特需病房2型糖尿病患者代谢综合征的患病率及危险因素分析

Study of metabolic syndrome prevalence and its risk factors of patients with type 2 diabetes in special care unit

目的 探讨特需病房2型糖尿病患者代谢综合征的患病率及其主要危险因素.方法 2010年1月至2012年7月特需病房住院的462例2型糖尿病患者及1 898例内分泌科普通病房住院的2型糖尿病患者为特需组和对照组,并进行体脂参数、血压、血糖、血脂谱、胰岛素、C肽等检查.结果 （1）特需组与对照组患者中男性[72.5％ （335/462）与56.6（1 075/1 898）],吸烟（40.5％与24.6％）,饮酒（24.9％与10.7％）及高收入者（76.6％与12.7％）的比例高于对照组,两组比较差异有统计学意义（x2值分别为32.1、16.9、12.3、32.8,P均＜0.001）.特需组与对照组的体质量指数（BMI）[（25.6±3.7） kg/m2与（24.8±3.5） kg/m2]、腰围[（91.0±9.5） cm与（89.1±10.3） cm]、丙氨酸氨基转移酶（ALT）[（27.8±19.7） U/L与（23.0±16.1）U/L]、γ-谷氨酰转移酶（γ-GT）[（34.1 ±26.3） U/L与（29.2±23.2） U/L]、甘油三酯（TG）[（2.35±2.31） mmol/L与（1.82±1.64） mmol/L]、血尿酸[（333.7±85.5） μmol/L与（317.1 ±85.2） μmol/L]、空腹C肽[（2.11±1.04）μ g/L与（1.74±1.05）μg/L]高于对照组,差异有统计学意义（F值分别为11.44、6.90、16.65、8.35、18.23、7.34、21.21,P均＜0.01）,而两组年龄[（52.9±11.1）岁与（60.4±12.2）岁]、糖尿病病程[5（2,10）年与7（2,12）年]、收缩压[（126.7±15.2） mmHg（1 mmHg =0.133 kPa）与（131.9±17.3） mmHg]、血高密度脂蛋白胆固醇（HDL-C）[（1.02±0.32） mmol/L与（1.10±0.32） mmol/L],糖化血红蛋白[（8.44±1.99）％与（9.16±2.32）％],特需组则低于对照组,差异有统计学意义（F值分别为79.41、12.71、18.93、12.78、18.52,P均＜0.01）.（2）特需组超重和/或肥胖、血脂紊乱及代谢综合征的患病率分别为55.6％、68.4％、60.2％,显著高于对照组的46.1％,52.9％,50.6％（x2值分别为7.59、18.76、7.18,P均＜0.01）,高血压患病率为39.6％,低于对照组50.7％ （x2=10.15,P＜0.01）.特需组代谢综合征患病率男女间差异无统计学意义（61.2％与57.5％,x2=0.01,P=0.92）.按＜45岁,45 ～59岁,≥60岁分组后,随着年龄的升高,女性代谢综合征患病率有增高趋势（33.3％、48.0％、74.1％,x2=4.43,P=0.04）,男性代谢综合征患病率各年龄组间差异无统计学意义（58.8％、62.5％、55.6％,x2=0.05,P=0.87）.（3）Logistic多元回归分析显示,在特需组中,年龄[OR=1.071,95％ CI为1.027 ～1.117,P=0.001]、BMI[OR=1.391,95％ CI为1.112～1.739,P=0.013]、腰围[OR=1.126,95％ CI为1.039～1.222,P=0.004]、TG[OR=1.747,95％ CI为1.124 ～2.717,P=0.013]、舒张压[OR=1.111,95％CI为1.045～1.180,P=0.001]是发生代谢综合征的危险因素,而HDL-C[OR=0.048,95％CI为0.005 ～0.464,P=0.009]是代谢综合征的保护因素.结论 特需病房住院的2型糖尿病患者约3/5合并代谢综合征.年龄、BMI、腰围、舒张压、TG、HDL-C与代谢综合征的发生有关.

