天津市糖尿病高危人群血脂异常患病率及相关危险因素分析

The prevalence and risk factors of dyslipidemia in high-risk population of diabetes in Tianjin

目的探讨天津市糖尿病高危人群血脂异常患病率及相关危险因素。方法在天津地区采用随机数字法选取1364名无明确糖尿病病史的健康查体者作为筛查对象。采用芬兰糖尿病风险积分表（FINDRSC）筛查糖尿病高危人群，将纳入的445名糖尿病高危人群按是否合并血脂异常分为血脂异常组（n=316）和血脂正常组（n=129）。比较两组间一般情况、生化指标及胰岛素抵抗和胰岛p细胞功能状态，测定纤溶酶原激活物抑制因子-1（PAI-1）及颈动脉内膜-中层厚度（IMT），并分析糖尿病高危人群血脂异常患病率及相关危险因素。结果天津地区糖尿病高危人群血脂异常总患病率为71．01％（316／445），高甘油三酯血症、高胆固醇血症、高低密度脂蛋白一胆固醇血症、低高密度脂蛋白一胆固醇血症的患病率分别为47．86％（213／445）、21．57％（96／445）、19．55％（87／445）、39．33％（175／445）。其中单纯型血脂异常患者占28．76％（128／445），混合型血脂异常患者占42．25％（188／445）。血脂异常的程度与吸烟、FINDRSC评分、腰围、体重指数、收缩压、谷草转氨酶、谷丙转氨酶、血尿酸、c反应蛋白、同型半胱氨酸（Hey）、IMT、PAI．1及稳态模型评估一胰岛素抵抗指数（HOMA2一IR）呈正相关（r=0．145～0．786，P均〈0．05），与规律运动及稳态模型评估一胰岛B细胞功能状态（HOMA2一％B）呈负相关（r=-0．344，-0．424，P均〈0．05）。二分类Logistic回归分析提示，血脂异常的发生与体重指数（OR=1．754，95％CI：1．399—2．199），腰围（OR=1．091，95％C1：1．004～1．186），收缩压（OR：1．201，95％CI：1．131～1．276），血尿酸（OR=1．008，95％CI：1．002—1．014），PAI-1（OR=1．233，95％CI：1．150—1．323），HOMA2-IR（OR=4．094，95％CI：1．352～12．397）及HOMA2-％B（OR=0．921，95％CI：O．888—0．954）独立相关（P均〈0．05）。结论血脂异常尤其混合型血脂异常在天津地区糖尿病高危人群中的患病率很高；高体重指数、高腰围、高收缩压、高尿酸、高PAI-1、高胰岛素抵抗程度及胰岛β细胞功能减低是血脂异常的独立危险因素。

Objective To explore the prevalence and risk factors of dyslipidemia in high-risk popu- lation of diabetes in Tianjin. Methods A total of 1 364 healthy individuals without diabetes history in Tian- jin were organized to complete the diabetes risk score （FINDRSC） according to the random number method and then 445 subjects were enrolled in this study and were divided into two groups based on the levels of blood lipids： dyslipidemia group （n = 316） and normal blood lipids group （n = 129）. The general condi- tions, biochemical indicators, insulin resistance and β-cell function were compared between the two groups. The level of plasminogen activator inhibitor-1 and intima-media thickness were detected. The prevalence and risk factors of dyslipidemia in high-risk polulation of diabetes were evaluated. Results The prevalence of dyslipidemia was 71.01% （316/445 ） in high-risk population of diabetes in Tianjin. The percentage of sub- jects with hypertriglyceridemia, hypercbolesterolemia, high level of blood low-density lipoprotein（LDL） cho- lesterol and low level of blood high-density lipoprotein（HDL） cholesterol was 47.86% （213/445）, 21.57% （96/445）, 19.55% （87/445） and 39.33% （175/445）, respectively. The prevalence of simple and mixed dyslipidemia was 28.76% （128/445） and 42.25% （188/445）, respectively. The severity of dyslipidemia was positively related to smoking, FINDRSC score, waist circumference, body mass index, systolic blood pressure, aspartate aminotransferase, alanine aminotransferase, uric acid, C-reactive protein, homocys- teine, intima-media thickness, plasminogen activator inhibitor-1 and homeostasis model assessment 2-insulin resistance （HOMA2-1R） index（ r = 0. 145-0. 786, all P 〈 0.05 ） , while negatively related to regular exercise and homeostasis model assessment 2-% 13 （ HOMA2-% [3） index （ r = - 0. 344, - 0.424, all P 〈 0.05 ）. The binary Logistic regression analysis showed that body mass index（ OR = 1. 754,95% CI： 1. 399-2. 199）, waist circumference（ OR = 1. 091, 95% CI： 1. 004-1. 186 ） , systolic blood pressure （ OR = 1. 201,95% CI ： 1. 131 - 1.276） , uric acid （ OR = 1.008, 95% CI： 1.002- 1.014 ） , plasminogen activator inhibitor-1 （ OR = 1. 233, 95% CI： 1. 150-1. 323 ）, HOMA2-IR （ OR = 4. 094, 95% CI： 1. 352- 12. 397 ） and HOMA2-% β （ OR = 0. 921, 95% CI： O. 888-0.954） were independent risk factors of dyslipidemia （ all P 〈 0.05 ）. Conclusion The prevalence of dyslipidemia, especially the mixed dyslipidemia, is quite high in high-risk population of diabetes in Tianjin. The high levels of body mass index, waist circumference, systolic blood pressure, uric acid, plasminogen activator inhibitor-I, HOMA2-IR index and low HOMA2-% β index are in- dependent risk factors of dyslipidemia.