正常糖耐量下空腹和2 h血糖水平与心脑血管疾病关联性

Association of two-hour post-load and fasting plasma glucose with cardiovascular diseases among people with normal glucose tolerance

目的探讨正常糖耐量范围内,空腹和2 h血糖与中国成人心脑血管疾病关联性,为心脑血管疾病危险因素的早期防控提供依据。方法以4 307名35~74岁成年人中空腹血糖(FPG)<6.1 mmol/L且2 h血糖(2hPG)<7.8 mmol/L糖耐量正常者为对象,采用多因素logistic回归分析评估2hPG> FPG组与2hPG≤FPG组人群心脑血管疾病患病率的风险比。结果 4 307名成年人中确诊心脑血管疾病患者1 815例,2hPG> FPG组人群心脑血管病患病率(42.4%)高于2hPG≤FPG组(36.2%)(P <0.01);与2hPG≤FPG组比较,2hPG> FPG组人群年龄偏大、体质指数、舒张压、总胆固醇、甘油三酯和胰岛素水平较高(P <0.01)。多因素logistic回归分析显示,2hPG> FPG、年龄、体质指数、甘油三酯和饮酒状况可增加心脑血管病风险,OR值及其95%CI分别为1.210(1.042~1.405)、1.073(1.064~1.082)、1.170(1.144~1.196)、1.396(1.127~1.729)和1.269(1.154~1.396)。分层分析结果显示,在女性、年龄<60岁及FPG <5.6 mmol/L亚组中,2hPG> FPG组人群心脑血管疾病患病风险较高;调整蔬菜、水果摄入、胰岛素抵抗和胰岛分泌水平后,2hPG> FPG组人群心脑血管病患病风险降低。结论正常血糖下,较高的2 h血糖可能增加心脑血管疾病患病风险。

Objective To explore the association of fasting plasma glucose （FPG） and two hour post-load plasma glucose （2hPG） with cardiovascular diseases （CVD） among adults with normal glucose tolerance （NGT） and to provide evidences for prevention and control of risk factors of CVD in China. Methods We randomly selected 4 307 permanent residents aged 35 - 74 years and with normal FPG （〈 6.1 mmol/L） and 2hPG （〈7.8 mmol/L） in 3 urban districts and 3 villages in Qingdao municipality. Multivariate adjusted odds ratio （ORs） and its 95% confidence interval （95% CI） for incidence of CVD were estimated for individuals with 2hPG 〉 FPG as compared with those with 2hPG ≤ FPG, controlling for underlying confounders. Results Of all the participants, 1 815 were identified with CVD. The prevalence of CVD was significantly higher in the participants with 2hPG 〉 FPG than in those with 2hPG ≤ FPG （42.4% vs. 36.2%）（P 〈 0.01）. Compared with those with 2hPG ≤ FPG, the participants with 2hPG 〉 FPG were at older age and had higher body mass index, diastolic blood pressure, total cholesterol, triglycerides, and insulin secretion （P〈 0.01 for all）. Multivariate logistic regression analysis demonstrated that the participants with following characteristics were at a higher risk of CVD： 2hPG 〉 FPG （OR = 1.210, 95% C1：1.042 - 1.405）, elder age （OR = 1.073, 95% C1：1.064 - 1.082）, high body mass index （OR = 1.170, 95% CI： 1.144 - 1.196）, high triglyceride （OR = 1.396, 95% CI： 1.127 - 1.729）, and alcohol drinking （1.269, 95% C1：1.154 - 1.396）. Stratified analysis revealed that for the female participants aged 〈 60 years and FPG 〈 5.6 mmol/L, those with 2hPG 〉 FPG were at a higher risk of CVD compared to those with 2hPG ≤ FPG. The risk of CVD was attenuated among the participants with 2hPG 〉 FPG after adjusting for vegetable and fruit consumption, insulin resistance, and insulin secretion. Conclusion The elevated 2hPG is associated significantly with increased risk of CVD among community adults with normal glucose tolerance.