北京市学龄儿童糖代谢异常的流行特征及影响因素

发布时间：2018-08-04 15:50

【摘要】：近年来,随着生活水平的提高和生活方式的改变,儿童肥胖越来越常见。与肥胖相关的糖代谢异常：糖调节受损(impaired glucose regulation, IGR)包括空腹血糖受损(impaired fasting glucose, IFG)和糖耐量减低(impaired glucose tolerance, IGT)和过去认为是成人疾病的2型糖尿病(Type2Diabetes Mellitus, T2DM)在儿童中的患病率也逐年增加。T2DM与成年期心血管疾病(cardiovascular disease, CVD)的发病密切相关,而CVD已经成为我国首位的死亡原因。IGR和T2DM发病的低龄化可使青壮年发生CVD的危险性增加,与1型糖尿病(Type1Diabetes Mellitus, T1DM)相比,T2DM相关并发症出现得更早,病死率更高。因此,儿童IGR和T2DM已经引起广泛的关注并成为目前重要的医学研究课题,早诊断,早治疗,对减少成人期T2DM和CVD等疾病的发病有着重大的意义。目前,对儿童IGR和T2DM研究相对较少,北京市乃至全国迄今尚未有基于儿童青少年人群的、有代表性的大规模调查。本研究的目的在于：1、了解北京市学龄儿童(6-18岁在校中小学生)血糖分布特征；2、了解IGR和糖尿病特别是T2DM的现患率及分布特征；3、探讨糖调节异常和T2DM的关联因素,包括：人口特征(性别、年龄)、城乡、糖尿病家族史、肥胖及相关代谢异常等；4、探讨基于人群的糖尿病分型及特点。本研究为现况调查,采用分层(城乡)随机(层内随机)整群(抽样单位内)的抽样方法,对北京市七个区县共19431名6-18岁中小学生进行血糖水,平及T2DM相关危险因素的调查。调查采用两个阶段过程,第一阶段,采用空腹指尖毛细血管全血糖(fasting capillary blood glucose, FCBG)测量技术对所有研究对象进行血糖水平检测。第一阶段还进行身高、体重、腰围、血压、青春期发育检测。参照1999年WHO指血糖诊断标准,对第一阶段筛查出的空腹高血糖(FCBG≥5.6mmol/L)儿童476人,经知情同意,226人(47.48%)进入第二阶段的临床诊断,进行空腹静脉血浆葡萄糖(fasting plasma glucose, FPG)、血脂四项和胰岛素的检测。其中180人同意进行口服糖耐量试验(oral glucose tolerance test, OGTT)。对第二阶段采集静脉血的人群,根据2012年美国糖尿病协会(American Diabetes Association, ADA)静脉血糖标准进行糖尿病和糖尿病前期的诊断,IFG:FPG5.6mmol/L-6.9mmol/L,同时OGTT2小时血糖7.8mmol/L; IGT:OGTT2小时血糖≥7.8mmol/L-11.0mmol/L,同时FPG5.6mmol/L;糖尿病：FPG7.0mmol/L或OGTT2小时血糖≥11.1mmol/L.糖尿病分型根据ADA建议儿童青少年T2DM筛查的高危对象标准和Dean提出的诊断标准作为临床诊断T2DM的依据。同时参考抗体检测,抗体阳性的儿童,诊断为T1DM可能性大。 (一)6—18岁学龄儿童血糖的分布特征： 1、男生FCBG在6-18岁各个年龄组间均高于女生。男、女生间FCBG值的差异有统计学意义,P0.001。男、女的血糖变化趋势基本一致,且.呈现双峰分布：男、女生在6—11岁期间,血糖水平随年龄增长有逐渐升高的趋势,11岁达到高峰,之后开始下降,在13岁时出现波谷。在14—15岁年龄段,血糖水平又出现上升,男生升幅大于女孩,之后又开始下降,在18岁时出现波谷。 2、城区、郊区儿童平均FCBG分别为4.7±0.5mmol/L和4.6±0.5mmol/L; BMI分别为19.44±4.21,18.54±3.7。城区儿童FCBG、BMI均高于郊区儿童,差异具有统计学意义,P均0.001。 3、体重正常、超重、肥胖儿童的FCBG分别为4.60±0.51mmol/L,4.69±0.60mmol/L和4.71±0.56mmol/L。与体重正常儿童相比,超重、肥胖儿童的FCBG明显升高,差异有统计学意义,P0.001。 4、筛查出空腹高血糖(FCBG5.6mmol/L)儿童476人,占筛查人群的2.45%,男孩321例(1.65%),女孩155例(0.80%),男女比例2.1：1,性别间差异有统计学意义,P0.001。 5、经多元logistic逐步回归分析可见糖尿病家族史、性别、高TG、黑棘皮病和高血压都是FCBG升高的危险因素。 (二)IGR和糖尿病特别是T2DM的现患率及分布特征、关联因素和糖尿病分型及特点： 1、共发现血糖异常人群96例,其中IFG81例,IGT6例,IFG+IGT5例,T1DM6例,T2DM6例,特殊类型糖尿病2例。另外问卷调查中自我报告糖尿病2例。 2、学龄儿童IFG患病率为8.78%0,IGT患病率为0.65‰,糖尿病患病率为1.52%o,男生糖尿病患病率为0.91‰,女生糖尿病患病率为1.97‰,女生高于男生 3、学龄儿童中T2DM患病率为0.65‰,IGR患病率为8.89‰,T2DM/IGR患病率为10.41‰。 4、超重、肥胖儿童中IGR和糖尿病的检出率为1.1%,非超重、肥胖儿童为0.4%。超重、肥胖儿童IGR和糖尿病的发生率与体重正常儿童有显著性差异,P0.001。 5、经多元logistic逐步回归分析,家族史、高TC、黑棘皮病、高血压、腹型肥胖、高TG和性别是影响IGR和糖尿病的危险因素。 6、在新诊断的14例糖尿病中T1DM6例,T2DM6例(均为女性),特殊类型糖尿病2例。T2DM和T1DM的比例为1：1。通过以上研究我们可以得到以下结论： 1、北京地区6-18岁学龄儿童的空腹血糖水甲与性别、年龄和肥胖有关,存在城乡差异。 2、学龄儿童IFG患病率为8.78‰,IGT患病率为0.65‰,T2DM患病率为0.65‰,IGR患病率为8.89%0,T2DM/IGR患病率为10.41‰,流行率较高。 3、家族史、高TC、黑棘皮病、高血压、腹型肥胖、高TG和性别是影响IGR和T2DM的主要危险因素。 4、T2DM在儿童糖尿病中所占的比例增高,达到50%,应该引起重视。综上所述,随着肥胖儿童的日益增多,儿童糖代谢异常逐渐增多,其与成年期糖尿病和CVD等疾病的发生密切相关,已经成为一个日益受到关注的公共健康问题。了解儿童糖代谢异常的流行特征及相关危险因素,对于预防和治疗儿童糖代谢异常均有重要的意义。目前,国际及国内以人群为基础的针对儿童糖代谢水半的大规模的研究非常少见,本研究反映了正常儿童血糖水平的变化趋势,获得了儿童青少年糖调节异常和糖尿病的流行特征,初步探讨了相关的危险因素,为今后儿童血糖相关课题的研究提供了参考。
