose, those in men though higher than in normal group but were not statistically significant. There was no significant increase in relative risk in the group with impaired fasting glucose. The relative risk of diabetes to coronary heart disease and stroke was higher than those of high serum cholesterol and smoking but lower than high blood pressure. Conclusion Diabetes is an important risk factor for coronary heart disease and stroke in middle-aged Chinese population.

关 键 词：中国 中年人 糖尿病 空腹血糖 心血管病 冠心病 心肌梗死 

分 类 号：R587.1[医药卫生—内分泌] R54[医药卫生—内科学]