河南省义马矿区糖尿病高危人群糖代谢特征及影响因素调查

Characteristics of glycometabolism and the influencing factors in the high risk group of diabetes mellitus in Yima coal mineral area of Henan province

目的:调查分析河南省义马矿区糖尿病高危人群的血糖异常状况及其相关危险因素。方法:①于2004-01/12对义马煤业集团下属的某居民区常住职工及家属进行糖尿病高危人群调查。均对调查项目知情同意。②用本院糖尿病诊治协作组自行设计的糖尿病高危人群筛查调查表,调查纳入对象的年龄、性别、疾病史、糖尿病家族史、糖尿病高危因素、体力劳动强度、家庭经济状况等。③测量纳入对象身高、体质量、血压、腰围、臀围的测量,计算体质量指数=体质量(kg)/身高(m)2。均常规测定空腹血糖和餐后2h血糖。④计量资料比较采用t检验及方差分析,计数资料进行四表格或行×列χ2检验。采用多类结果的logistic模型进行多因素分析。结果:①纳入具有糖尿病高危因素居民2000人,资料完整者1015人进入结果分析,男659人,女356人,平均年龄(51±9)岁。<40岁94人,40～49岁409人,50～59例313人,60～69岁149人,70～79岁50人。②男性空腹血糖及餐后2h血糖水平均明显高于女性(t=3.06,2.74,P<0.01),糖尿病检出率也高于女性(χ2=5.066,P<0.05)。血糖异常的检出率由高到低依次为空腹血糖受损、糖耐量减低、糖尿病。③血糖水平随年龄增长有增高趋势(F=10.30,11.73,P=0.000)。空腹血糖受损和糖耐量受损以50～59和60～69岁年龄段检出率最高,糖尿病检出率随年龄增长逐渐升高(χ2=66.6131,P=0.000)。④糖代谢异常情况随着高血压、糖尿病家族史、曾有血糖升高检出率的增高而加重(χ2=17.9683,19.9540,12.6355,P<0.01),少体力活动和高血脂人群以空腹血糖受损最多见。⑤血糖异常影响因素多类结果的Logistic回归分析表明,年龄、糖尿病家族史、收缩压、舒张压、体质量指数、腰臀比均为血糖异常的影响因素(95%CI:0.0128～0.0243,P=0.000;95%CI:0.2352～0.5258,P=0.000;95%CI:0.0020～0.0112,P=0.04;95%CI:0.0005～0.0119,P=0.031;95%CI:0.0208～0.0594,P=0.000;95%CI:1.4185～3.7153,P=0.000)。结论:①义马矿区居民以空腹血糖受损检出率最高,血糖水平存在性别差异。②糖调节受损(空腹血糖受损、糖耐量减低)在50～69岁时最高,糖尿病检出率随年龄增长而增高。③在各种糖尿病危险因素中,以年龄、糖尿病家族史、高血压史、体质量指数、腰臀比、体力活动少、高血脂史对血糖的影响明显。

AIM： To investigate and analyze the blood glucose abnormality and related risk factors in the diabetic high risk group in Yima coal mineral area of Henan province. METHODS： （1） Between January and December 2004, the employees and their relatives, who were living in a community of Yima Coal Industry （Group） Co.Ltd., were surveyed for diabetic high risk group, and they all voluntarily participated in it. （2） Their age, gender, disease history, diabetic family history, diabetic high risk factors, intensity of physical work and family economic status were investigated with the self-designed inventory for screening diabetic high risk group. （3） The body height, body mass, blood pressure, waist and hip circumferences were measured, and the body mass index was calculated [body mass index=body mass （kg）/body height （m）^2. Fasting blood glucose and 2-hour postprandial glucose were detected. （4） The measurement data were compared with the t test and analysis of variance, and the enumeration data were analyzed with the four-table or row xline χ^2 test. The Logistic model was applied in the multivariate analysis. RESULTS： （1） Totally 2 000 subjects with diabetic high risk factors were involved, and 1015 with complete data entered the analysis of results, including 659 males and 356 females with an average age of （51±9） years, 94 cases aged 〈 40 years, 409 cases aged 40-49 years, 313 cases aged 50-59 years, 149 cases aged 60-69 years, 50 cases aged 70-79 years. （2） The levels of fasting blood glucose and 2-hour postprandial glucose in males were obviously higher than in females （t=3.06, 2.74, P 〈 0.01）, and the detection rate of diabetes mellitus was also higher in males than in females （χ^2=5.066, P 〈 0.05）. The detection rate of blood glucose abnormalities from high to low in order was impaired fasting blood glucose, impaired glucose tolerance and diabetes mellitus respectively. （3） The blood glucose level showed an increasing trentl with aging （F=10.30, 11.73, P=0.000）, the detection rates of impaired fasting blood glucose, impaired glucose tolerance were the highest at 50-59 and 60-69 years old, and the detection rate of diabetes mellitus was increased with aging （χ^2=66.613 1, P=-0,000）. （4） The abnormality of glycometabolism was aggravated with the increased detection rates of hypertension, diabetic family history and past increase of blood glucose （χ^2=17,968 3, 19,954 0, 12,635 5, P 〈 0.01）. The impaired fasting blood glucose occurred the most in the subjects with fewer physical activity and higher blood lipids, （5） The Logistic regression analysis showed that age, diabetic family history, systolic pressure, diastolic pressure, body mass index and waist-to-hip ratio were all the influencing factors for the abnormality of blood glucose （95%CI：0.012 8-0.024 3, P =0.000; 95%CI：0.235 2-0.525 8, P=0.000; 95%CI：0.002 0-0.011 2, P =0.04; 95%CI：0.000 5-0.011 9, P=0.031; 95%CI：0.020 8-0.059 4, P =0.000; 95%CI：1.418 5-3.715 3, P=0.000）. CONCLUSION： （1） In the residents of Yima coal mineral area, the detection rate of impaired fasting blood glucose is the highest, and blood glucose level has gender difference. （2） The impaired glucose regulation （impaired fasting blood glucose, impaired glucose tolerance） is the highest at 50-69 years old, and the detection rate of diabetes mellitus increases with aging, （3） Of the diabetic risk factors, age, diabetic family history, history of hypertension, body mass index, waist-to-hip ratio, fewer physical activities and history of hyperlipidemia have obviously influence on blood glucose.