Objective To investigate the prevalence and risk factors of metabolic syndrome （MS） in patients with type 2 diabetes in special care unit.Methods Two thousand three hunrded and sixty patients with type 2 diabetes were selected as our subject in The Sixth People＇s Hospital Affiliated to Shanghai Jiaotong University from Jan.2010 to Jul.2012.Among these patients,462 patients from special care unit were served as special care group and 1 898 patients from endocrinology ward were assigned to control group.The disease history information was recorded and physical examination and biochemical tests,including blood lipids,blood pressure,fasting glucose,glycosylated hemoglobin,serum insulin,C peptide were measured.Results （1） In special care group,there were 335 male （72.5%） and the prevalence of smoking,alcohol drinking and the proportion of the high income people were 40.5%,24.9%,76.6% respectively,higher than that of control group （56.6%,24.6%,10.7%,12.7% ;x2 =32.1,16.9,12.3,32.8 ;P 〈 0.01）.The body mess index （BMI）,levels of waist circumference,alanine aminotransferase （ALT）,gamma glutamyhransferase （γ-GT）,triglyceride （TG）,serum uric acid and fasting C peptide in special care group were （（25.6 ± 3.7） kg/m2,（91.0 ± 9.5） cm,（27.8 ±19.7） U/L,（34.1 ±26.3） U/L,（2.35 ±2.31） mmol/L,（333.7 ±85.5） μmol/L,（2.11 ±1.04） μg/L） higher than those of control group （（24.8 ± 3.5） kg/m2,（89.1 ± 10.3） cm,（23.0 ± 16.1） U/L,（29.2 ±23.2） U/L,（1.82 ±1.64） mmol/L,（317.1 ±85.2） μ mol/L,（1.74 ± 1.05） μg/L;F =11.44,6.90,16.65,8.35,18.23,7.34,21.21 ; P 〈 0.01）.The age,duration of diabetes,systolic blood pressure,level of serum high-density lipoprotein-cholesterol （HDL-C）,and glycosylated hemoglobin were （（52.9 ± 11.1） years,5 （2,10） years,（126.7 ± 15.2） mmHg,（1.02 ± 0.32） mmol/L,（8.44 ± 1.99） %） lower than those of control group（（60.4 ± 12.2） years,7 （2,12） years,（131.9 ± 17.3） mmHg,（1.10 ± 0.32） mmol/L,（9.16 ±2.32）%;F =79.41,12.71,18.93,12.78,18.52; P 〈 0.01）; （2） The rate of overweight/obesity,dyslipidemia and MS prevalence rates in special care group were 55.6%,68.4%,60.2%,significantly higher than the control group（46.1%,52.9%,50.6% ;x2 =7.59,18.76,7.18,P 〈 0.01）.While the prevalence of hypertension in special care group was significantly lower than control group（39.6% vs 50.7%,x2 =10.15,P =0.01）.There was on significant difference between male and female in term of the prevalence of the MS in the special care group（61.2% vs 57.5%,x2 =0.01,P =0.92）.According to age,patients in special care group were divided into three groups and that were 〈45 years group,45-59 years group and ≥60 years group.With the increase of age group of female,the prevalence of MS was increasing（33.3%,48.0%,74.1% ;x2 =4.43,P =0.04）.Among the male patients,there was no significant different was seen among three groups （58.8%,62.5%,55.6% ;x2 =0.05,P =0.87）.（3） Multiple Logistic regression analysis showed that the independent risk factors of MS in special care group including age（OR =1.071,95% CI（1.027-1.117）,P =0.01）,BMI （OR =1.391,95% CI（1.112-1.739） ; P =0.013）,waist circumference （OR =1.126,95% CI（1.039-1.222） ; P =0.004）,TG （OR =1.747,95 % CI（1.124-2.717） ; P =0.013） and diastolic blood pressure （OR =1.111,95%CI（1.045-1.180）;P =0.001）.HDL-C（OR=0.048,95%CI（0.005-0.464） ;P =0.009） were protective factors of MS in special care group.Conclusion Approximately 3/5 patients with diabetes in special care unit got MS.The factors including age,BMI,waist circumference,diastolic blood pressure,TG,HDL-C were related to MS occurrence.