基于不同标准诊断的代谢综合征对2型糖尿病6年发病风险的预测价值

发布时间：2018-05-06 06:20

本文选题：代谢综合征 + 2型糖尿病　；参考：《郑州大学》2017年硕士论文

【摘要】：目的1.比较2005年NCEP-ATPⅢ修订标准(A标准),2009年IDF、AHA和NHLBI标准(B标准),2016年中国JCDCG标准(C标准)诊断的代谢综合征(MS)与2型糖尿病(T2DM)发病的关系及其原因。2.比较A标准、B标准和C标准诊断的MS对T2DM发病的预测价值,确定最适合筛查T2DM高危人群的标准及其原因。方法本研究于2007年7—8月和2008年7—8月选择河南省新安县的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,对抽取的18岁以上的20194名农村常住居民进行问卷调查、体格检查、空腹血糖及脂质谱检测。2013年7—8月和2014年7—10月进行与基线相同内容的随访研究。最终对12252名(男:4650名;女:7602名)研究对象应用Cox比例风险回归模型和Spiegelman法,分析三个标准诊断的MS与T2DM发病的关系及其原因,并应用ROC曲线比较三个标准诊断的MS对T2DM发病的预测价值及其原因。结果1.在平均5.92年的随访期间,12252名非T2DM研究对象共发生T2DM 776例(发病密度:10.71/1000人年),其中男性296例(发病密度:10.61/1000人年,女性480例(发病密度:10.77/1000人年)。2.三个标准MS组的T2DM发病密度(/1000人年)均显著高于非MS组(P0.0001),其中C标准的T2DM发病密度最高,B标准的T2DM发病密度最低(A:20.87[19.14-22.60]和4.98[4.34-5.62];B:20.60[18.91-22.28]和4.78[4.15-5.42];C:25.91[23.37-28.45]和6.74[6.07-7.41])。男性和女性研究对象中显示相似的结果。3.调整研究对象基线时的性别、年龄、吸烟、饮酒、糖尿病家族史、体力活动和静息心率后,以非MS组为参照,三个标准MS组的T2DM发病风险(HR[95%CI])均显著增加(P0.0001),其中C标准的最低(A,5.11[4.24-6.16];B,5.07[4.20-6.12];C,4.16[3.53-4.91]);不同标准MS组的T2DM人群归因危险度(PAR[95%CI])同样是C标准的最低:A,0.61[0.55-0.66];B,0.62[0.56-0.67];C,0.42[0.36-0.48]。男性和女性研究对象中显示相似的结果。4.不同标准WC、血压、TG、HDL-C和FPG异常组的T2DM发病密度(/1000人年)均显著高于正常组(WC:A,16.54[15.14-17.93]和6.07[5.31-6.82];B,16.10[14.80-17.39]和5.32[4.57-6.07];C,19.33[17.55-21.10]和6.66[5.94-7.38];血压:A/B/C,15.43[14.03-16.82]和7.39[6.58-8.21];TG:A/B/C,17.64[15.97-19.31]和7.32[6.57-8.08];HDL-C:A/B,12.42[11.36-13.49]和8.42[7.41-9.44];C,13.37[11.89-14.84]和9.45[8.60-10.31];FPG:A/B,25.25[23.10-27.40]和4.98[4.37-5.58];C,50.60[45.20-56.00]和6.90[6.27-7.53];P0.0001);男性和女性研究对象中显示相似的结果。5.调整研究对象基线时的性别、年龄、吸烟、饮酒、糖尿病家族史、体力活动和静息心率后,不同标准诊断的MS各异常组分与T2DM发病的关系不完全一致。以WC正常组为参照,不同标准WC异常组的T2DM发病风险(HR[95%CI])均显著增加,其中B标准的发病风险最高,C标准的最低(A,3.20[2.65-3.85];B,3.26[2.69-3.96];C,3.13[2.64-3.70];P0.0001);B标准WC异常组T2DM的PAR(95%CI)最高,C标准的最低:A,0.49(0.41-0.56);B,0.54(0.46-0.61);C,0.42(0.35-0.48);男性和女性研究对象中显示相似的结果。以正常组为参照,总体、男性和女性血压、TG异常组的T2DM发病风险(HR[95%CI])均显著增加(P0.0001)(血压:1.93[1.63-2.30]、1.68[1.28-2.21]和2.06[1.65-2.59];TG:2.63[2.23-3.09]、2.26[1.73-2.94]和2.80[2.26-3.46]);总体、男性和女性血压及TG异常组T2DM的PAR(95%CI)分别为0.30(0.23-0.36)、0.23(0.12-0.33)和0.34(0.27-0.40),0.36(0.29-0.42)、0.28(0.19-0.38)和0.40(0.32-0.47)。以HDL-C正常组为参照,不同标准HDL-C异常组的T2DM发病风险(HR[95%CI])均显著增加(A/B,1.56[1.30-1.86];C,1.46[1.23-1.72];P0.0001);不同标准HDL-C异常组T2DM的PAR(95%CI)分别为:A/B,0.24(0.15-0.33);C,0.13(0.07-0.18);男性和女性研究对象中显示相似的结果。以FPG正常组为参照,不同标准FPG异常组的T2DM发病风险(HR[95%CI])均显著增加(P0.0001),并且A/B标准的发病风险低于C标准:6.41[5.36-7.66]和8.81[7.42-10.47];A/B标准FPG异常组T2DM的PAR(95%CI)均高于C标准:0.63(0.57-0.68)和0.44(0.38-0.50);男性和女性研究对象中显示相似的结果。6.A标准和B标准诊断的MS对T2DM发病预测的曲线下面积(AUC)无显著差异(P0.05),但是均显著高于C标准(P0.05):总体(A,0.678[0.670-0.686];B,0.680[0.672-0.688];C,0.654[0.645-0.662])、男性(A,0.654[0.640-0.667];B,0.659[0.645-0.673];C,0.647[0.633-0.661])和女性(A/B,0.693[0.683-0.704];C,0.658[0.647-0.669])。三个标准诊断的MS预测T2DM发病的灵敏度和阴性预测值均为B标准最高(P0.05)。7.不同标准诊断的WC异常预测T2DM发病的AUC、灵敏度和阴性预测值均为B标准最高(P0.05)。血压异常、TG异常和HDL-C异常预测T2DM发病的AUC、灵敏度和阴性预测值稍低。A/B标准诊断的FPG异常对T2DM发病预测的AUC、灵敏度和阴性预测值均高于C标准(P0.05)。结论1.三个标准诊断的MS及其异常组分均是T2DM发病的危险因素。2.2016年中国JCDCG标准诊断的MS患者T2DM发病风险和PAR最低,主要归因于不同标准间WC异常或FPG异常的差异。3.2005年NCEP-ATPⅢ修订标准和2009年IDF、AHA和NHLBI标准诊断的MS对T2DM发病的预测能力均优于2016年中国JCDCG标准,主要归因于不同标准间FPG异常的差异。4.2009年IDF、AHA和NHLBI标准诊断的MS最适合筛查T2DM的高危人群。
