河南省某农村人群多代谢异常与2型糖尿病发病风险的队列研究

发布时间：2018-05-04 11:32

本文选题：2型糖尿病 + 多代谢异常　；参考：《郑州大学》2016年硕士论文

【摘要】：2013年,中国糖尿病的患病人数为9840万例,居全球首位,糖尿病[其中90%以上是2型糖尿病(type 2 diabetes mellitus,T2DM)]已经成为中国一个重大的公共卫生问题。多代谢异常是指超重或肥胖、高血压、高血糖、血脂异常等多代谢异常组分的个体聚集情况,可显著增加T2DM的发病风险。因此,有效地检出和控制与T2DM相关的危险因素,筛查T2DM高危人群,是预防控制T2DM的重要措施。目的1.基线多代谢异常各组分与T2DM发病风险的关系。2.基线体质指数(body mass index,BMI)、腰围(waist circumference,WC)与腰身比(waist-to-height ratio,WHtR)的组合与T2DM发病风险的关系。3.基线多代谢异常的聚集与T2DM发病风险的关系。4.多代谢异常基线和随访的动态变化与T2DM发病风险的关系。方法于2007年7—8月和2008年7—8月选择河南省新安县的两个乡镇(磁涧镇和铁门镇)为研究现场,以自然村为单位,采用整群抽样的方法,抽取18岁及以上的居民20194名作为研究对象。研究内容包括问卷调查、体格检查、空腹血糖及脂质谱检测。2013年7—8月和2014年7—10月对这些研究对象进行相同研究内容的随访,共随访到17265名(应答率为85.50%),最终11718名(男性4426名,女性7292名)研究对象被纳入本研究。应用发病密度及Cox比例风险回归模型对多代谢异常与T2DM发病风险的关系进行分析研究。结果1.11718名研究对象中,男性4426名,女性7292名,平均随访时间为6.01年,共计70016.18人年。随访期间新发T2DM 677例(男性254例,女性423例),发病密度为9.67/1000人年(男性为9.52/1000人年、女性为9.76/1000人年)。2.基线多代谢异常各组分及其聚集以及基线BMI、WC与WHtR的组合与t2dm发病风险的关系:(1)调整基线时性别、年龄、吸烟、饮酒、糖尿病家族史后,bmi超重组、bmi肥胖组以及wc、whtr、收缩压(systolicbloodpressure,sbp)、舒张压(diastolicbloodpressure,dbp)、空腹血糖(fastingplasmaglucose,fpg)、总胆固醇(totalcholesterol,tc)、甘油三酯(triglyceride,tg)、高密度脂蛋白胆固醇(highdensitylipoprotein-cholesterol,hdl-c)异常组人群的t2dm发病风险分别高于相应指标正常组人群,其hr(95%ci)分别为2.28(1.83-2.84)、4.78(3.80-6.01)、3.00(2.47-3.65)、3.37(2.68-4.22)、1.56(1.27-1.92)、1.68(1.37-2.06)、9.10(7.61-10.89)、2.10(1.49-2.96)、2.83(2.36-3.39)、1.52(1.28-1.82),且fpg异常组人群的t2dm发病风险最高。(2)调整基线时性别、年龄、吸烟、饮酒、糖尿病家族史后,以bmi正常且whtr正常组为参照,无论bmi正常与否,whtr异常人群的t2dm发病风险均有所增加,bmi正常且whtr异常组、bmi异常且whtr异常组的hr(95%ci)分别为1.80(1.27-2.56)、3.79(2.99-4.80);同样调整上述因素之后,以wc正常且whtr正常组为参照,无论wc正常与否,whtr异常人群的t2dm发病风险均有所增加,wc正常且whtr异常组、wc异常且whtr异常组的hr(95%ci)分别为2.21(1.62-3.00)、3.98(3.14-5.04)。(3)调整基线时性别、年龄、吸烟、饮酒、糖尿病家族史后,以多代谢异常组分聚集个数0为参照,随多代谢异常组分[中心性肥胖(wc)、高血压、空腹血糖受损、血脂异常]聚集个数由1个逐渐增加到2、3、4个,t2dm发病风险逐渐增高,hr(95%ci)分别为1.55(1.11-2.18)、4.39(3.20-6.00)、8.68(6.27-12.04)、28.07(19.10-41.26)。3.多代谢异常基线和随访的动态变化与t2dm发病风险的关系:(1)调整基线时性别、年龄、吸烟、饮酒、糖尿病家族史后,基线wc、whtr、dbp、tc、tg或hdl-c正常组人群中,随访转变为异常的人群与保持正常的人群相比,t2dm发病风险均有所增加,hr(95%ci)分别为2.28(1.67-3.13)、3.15(2.09-4.74)、1.42(1.07-1.90)、3.19(2.32-4.38)、3.17(2.50-4.03)、1.53(1.20-1.95);基线bmi、wc、whtr、tc或tg异常组人群中,随访未控制组人群较随访控制组人群t2dm发病风险高,hr(95%ci)分别为1.47(1.00-2.14)、1.60(1.10-2.33)、1.84(1.20-2.83)、2.22(1.12-4.39)、1.41(1.03-1.93)。(2)调整基线性别、年龄、吸烟、饮酒、糖尿病家族史后,基线血脂正常组人群中,随访转变为血脂异常的人群与血脂保持正常的人群相比,t2dm发病风险有所增加,hr(95%ci)为2.41(1.83-3.19);基线血脂异常组人群中,随访血脂未控制组人群较随访血脂控制组人群的t2dm发病风险高,hr(95%ci)为1.53(1.15-1.99)。结论1.基线多代谢异常各组分异常均可增加T2DM的发病风险。2.BMI、WC与WHtR三个肥胖测量中,无论基线BMI或者WC正常与否,基线WHtR异常人群的T2DM发病风险均有所增加。3.随着基线多代谢异常组分的聚集个数的增加,T2DM发病风险逐渐增高。4.无论基线WC、WHt R、TC或TG正常与否,如能有效控制WC、WHtR、TC或TG在正常水平均可降低T2DM的发病风险。
