收缩压和静息心率与新发糖尿病的关系

The association of systolic blood pressure and resting heart rate with new-onset diabetes

目的观察收缩压和静息心率对新发糖尿病的联合影响。方法选择参加2006-2007年度开滦集团公司职工健康体检且无糖尿病病史的研究对象作为观察队列。于2008-2009、2010-2011、2012-2013年度分别对观察队列进行第2、3、4次健康体检。将研究对象按基线静息心率(≤60、61~70、71~80、>80次/min)和收缩压水平(≤120、121~140、141~160、>160mm Hg)进行分组,比较各组糖尿病发生率的差异,并采用多因素Cox回归分析各组糖尿病发病风险。结果共入选离退休职工69 048人进行最后分析。随访6年,新发糖尿病5931例,发生率为8.6%。随静息心率和收缩压水平升高,糖尿病发生率呈递增趋势,其中静息心率>80次/min且收缩压>160mm Hg组糖尿病发生率最高,为18.0%,而静息心率≤60次/min且收缩压≤120mm Hg组糖尿病发生率最低,为4.6%。多因素Cox回归分析显示,在校正基线年龄、性别、体质量指数等混杂因素后,静息心率>80次/min且收缩压>160mm Hg组发生糖尿病的风险最高,为静息心率≤60次/min且收缩压≤120 mm Hg组的2.88(95%CI2.26~3.66)倍。结论收缩压升高和静息心率加快者的糖尿病发病风险增加。

Objective To investigate the association of systolic blood pressure and resting heart rate with new-onset diabetes. Methods The staff from Kailuan Group Company who participated in the health examination in 2006-- 2007 and had no history of diabetes were selected as the subjects. The second, third, and fourth health examina- tions were conducted in 2008--2009, 2010--2011 and 2012--2013, respectively. The subjects were divided into 16 groups according to different levels of systolic blood pressure （≤ 120, 121 -- 140, 141 -- 160, 〉 160 mm Hg） and resting heart rate（≤60, 61--70, 71--80, 〉80 beats/min）. The incidence of new-onset diabetes among these 16 groups were compared, and the risk of diabetes was analyzed using multivariable Cox regression analysis. Results A total of 69 048 subjects were involved in the final statistical analysis and 5931 subjects developed diabetes during the follow-up of 6 years, with the incidence rate of 8.6%. The incidence rate of diabetes increased with the in- crease of resting heart rate and systolic blood pressure, and which was the highest （18.0%） in the group with sys- tolic blood pressure 〉160 mm Hg and resting heart rate 〉80 beats/rain, and was the lowest （4.6%） in the group with systolic blood pressure ≤120 mm Hg and resting heart rate ≤60 beats/min. Multivariable Cox regression analysis showed that the risk of diabetes in the group with systolic blood pressure 〉160 mm Hg and resting heart rate 〉80 beats/min was 2.88 times （95 % CI 2.26--3.66） higher than that in the group with systolic blood pressure ≤120 mm Hg and resting heart rate ≤60 beats/rain after adjusting for age, gender, body mass index and other con- founders at baseline. Conclusion Increased systolic blood pressure and resting heart rate could increase the risk of diabetes.