上海淞南社区2型糖尿病患者合并其他心血管代谢异常的现况流行病学调查

doi:10.16150/j.1671-2870.2019.03.015

摘要/Abstract

摘要：

目的： 分析上海社区中老年2型糖尿病患者合并其他心血管代谢异常的现况。方法： 采用整群抽样的方法,选取上海宝山区淞南社区40岁及以上的2型糖尿病患者1 322例,进行问卷调查、体格检查和生化指标检测。按性别分组,分析2型糖尿病患者合并其他心血管代谢异常的现况;按心血管代谢异常个数分组,分析年龄、性别、糖化血红蛋白等危险因素与心血管代谢异常间的相关性。结果： 1 322例2型糖尿病患者中,男性591例,平均年龄为（62.9±9.8）岁;女性731例,平均年龄为（64.1±9.8）岁。男性和女性糖尿病患者中合并其他心血管代谢异常的比例为,一般肥胖,9.8%和17.4%;腹型肥胖,57.5% 和69.6%;高血压,72.9% 和 76.6%;血脂异常为50.1%和55.3%;白蛋白尿为26.4%和23.9%;最大颈动脉内中膜厚度（maximum carotid intima-media thickness,CIMT_max）增厚为19.1%和12.0%。以糖尿病合并其他心血管代谢异常个数分组,0~2个为组1,3个为组2,4~5个为组3,以其为因变量进行多因素Logistic回归分析显示,年龄增大、糖化血红蛋白及C反应蛋白水平升高、当前吸烟、合并胰岛素抵抗与糖尿病人群合并其他心血管代谢异常的风险增加相关（P均<0.05）。结论： 在上海宝山区淞南社区的老年糖尿病人群中,合并其他心血管代谢异常的比例较高,而年龄增大、糖化血红蛋白及C反应蛋白水平升高、当前吸烟、合并胰岛素抵抗与其心血管代谢异常风险增加相关。

关键词: 糖尿病, 心血管代谢异常, 流行病学

Abstract:

Objective: To investigate the prevalence of cardiometabolic abnormalities and the association between the risk factors and cardiometabolic abnormalitiesin community residents with type 2 diabetes. Methods: A cross-sectional study was conducted among 1 322 diabetic adults aged 40 years in Songnan district, Shanghai in 2009. Clinical data, anthropometric measurements, and results of biochemical analysis were collected, and participants were categorized into male and female and divided into three groups according to the number of cardiometabolic abnormalities present (including general obesity or abdominal obesity, hypertension, dyslipidemia, albuminuria, elevated CIMT_max): group 1 (0-2 abnormality), group 2 (3 abnormalities), and group 3(4-5 abnormalities), to analyze the association between risk factors such as age, sex, glycated hemoglobin and cardiometabolic abnormalities. Results: Of the 1 322 type 2 diabetic patients, there were 501 men and 731 women, average age was (64.1±9.8) years. Ratios of cardiometabolic abnormalities in male vs. female diabetic patients were 9.8% vs. 17.4% (general obesity); 57.5% vs. 69.6% (abdominal obesity); 72.9% vs. 76.6% (hypertension); 50.1% vs. 55.3% (dyslipidemia); 26.4% vs. 23.9% (albuminuria); 19.1% vs.12.0% (elevated CIMT_max). Multiple logistic regression analysis showed that increasing age, high serum HbA1c and C reactive protein levels, current smoking,and insulin resistance were risk factors of associated cardiometabolic abnormalities(all P<0.05). Conclusions: A high prevalence of cardiometabolic abnormalities existed in community residents with type 2 diabetes in Songnan district, Shanghai.Increasing age, high serum HbA1c and C reactive protein levels, current smoking, and insulin resistance are correlated with the increase of associated cardiometabolic abnormalities.

Key words: Diabetes, Cardiometabolic abnormalities, Epidemiology

中图分类号:

R541.4

刘珊珊, 牛静雅, 王天歌, 李勉, 赵志云, 徐瑜, 陆洁莉, 徐敏, 毕宇芳, 张迪. 上海淞南社区2型糖尿病患者合并其他心血管代谢异常的现况流行病学调查[J]. 诊断学理论与实践, 2019, 18(03): 323-328.

LIU Shanshan, Niu Jingya, WANG Tiange, LI Mian, ZHAO Zhiyun, XU Yu, LU Jieli, XU Min, BI Yufang, ZHANG Di. Epidemiological investigation on cardiometabolic abnormalities in Songnan Community residents with type 2 diabetes[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(03): 323-328.