[Abstract]:In 2013, the number of diabetes in China was 98 million 400 thousand and ranked first in the world. Diabetes [more than 90% of type 2 diabetes (type 2 diabetes mellitus, T2DM)] has become a major public health problem in China. Polymetabolic abnormalities refer to the individual accumulation of multiple metabolic abnormalities, such as overweight or obesity, hypertension, hyperglycemia, and abnormal blood lipid. It can significantly increase the risk of T2DM. Therefore, the effective detection and control of risk factors associated with T2DM and screening of high risk population in T2DM are important measures to prevent and control T2DM. The relationship between the components of 1. baseline multiple metabolic abnormalities and the risk of T2DM is.2. baseline physical index (body mass index, BMI), and the waist circumference (waist circumference,) WC) the relationship with the combination of the waist to waist ratio (waist-to-height ratio, WHtR) and the risk of T2DM; the relationship between the aggregation of multiple metabolic abnormalities and the risk of T2DM incidence in.3. baseline.4., the relationship between the baseline and the dynamic changes of multiple metabolic abnormalities and the risk of T2DM. Methods selected two townships in Xin'an County, Henan, from 7 to August, 2007 and 2008. (magnetic Jian town and tie gate town) for the study site, taking the natural village as a unit, using a cluster sampling method, 20194 people aged 18 and above were selected as the research object. The research contents included questionnaire survey, physical examination, fasting blood glucose and lipid mass spectrometry test for the same research contents in.2013 years from 7 to August and 2014 from 7 to October. A total of 17265 (response rates of 85.50%) were followed up, and the final 11718 subjects (4426 men and 7292 women) were included in this study. The relationship between the incidence of multiple metabolic abnormalities and the risk of T2DM was analyzed with the incidence of incidence density and the Cox proportional hazard regression model. Among 1.11718 subjects, 4426 men and 7292 women. The average follow-up time was 6.01 years, a total of 70016.18 years. During the follow-up period, there were 677 new T2DM cases (male 254, female 423), the incidence density was 9.67/1000 year (male 9.52/1000 year, female 9.76/1000 year),.2. baseline multiple metabolism abnormality components and their aggregation and baseline BMI, WC and WHtR association with the risk of T2DM: (1) After adjusting the baseline sex, age, smoking, drinking, and family history of diabetes, BMI superrecombination, BMI obesity group and WC, WHtR, systolicbloodpressure (SBP), diastolic pressure (diastolicbloodpressure, DBP), fasting blood glucose (fastingplasmaglucose, FPG), total cholesterol (Totalcholesterol, TC), triglyceride (Totalcholesterol, TC), triglycerides, high-density fat eggs The risk of T2DM in highdensitylipoprotein-cholesterol (HDL-C) group was higher than that of the normal group. The HR (95%ci) was 2.28 (1.83-2.84), 4.78 (3.80-6.01), 3 (2.47-3.65), 3.37 (2.68-4.22), 1.56 (1.27-1.92), 1.68 (1.37-2.06), 9.10 (7.61-10.89), 2.10, 2.83 (1.52), 1.52 (1.52). 