社区自然人群糖调节受损者5年转归及其影响因素

Five-year outcome of impaired glucose regulation and its risk factors in community residents

目的 探讨糖调节受损人群发生糖尿病的危险性及其影响因素.方法 2002年6月至8月,采用抽样分层横断面现场调查方法于上海市浦东新区社区中检出192例糖调节受损者.2007年同期进行随访,观察单纯糖耐量受损、单纯空腹血糖受损、糖耐量受损合并空腹血糖受损、糖尿病人群比例,变化.使用t检验、方差分析、卡方检验进行统计学分析.结果 5年中死亡5例,存活的187例中79例发生糖尿病,糖尿病年转化率为8.4%(79/187/5年).基线单纯糖耐量受损者糖尿病年转化率为8.2%(47/114/5年),基线单纯空腹血糖受损者精尿病年转化率为6.3%(12/38/5年),基线糖耐量受损合并空腹血糖受损者糖尿病年转化率为11.4%(20/35/5年).正常糖耐量年转化率为6.3%(59/187/5年).单纯糖耐量受损者和糖耐量受损合并空腹血糖受损者发生糖尿病的风险分别是单纯空腹血糖受损者的1.4倍(95%可信区间为0.753～2.508,P=0.29)和107倍(95%可信区间为1.021～2.80,P=0.028).转化为糖尿病者较未转化为精尿病者高血压、肥胖的比例增高,基线年龄、体重指数、腰围、腰臀比和2 h血精明显升高,随访结束时体重指数和收缩压较基线时增高.结论 上海市浦东新区糖耐量受损合并空腹血糖受损者糖尿病转化率最高.多种代谢异常可促进糖调节受损人群向糖球病转化.

Objective To investigate the outcome and risk factors of subjects with impaired glucose regulation (IGR). Methods A total of 192 IGR subjects from a cross-sectional survey in June to August 2002 were followed up for 5 years. Anthropometric measurement and 75 g oral glucose tolerance test were performed. The prevalence of isolated impaired fasting glucose (I-IFG), isolated impaired glucose tolerance (I-IGT), IFG + IGT, normal glucose tolerance (NGT) and diabetes mellitus (DM) was compared, t test,Chi-square test, and analysis of variance were used for data analysis. Results Five participants died during 5 years'follow up. Of the rest 187 subjects, 79 were found to develop DM. The annual incidence of DM and NGT was 8.4 % (79/187/5-y)and 6. 3% (59/187/5-y) , respectively. The annual incidence of DM was 8.2 % (47/114/5-y), 6. 3% (12/38/5-y) and 11.4% (20/35/5-y) for the subjects with I-IGT, I-IFG and IFG + IGT, respectively. The risk of DM was significantly higher in IFG + IGT subjects than I-IFT subjects. Compared with IGR subjects, those with new DM were characterized with hypertension, obesity,older age, and higher level of body mass index (BMI), waist circumference, waist-to-hip ratio and 2 h postprandial plasma glucose at baseline. BMI and systolic blood pressure during follow up were significantly higher than at baseline in subjects with new DM. Conclusions There might be a different course of I-IFG,I-IGT and IFG + IGT progressing to DM among community residents, and there is a higher conversion rate in IFG + IGT subjects. Various metabolic abnormalities can promote IGR progressing to DM.