上海农村社区中老年人群2型糖尿病危险因素的调查:巢式病例-对照

Risk factors for type 2 diabetes mellitus in middle-aged and elderly populations of Shanghai rural areas: A nested case-control study

目的:采用1∶2频数匹配,病例-对照设计,分析上海市农村社区中老年人群2型糖尿病的危险因素。方法:①于2003年和2005年,以整群抽样的方法,抽取上海市奉贤区光明镇和钱桥镇40～85岁常住人口共计10582人,合并建立卒中队列研究人群。选择其中199例2型糖尿病患者为病例组,根据其年龄、性别分布情况,以1∶2的比例从上述同一人群中选取398例非糖尿病患者为对照组。②根据知情同意原则,应用自行设计统一的调查表格进行基线调查,并接受无创性的脑血管功能检测。调查内容包括一般人口学特征、卒中常见危险因素(高血压、冠心病、糖尿病、高脂血症、家族遗传史等),当场测量身高、体质量、血压水平,计算脑血管血液动力学指标积分,分值0～100分,分值越低,脑血管功能异常越严重。③率或构成比的比较用χ2检验,均数的比较用t检验或方差分析,单因素分析主要评价指标为优势比(OR),多因素分析用非条件logistic回归方程。结果:①单因素分析显示,高血压、冠心病、高脂血症、超重或肥胖、糖尿病家族史、吸烟、饮酒、脑血管血液动力学积分异常的均为糖尿病发病的影响因素[OR(95%CI)分别为2.90(1.98,4.23),2.08(1.16,3.74),3.40(1.53,7.62),1.58(1.05,2.39),6.16(2.97,13.01),1.51(1.02,2.23),0.48(0.27,0.86),2.44(1.69,3.51),P<0.05～0.01]。②多因素分析提示,糖尿病家族史、高血压、高脂血症是2型糖尿病的独立危险因素(Exp(B)分别为8.840,1.777,1.833,P<0.01),脑血管血液动力学积分异常与2型糖尿病有关(Exp(B)为1.010,P<0.05)。结论:2型糖尿病的主要致病危险因素是高血压、高脂血症和糖尿病家族史。

AIM： To explore the risk factors of type 2 diabetes mellitus （T2DM） in the middle-aged and elderly populations who live in Shanghai rural areas through a case-control study according to 1： 2 frequency matching. METHODS： A total of 10 582 community populations who aged 40-85 years were cluster sampled from Shanghai rural areas in 2003 and 2005. Patient group included 199 T2DM cases and 398 controls were selected according to 1：2 proportion. （2）With the informed consents, all the patients were detected non-invasively for cerebrovascular function and surveyed by questionnaires, including demographical feature and risk factors of stroke （hypertension, coronary artery disease, diabetes, hyperlipemia, and family inheritance history, etc）. The height, weight and blood pressure level were measured on spot, then the cerebrovascular hemodynamic index （CVHt） was scored from 0 to 100, and lower scores indicated severer cerebrovascular functional abnormality. （3）Rate or constituent ratio was compared with Х^2 test, while t test or analysis of variance was used to compare the mean value. The relationship between risk factors and T2DM was analyzed by univariate and non-traditional multivariate logistic regression. RESULTS： （1）Univariate analysis indicated that the influencing factors of T2DM included hypertension, coronary heart disease, hyperlipemia, overweight or obesity, family history of DM, cigarette smoking, drinking, CVHI score abnormity [OR（95% CI）： 2.90 （1.98, 4.23）, 2.08 （1.16, 3.74）, 3.40 （1.53, 7.62）, 1.58 （1.05, 2.39）, 6.16 （2.97, 13.01）, 1.51 （1.02, 2.23）, 0.48 （0.27, 0.86）, 2.44 （1.69, 3.51）, P 〈 0.05-0.01].（2）Multivariate analysis showed that family history of DM, hypertension, and hyperlipemia were the independent risk factors of T2DM [Exp （B）： 8.840, 1.777, 1.833, P 〈 0.01], CVHI score abnormity had the relationship with T2DM [Exp （B）： 1.010, P 〈 0.05]. CONCLUSION： Hypertension, hyperlipemia and family history of DM are the major risk factors of T2DM.