[Abstract]:In recent years, with the improvement of living standards and lifestyle changes, obesity is becoming more and more common in children. Impaired glucose metabolism associated with obesity: impaired glucose regulation (impaired glucose regulation, IGR) including impaired fasting blood glucose (impaired fasting glucose, IFG) and impaired glucose tolerance (impaired glucose tolerance, IGT) and the past thought to be The prevalence of Type2Diabetes Mellitus (T2DM) in adult disease (T2DM) is also closely related to the incidence of.T2DM in children year by year and the incidence of cardiovascular disease (CVD) in adulthood, and CVD has become the first cause of death in China, and the low age of.IGR and T2DM hair disease can increase the risk of CVD in young and young adults. Compared with type 1 diabetes (Type1Diabetes Mellitus, T1DM), T2DM related complications are earlier and more fatality. Therefore, children's IGR and T2DM have attracted wide attention and become important medical research topics. Early diagnosis and early treatment are of great significance for reducing the incidence of T2DM and CVD diseases in adult stage. There are relatively few studies on child IGR and T2DM. There is not yet a representative large scale survey based on children and adolescents in Beijing and even the whole country. The purpose of this study is: 1, to understand the blood sugar distribution characteristics of school aged children in Beijing (6-18 years old school students); 2, to understand the prevalence and distribution characteristics of IGR and diabetes, especially T2DM 3, to explore the related factors of abnormal glucose regulation and T2DM, including demographic characteristics (sex, age), urban and rural, family history of diabetes, obesity and related metabolic abnormalities, and 4, to explore the classification and characteristics of diabetes based on population.
In this study, a survey was conducted with a stratified (urban and rural) random (stratified random) cluster sampling method. A total of 19431 6-18 - year - old students in seven districts and counties in Beijing were investigated for blood glucose, level and risk factors related to T2DM. Two stages were used, and the first stage was the use of fasting fingertip capillary blood glucose (FAS Ting capillary blood glucose, FCBG) measurement of blood glucose level for all the subjects. The first stage also carried out the height, weight, waist circumference, blood pressure, puberty development test. According to the 1999 WHO index of blood glucose diagnosis, 476 children with high blood sugar (FCBG > 5.6mmol/L) were screened for the first stage, and 226 people (4 7.48%) into the second stage of clinical diagnosis, fasting plasma glucose (FPG), blood lipid four and insulin test. 180 of them agreed to take oral glucose tolerance test (oral glucose tolerance test, OGTT). For the second stage of collecting venous blood, according to the 2012 American Diabetes Association (Americ) An Diabetes Association, ADA) the standard of venous blood glucose for the diagnosis of diabetes and prediabetes, IFG:FPG5.6mmol/L-6.9mmol/L, and OGTT2 hour blood glucose 7.8mmol/L, IGT:OGTT2 hourly blood glucose more than 7.8mmol/L-11.0mmol/L, and FPG5.6mmol/L; diabetes: FPG7.0mmol/L or OGTT2 hours diabetes classification based on diabetes mellitus It is suggested that the standard of high risk subjects for T2DM screening in children and adolescents and the diagnostic criteria proposed by Dean are the basis for clinical diagnosis of T2DM. At the same time, reference to antibody test and antibody positive children, the possibility of diagnosis of T1DM is great.
