湘西地区侗族2型糖尿病危险因素的病例对照研究

Case-control study on the risk factors of type 2 diabetes of Dong nationality in Western Hunan

目的:探讨湘西地区侗族人群2型糖尿病(type 2 diabetes mellitus,T2DM)的相关危险因素,为该地区T2DM的防治提供科学依据。方法:采用病例对照研究方法,通过口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)将研究对象分为T2DM,糖调节受损(impaired glucose regulation,IGR)和糖耐量正常(normal glucose tolerance,NGT)3组,分别对3组人群进行问卷调查、体格测量以及血糖、血脂、血清胰岛素等生化指标检测。结果:单因素分析结果发现:不同糖代谢组间的年龄,空腹胰岛素(fasting insulin,FINS),HOMA模型胰岛素抵抗指数(HOMA insulin resistance index,HOMA-IRI)和β细胞功能指数(HOMAβ-cell function index,HOMA-βC),三酰甘油(trigalloyl glycerol,TG),高密度脂蛋白胆固醇(high density lipoprotein cholesferol,HDL-C),收缩压,舒张压等指标差异有统计学意义(P<0.05);体质量指数(body mass index,BMI)、腰臀比(waist/hip ratio,WHR)、糖尿病家族史、每周体力活动次数、吃饭口味、高脂高蛋白食物、新鲜蔬菜和水果摄入量与糖尿病有关。多因素非条件ordinal logistic回归分析发现:年龄是糖尿病的危险因素,与年龄≤50岁组相比,50岁<年龄≤60岁组,60岁<年龄≤70岁组和年龄>70岁组的OR值分别是1.85,2.83和2.64(P<0.05);BMI为超重或肥胖人群患糖尿病的风险是BMI正常人群的2.13倍(P<0.01);其他影响因素包括WHR(OR=2.06),糖尿病家族史(OR=11.36),高脂高蛋白食物(OR=1.90)。结论:湘西地区侗族人群T2DM的影响因素主要有年龄、BMI、WHR、糖尿病家族史、高脂高蛋白食物,提示今后应加强湘西地区侗族人群T2DM的健康教育,降低患T2DM的风险。

Objective： To explore the risk factors of type 2 diabetes mellitus （T2DM） of Dong nationality in Western Hunan, and to provide a scientific basis for the prevention and treatment of T2DM in the district. Methods： In the case-control study, the subjects were divided into a T2DM group, an impaired glucose regulation （IGR） group and a normal glucose tolerance （NGT） group through oral glucose tolerance test （OGT）. A questionnaire survey was conducted, and physical measurements and the detection of blood glucose, blood lipids and serum insulin were done. Results： Univariate analysis found significant difference in age, fasting insulin （FINS）, HOMA insulin resistance index （HOMA-IRI）, HOMA B-cell function index （HOMA-BC）, trigalloyl glycerol （TG）, high density lipoprotein cholesterol （HDL-C）, systolic blood pressure, and diastolic blood pressure in the glucose metabolism among different groups （P〈0.05）. Body mass index （BMI）, waist/hip ratio （WHR）, family history of diabetes, number of physical activities per week, dinner taste, fat and protein-rich foods, fresh vegetables and fruits intake were associated with T2DM. Multifactor non-conditional ordinal logistic regression indicated that age was the risk factor of T2DM and IGR. Compared with the group whose age was ≤ 50, the odds ratios of the groups of 50≤age ≤ 60, 60〈age ≤ 70 and age〉70 were 1.85, 2.83 and 2.64 respectively, P〈0.05. The risk of suffering from diabetes of the overweighted or obese people was 2.13 times that of a normal BMI group, P〈O.O1. The other influencing factors included WHR （0R=2.06）, family history of diabetes （OR=I 1.36）, and fat and protein-rich foods （OR=1.90）. Conclusion： The main influencing factors of T2DM of Dong nationality in Western Hunan include age, BMI, WHR, family history of diabetes, fat and protein-rich foods. We must strengthen the health eduation ofT2DM of Dong nationality in Western Hunan to reduce the risk of T2DM.