中老年人糖化血红蛋白水平与颈动脉内膜-中层厚度的相关性研究:广州生物库心血管疾病亚队列

Effects of plasma levels of glycosylated hemoglobin A1c on carotid intima media thickness in the elderly Chinese people:the cardiovascular disease subgroup of Guangzhou Biobank Cohort Study

目的 探讨相对健康的中老年人血中糖化血红蛋白(HbAlc)含量对颈动脉硬化的影响.方法 从广州生物库队列中单纯随机抽样收集1863名年龄≥50岁的广州市居民的个人资料,问卷调查其病史、体格检查及测定血清空腹血糖、血脂、HbA1c的含量并应用彩色多普勒超声测量颈总动脉内膜-中层厚度(intima media thickness,IMT).在调整相关混染因素后,应用协方差分析进行连续变量分析.结果 (1)在调整年龄、性别和空腹血糖等因素后,平均颈总动脉IMT随HbA1c含量升高呈明显增加趋势(P=0.005).线性回归模型显示,在调整年龄、性别、吸烟状态、腰围、收缩压和舒张压、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇和空腹血糖等潜在危险因素后,结果仍然显示HbA1c水平与平均颈总动脉IMT有明显的线性相关(回归系数为0.014,P=0.03);(2)经过调整多种潜在混杂因素后,与HbA1c理想组(HbA1c<6.5%)比较,良好组(HbA1c为6.5%～7.5%)和差组(HbA1c>7.5%)发生颈动脉硬化的比值比(95%置信区间)分别为1.62(1.10,2.38)和1.76(0.86,3.63),趋势检验(P=0.01).结论 相对健康的中老年人HbA1c含量升高是颈动脉硬化的独立危险因素之一,提示降低HbA1c水平对阻止或延缓颈动脉硬化的发生与发展有重要意义.

Objective To investigate the effect of glycosylated hemoglobin A1c(HbA1c) on carotid atheresclerosis in relatively healthy elderly Chinese people.Methods A total of 1863 relatively healthy Chinese people(≥50 years old)were randomized enrolled from the Guangzhou Biobank Cohort Study(GBCS).Personal general historiy Was collected before the study in all object.The blood pressure,fasting glucose,lipids,HbA1c and common carotid artery intima-median thickness(CCA-IMT)were measured respectively.After adjustment relevant confounding factors,analysis of convariance was used for continuous variable analysis.Results (1)Ater adjusting for age,sex and fasting glucose,mean CCA-IMT were increased significantly with the increase of HbA1c level in all participant(P=0.005).The results of linear regression models show that, HbA1c levels was positively associated with mean CCA-IMT after adjusting for age,sex,smoking,physical activity,waist circumference,systolic and diastolic blood pressure,triglyceride,hish-density,low-density lipoprotein cholesterol and fasting glucose(regression coefficient t=0.014,P=0.03).Compared to the optimal group(HbA1c<6.5%),adjusted odds ratios (95% confidence interval)for carotid atherosclerosis in the satisfactory group(HbA1c 6.5%-7.5%)and unsatisfactory group(HbA1c>7.5%)were 1.62(1.10,2.38)and 1.76(0.86,3.63)respectively(P for trend=0.01).Conclusions Increasing HbA1c level is an independent risk factor for carotid athemsclerosis;that HbA1c-lowering treatment may be an important means for preventing the progression of carotid atherosclerosis.