(1) distribution characteristics of blood glucose in children aged 6 to 18 years of age:
1, male FCBG was higher than girls in all age groups of 6-18 years. The difference of FCBG value between male and female was statistically significant. The trend of blood sugar change in P0.001. male and female was basically the same, and the distribution of blood sugar in Shuangfeng was the same, and the trend of blood sugar level increased gradually during the age of 6 to 11, the peak of blood sugar level increased with age, and then reached the peak at the age of 11, then began to decline, 1 At the age of 14-15, blood glucose levels rose again, boys increased more than girls, and then began to decline again. At the age of 18, there was a trough.
2, the average FCBG of children in urban areas was 4.7 + 0.5mmol/L and 4.6 + 0.5mmol/L, respectively, and BMI was 19.44 + 4.21,18.54 + 3.7. urban children FCBG, and BMI was higher than those in suburban children. The difference was statistically significant, P 0.001. was all 0.001..
3, normal weight, overweight, obese children FCBG were 4.60 + 0.51mmol/L, 4.69 + 0.60mmol/L and 4.71 + 0.56mmol/L. compared with normal weight children, overweight, obese children's FCBG significantly increased, the difference was statistically significant, P0.001.
4, 476 children were screened for fasting hyperglycemia (FCBG5.6mmol/L), accounting for 2.45% of the screening population, 321 in boys (1.65%), 155 in girls (0.80%), and the proportion of men and women was 2.1:1, and the gender difference was statistically significant, P0.001.
5. Multiple logistic stepwise regression analysis showed that family history of diabetes mellitus, sex, high TG, acanthosis nigricans and hypertension were risk factors for increased FCBG.
(two) the prevalence and distribution characteristics of IGR and diabetes, especially T2DM, the related factors and types and characteristics of diabetes:
1, 96 cases of abnormal blood glucose were found, including IFG81, IGT6, IFG+IGT5, T1DM6, T2DM6, and 2 cases of special type diabetes. In addition, 2 cases of diabetes were reported in the questionnaire survey.
2, the prevalence rate of IFG in school-age children was 8.78%0, the prevalence rate of IGT was 0.65 per thousand, the prevalence rate of diabetes was 1.52%o, the prevalence rate of male diabetes was 0.91 per thousand, the prevalence rate of girls was 1.97 per thousand, and the female students were higher than the boys.
3, the prevalence of T2DM among school-age children was 0.65 per thousand, the prevalence rate of IGR was 8.89 per thousand, and the prevalence of T2DM/IGR was 10.41 per thousand.
4, overweight, obese children IGR and diabetes detection rate is 1.1%, non overweight, obese children are 0.4%. overweight, obese children IGR and diabetes incidence and weight normal children have significant differences, P0.001.
5. Multiple logistic stepwise regression analysis showed that family history, high TC, acanthosis nigricans, hypertension, abdominal obesity, high TG and sex were risk factors for IGR and diabetes.
6. Of the 14 newly diagnosed diabetes mellitus cases, 6 were T1DM6, 6 were T2DM6 (all female), and 2 were of special type. The ratio of T2DM to T1DM was 1:1.
Through the above research, we can draw the following conclusions:
1, fasting glycemic beetle in 6-18 years old school children in Beijing is related to gender, age and obesity, and there is a difference between urban and rural areas.
2, the prevalence rate of IFG in school-age children was 8.78 per thousand, the prevalence rate of IGT was 0.65 per thousand, the prevalence rate of T2DM was 0.65 per thousand, the prevalence rate of IGR was 8.89%0, the prevalence rate of T2DM/IGR was 10.41 per thousand, and the prevalence rate was high.
3, family history, high TC, acanthosis nigricans, hypertension, abdominal obesity, high TG and gender are the major risk factors for IGR and T2DM.
4, the proportion of T2DM in children's diabetes increased to 50%, which should be paid attention to.
To sum up, with the increasing number of obese children, the abnormal metabolism of sugar metabolism in children is increasing gradually. It is closely related to the occurrence of diabetes and CVD and other diseases in adult. It has become an increasingly concerned public health problem. To understand the epidemic characteristics and related risk factors of abnormal glucose metabolism in children and to prevent and treat children's sugar generation. Xie Yichang has important significance. At present, a large scale of international and domestic research on children's glucose metabolism water half is rare. This study reflects the change trend of blood glucose level in normal children, obtains the characteristics of abnormal glucose regulation and diabetes in children and adolescents, and discusses the related risk factors preliminarily. It provides a reference for future research on children's blood glucose related subjects.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R725.8

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