1.28-1.82), and the risk of T2DM in the FPG abnormal group was the highest. (2) to adjust the baseline sex, age, smoking, drinking, and diabetes family history, with the normal BMI and the normal WHtR group as reference, no matter whether BMI normal or not, the T2DM incidence of abnormal WHtR population increased, BMI normal and WHtR abnormal group, BMI abnormality and WHtR abnormality group. 1.80 (1.27-2.56) and 3.79 (2.99-4.80) respectively. After the same adjustment of the above factors, the risk of T2DM incidence in WHtR abnormal groups increased with normal WC and normal WHtR group, WC normal and WHtR abnormal group, WC abnormal and WHtR exception group were 2.21, 3.98 (3) adjusted baseline. In the history of sex, age, smoking, drinking, and diabetes family history, the number of multiple metabolic abnormalities was 0 as reference. The number of multiple metabolic abnormalities [central obesity (WC), hypertension, impaired fasting blood glucose, dyslipidemia] increased from 1 to 2,3,4, and the risk of T2DM increased gradually, and HR (95%ci) was 1.55 (1.11-2.18), 4.39 (3). .20-6.00), 8.68 (6.27-12.04), 28.07 (19.10-41.26).3. multiple metabolic abnormalities baseline and follow-up dynamic changes associated with the risk of T2DM: (1) adjust the baseline sex, age, smoking, drinking, and diabetes family history, baseline WC, WHtR, DBP, TC, TG, or HDL-C groups, followed by an abnormal population and a normal population. The risk of T2DM was increased, HR (95%ci) was 2.28 (1.67-3.13), 3.15 (2.09-4.74), 1.42 (1.07-1.90), 3.19 (2.32-4.38), 3.17 (2.50-4.03), 1.53 (1.20-1.95), and the baseline of BMI, WC, WHtR, or abnormality was higher in the uncontrolled group than those in the follow-up control group, 1.47 (1.6), 1.6 respectively. 0 (1.10-2.33), 1.84 (1.20-2.83), 2.22 (1.12-4.39), 1.41 (1.03-1.93). (2) adjusted baseline sex, age, smoking, drinking, and diabetes family history, in the baseline blood lipid group, the risk of T2DM was increased, HR (95%ci) was 2.41 (1.83-3.19), and HR (95%ci) was 2.41 (1.83-3.19). Among the abnormal groups, the risk of T2DM was higher in the group of blood lipid uncontrolled groups than those in the blood lipid control group, and HR (95%ci) was 1.53 (1.15-1.99). Conclusion the abnormality of the 1. baseline multiple metabolic abnormalities could increase the risk of T2DM,.2.BMI, WC and WHtR in three obesity measurements, no matter the baseline BMI or WC is normal or not, baseline WHtR abnormality person The risk of T2DM morbidity in the group increased with the increase of the number of.3. in the baseline multiple metabolic abnormalities. The risk of T2DM was increased by.4. regardless of baseline WC, WHt R, TC, or TG, if the risk of WC, WHtR, TC, or at normal levels could be reduced.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R587.1

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