[Abstract]:Objective 1. to compare the 2005 NCEP-ATP III revised standard (A standard), the 2009 IDF, AHA and NHLBI standard (B standard), the relationship between the metabolic syndrome (MS) and type 2 diabetes (T2DM) diagnosed by the Chinese JCDCG standard (C standard) in 2016 and its cause.2. comparison A standard. The standard and causes of DM high risk population were studied in 7 - August 2007 and from 7 to August in Xin'an County of Henan province. The study site was selected from the Xin'an County of Henan province and iron gate town. The follow up study of the same content with the baseline was carried out from 7 to August and 7 to October 2014 in.2013, and 12252 subjects (male: 4650; 7602 women) were finally used in the Cox proportional risk regression model and Spiegelman method to analyze the relationship between the three standard diagnosed MS and T2DM and the reasons, and the ROC curve was used to compare three markers. The predictive value of quasi diagnostic MS for T2DM and its cause. 1. during an average of 5.92 years of follow-up, 12252 non T2DM subjects had T2DM 776 cases (incidence density: 10.71/1000 man year), of which 296 cases (incidence density: 10.61/1000 person year, 480 female (10.77/1000 person year).2. three MS group T2DM pathogenesis The density (/1000 year) was significantly higher than that in the non MS group (P0.0001), in which the T2DM density of the C standard was the highest, and the B standard was the lowest (A:20.87[19.14-22.60] and 4.98[4.34-5.62]; B:20.60[18.91-22.28] and 4.78[4.15-5.42]; C:25.91[23.37-28.45] and female). The gender, age, smoking, smoking, drinking, family history of diabetes, physical activity and resting heart rate at the baseline were taken as a reference to the non MS group, and the T2DM risk (HR[95%CI]) in the three standard MS groups increased significantly (P0.0001), of which the C standard was the lowest (A, 5.11 [4.24-6.16]; B, 5.07[4.20-6.12]; C, 4.16[3.53-4.91]); M population attributable risk (PAR[95%CI]) was the same as the lowest C standard: A, 0.61[0.55-0.66], B, 0.62[0.56-0.67]; C, and 0.42[0.36-0.48]. male and female subjects showed similar results of.4. different WC WC, blood pressure, TG, and abnormality were significantly higher than those of the normal group. 