糖尿病患者脂肪分布与大血管并发症的相关性研究

Associations between adipose tissue distribution and macro-vascular complications：A cross-sectional study in type 2 diabetic patients

目的：本研究旨在探讨在中国2型糖尿病患者中脂肪分布与糖尿病大血管并发症的相关性。方法本研究采取整群抽样的方法，在2010年上海嘉定地区抽取40岁及以上常驻居民作为调查对象（n=10375），在此人群中抽选已诊断糖尿病和血糖代谢符合糖尿病诊断者（清晨空腹血糖超过7.0 mmol/L或者葡萄糖耐量试验2 h血糖超过11.1 mmol/L者）。每位受试者均接受标准化问卷调查、身体测量、生化检测，大血管功能检测包括颈动脉内中膜层厚度、臂踝脉搏波传导速度、踝臂指数和颈动脉斑块。每位受试者的十年心血管疾病风险由ASCVD心血管风险与Framingham心血管风险评估方法计算得出。结果研究人群腰臀比四分位数与十年心血管事件风险增加存在显著相关性：即腰臀比每增加1个四分位，十年心血管事件风险增加1.17倍[ASCVD心血管风险评估：OR=1.17（1.05~1.31）]或1.13倍[Framingham心血管风险评估：1.13（1.00~1.29）]。而腰臀比四分位数与颈动脉内中膜层厚度、踝臂指数异常、高臂踝脉搏波传导速度和颈动脉粥样硬化斑块的患病风险之间无显著相关性。结论在中国2型糖尿病患者中，脂肪分布与十年心血管事件的高风险具有独立且显著的相关关系。然而，腹部脂肪并不额外增加糖尿病患者颈动脉内中膜厚度增厚、踝臂指数异常、臂踝脉搏波传导速度增高、颈动脉粥样硬化斑块的患病风险。

Objective This study aimed to investigate the associations between adipose tissue distribution and risks of macro-vascular complications in type 2 diabetic patients. Methods The study included T2DM patients either previously diagnosed by questionnaire or newly diagnosed with fasting plasma glucose（FPG）≥7. 0 mmol/L and/or 2 hour postprandial glucose （ 2h PG ）≥11. 1 mmol/L from residents older than 40 years from Jiading Community, Shanghai, China（n=10 375）. Each participant had gone through anthropometric measurements, blood tests, vascular function tests including carotid intima-media thickness （ CIMT ） , ankle-brachial index （ ABI ） , branchial-ankle pulse wave velocity（ baPWV） as well as carotid plaques. Results WHR quartiles was significantly associated with high risks for ten-year cardiovascular disease risks [ ASCVD high risk： OR：1. 17 （ 1. 05-1. 31 ）;Framingham high risk：1. 13（1. 00-1. 29）]. However, WHR has no significant relations with risks of increased carotid intima-media thickness（ CIMT） , abnormal ankle-brachial index（ ABI） , increased brachial ankle pulse wave velocity（ baPWV） or carotid plaques. Conclusions In type 2 diabetic patients, abdominal adipose tissue has an independent role in high risk for ten-year cardiovascular diseases. However it has no relations with other vascular functions including increased CIMT, abnormal ABI, increased baPWV, or carotid plaque.