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变量	男性（n=591）	女性（n=731）	P值
年龄（岁）	62.9±9.8	64.1±9.8	0.026 5
受教育年限≥9年[n（%）]	472(79.9)	409(56.0)	<0.000 1
糖尿病家族史[n（%）]	155(26.2)	233(31.9)	0.025 0
糖尿病病程（年）	1.3(0~7.0)	2.1(0~8.3)	0.782 8
当前吸烟[n(%)]	245(41.5)	19(2.6)	<0.000 1
当前饮酒[n(%)]	195(33.0)	25(3.4)	<0.000 1
体力活动（MET-h/wk）	23.1(11.6~46.2)	23.1(11.6~46.2)	0.718 8
腰围（cm）	91.2±8.9	90.0±10.2	0.019 7
臀围（cm）	97.6±6.9	97.3±8.5	0.409 3
体质量指数（kg/m²）	25.8±3.4	26.7±4.3	<0.000 1
收缩压（mmHg）	144.6±20.2	149.2±22.9	0.000 1
舒张压（mmHg）	81.7±10.2	78.5±10.2	<0.000 1
三酰甘油（mmol/L）	1.57(1.11~2.48)	1.78(1.29~2.58)	0.049 4
高密度脂蛋白胆固醇（mmol/L）	1.23±0.27	1.36±0.29	<0.000 1
低密度脂蛋白胆固醇（mmol/L）	2.32±0.72	2.48±0.75	<0.000 1
总胆固醇（mmol/L）	4.97±1.00	5.45±1.13	<0.000 1
空腹血糖（mmol/L）	7.52±2.60	7.56±2.63	0.761 2
2 h血糖（mmol/L）	16.40±4.52	16.79±5.80	0.169 4
糖化血红蛋白（%）	7.6(6.6~9.0)	7.4(6.6~8.5)	0.099 2
空腹胰岛素（μIU/L）	7.56(5.10~11.73)	10.27(7.09~15.61)	<0.000 1
2 h胰岛素（μIU/L）	44.77(24.97~71.20)	60.53(35.93~102.20)	<0.000 1
胰岛素抵抗指数	2.50(1.57~3.91)	3.24(2.11~5.32)	<0.000 1
C反应蛋白（mg/L）	0.32(0.09~1.21)	0.51(0.14~1.91)	<0.000 1
尿蛋白肌酐比（mg/g）	7.25(2.97~17.78)	8.18(3.72~23.71)	0.003 8
CIMT_max（mm）	0.7 (0.6~0.8)	0.6 (0.6~0.8)	<0.000 1

变量	0~2个（734例）	3个（384例）	4~5个（204例）	趋势P值
男性	338(46.1)	162(42.2)	91(44.6)	0.452 5
年龄（岁）	62.3±9.4	64.6±9.6	66.1±10.6	<0.000 1
受教育年限≥9年	514(70.0)	246(64.1)	121(59.3)	0.001 7
糖尿病家族史	233(31.7)	90(23.4)	65(31.9)	0.310 4
糖尿病病程（年）	4.7±6.3	4.2±5.5	5.2±6.6	0.481 3
当前吸烟[n(%)]	141(19.2)	79 (20.6)	44(21.6)	0.411 9
当前饮酒[n(%)]	119(16.2)	68(17.7)	33(16.2)	0.826 5
体力活动（MET-h/wk）	23.1(11.6~46.2)	23.1(11.6~46.2)	23.1(11.6~46.2)	0.641 4
糖化血红蛋白（%）	7.3(6.5~8.6)	7.5(6.8~8.7)	7.9(6.9~9.3)	<0.000 1
胰岛素抵抗[n(%)]	354(48.2)	258(67.2)	158(77.5)	<0.000 1
C反应蛋白（mg/L）	0.25(0.08~1.01)	0.57(0.17~1.78)	1.18(0.37~4.17)	<0.000 1

危险因素	3 个（384例）OR（95% CI）	P值	4~5个（204例）OR（95% CI）	P值
男性比女性	0.75（0.54~1.03）	0.074 2	0.92（0.61~1.37）	0.668 0
年龄（增加10岁）	1.37（1.16~1.62）	0.000 2	1.64（1.33~2.03）	<0.000 1
受教育年限≥9年	1.10（0.79~1.53）	0.593 7	0.96（0.63~1.45）	0.844 7
糖尿病家族史	0.76（0.56~1.03）	0.088 3	1.24（0.85~1.82）	0.268 5
糖尿病病程≥10年	0.97（0.95~0.99）	0.006 4	0.99（0.96~1.02）	0.402 3
当前吸烟	1.43（0.98~2.09）	0.067 2	1.77（1.09~2.88）	0.022 1
当前饮酒	1.38（0.94~2.02）	0.098 3	1.11（0.68~1.81）	0.688 3
体力活动（增加1 MET-h/wk）	1.00（1.00~1.00）	0.320 6	1.00（1.00~1.00）	0.973 4
糖化血红蛋白≥6.5%	1.78（1.25~2.55）	0.001 5	1.62（0.99~2.66）	0.056 2
胰岛素抵抗	1.78（1.37~2.32）	<0.000 1	3.68（2.56~5.27）	<0.000 1
C反应蛋白（增加1 mg/L）	1.02（1.00~1.03）	0.083 1	1.02（1.00~1.04）	0.021 1