7[5.31-6.82]; B, 16.10[14.80-17.39] and 5.32[4.57-6.07]; C, 19.33[17.55-21.10] and 6.66[5.94-7.38]; blood pressure: A/B/C, 15.43[14.03-16.82] and 7.39[6.58-8.21]; TG:A/B/C. And 4.98[4.37-5.58]; C, 50.60[45.20-56.00] and 6.90[6.27-7.53]; P0.0001); in male and female subjects, a similar result showed that.5. adjusted the gender, age, smoking, drinking, family history of diabetes, physical activity and resting heart rate, and the relationship between the abnormal MS components of the standard diagnosed MS and T2DM onset was incomplete. With WC normal group as reference, the risk of T2DM incidence (HR[95%CI]) of different standard WC abnormal groups increased significantly, of which the risk of B was the highest, C standard was the lowest (A, 3.20[2.65-3.85]; B, 3.26[2.69-3.96]; C, 3.13[2.64-3.70];). 0.46-0.61); C, 0.42 (0.35-0.48); the male and female subjects showed similar results. In the normal group, the overall, male and female blood pressure, and the T2DM risk (HR[95%CI]) in the TG abnormal group increased significantly (P0.0001) (blood pressure: 1.93[1.63-2.30], 1.68[1.28-2.21] and 2.06[1.65-2.59]; TG:2.63[2.23-3.09], 2.26[1.73-2.94] and 2.06[1.65-2.59]) 26-3.46]); as a whole, the PAR (95%CI) of T2DM in the blood pressure and the TG abnormality group was 0.30 (0.23-0.36), 0.23 (0.12-0.33) and 0.34 (0.27-0.40), 0.36 (0.29-0.42), 0.28 (0.19-0.38) and 0.40 (0.32-0.47). 1.46[1.23-1.72]; P0.0001); PAR (95%CI) of T2DM in different standard HDL-C abnormal groups were A/B, 0.24 (0.15-0.33), C, 0.13 (0.07-0.18); the male and female subjects showed similar results. Risk is lower than C standard: 6.41[5.36-7.66] and 8.81[7.42-10.47]; PAR (95%CI) of T2DM in A/B standard FPG exception group is higher than C standard: 0.63 (0.57-0.68) and 0.44 (0.38-0.50). Significantly higher than the C standard (P0.05): the overall (A, 0.678[0.670-0.686]; B, 0.680[0.672-0.688]; C, 0.654[0.645-0.662]). The male (A, 0.654[0.640-0.667]; B, 0.659[0.645-0.673]; C) and the female are both sensitive and negative. The AUC, sensitivity and negative predictive value of the WC anomaly predicted by the standard maximum (P0.05).7. standard was the highest of B standard (P0.05). Abnormal blood pressure, TG abnormality and HDL-C abnormal prediction of T2DM AUC, sensitivity and negative predictive values were slightly lower than those of.A/B standard diagnosis, sensitivity and negative prediction The values were all higher than the C standard (P0.05). Conclusion 1. the three standard diagnostic MS and its abnormal components are the risk factors of T2DM, the risk of T2DM incidence and PAR in MS patients diagnosed by JCDCG standard in.2.2016 years are the lowest, mainly attributable to the difference of WC abnormality or FPG abnormality in different standard intervals. The predictive ability of standard diagnostic MS to T2DM is superior to that of the Chinese JCDCG standard in 2016, mainly attributable to the difference of FPG abnormalities between different standards in.4.2009 years IDF, and MS for AHA and NHLBI standards is the most suitable for screening high-risk groups of T2DM.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1

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