低水平砷暴露的2型糖尿病患者尿砷与糖化血红蛋白的关系

Relationships between urine arsenic levels and hemoglobin A1C in type 2 diabetic patients exposed to arsenic

目的:探讨环境低水平砷暴露的2型糖尿病患者尿砷水平与糖化血红蛋白(Hb A1C)的关系。方法:采取病例系列研究的方法,选择401名广州市某区低水平砷暴露的2型糖尿病患者作为研究对象,通过问卷和体格检查获取患者基本资料;采集患者生物样本(血液和尿液)检测血糖、血脂、糖化血红蛋白和尿砷等指标。根据尿砷的水平将患者划分为3组,采用t检验、χ2检验和方差分析等方法比较各组间血糖、血脂、糖化血红蛋白和尿砷等指标的差异;采用多变量Logistic回归分析评估2型糖尿病患者糖化血红蛋白的影响因素。结果:401名低水平砷暴露的2型糖尿病患者尿砷的中位数为38.31μg/L,四分位距为48.25μg/L。2型糖尿病患者不同尿砷水平组间糖化血红蛋白随尿砷变化呈线性升高趋势,与低砷组相比,高砷组糖化血红蛋白增加,差异有统计学意义(P<0.05)。随着组间尿砷水平的增加,药物控制后糖化血红蛋白水平正常(Hb A1C<7.0%)人数逐渐减少,异常(Hb A1C≥7.0%)人数逐渐升高,差异有统计学意义(P<0.05)。多变量回归分析发现,尿砷是糖化血红蛋白的影响因素,与低砷组相比,高砷组OR(95%CI)为2.077(1.049,4.110),差异有统计学意义(P<0.05)。结论:尿砷与2型糖尿病患者糖化血红蛋白水平有关,可能是糖化血红蛋白的影响因素。

OBJECTIVE: To explore the relationships between urine arsenic levels and hemoglobin A1 C(HbA1 C) in type 2 diabetic mellitus(T2 DM) patients who were exposed to low levels of arsenic. METHODS:A case-series study involving 401 patients with T2 DM and with exposure to arsenic in a district of Guangzhou were selected as the study subjects in 2018. The basic data of patients were obtained by questionnaire and physical examination,and the biological samples(the blood and urine samples) of patients were collected to detect blood glucose,blood lipid,HbA1 Cand urine arsenic. According to the levels of arsenic in urine,the patients were divided into three groups. t-test, χ2 test and analysis of variance(ANOVA) were used to compare the differences of indicators such as blood glucose,blood lipid,HbA1 Cand urine arsenic among the gpraotiuepnst.s Mwuitlthiv aTri2 aDteM.l ogRisEtiScU rLeTgrSes:si oAn taotnaall ysoefs 4 w0 e1 r e pcatoinedntusc teedx ptoos eedv atlou atleo wt-h ed oisnef luaersnecniincg fwaecrteor si nocfl udHebd.A 1 CThine median of urine arsenic was 38.31 μg/L, and the interquartile range was 48.25 μg/L. There was a linear increasing trend of HbA1 Cwith changes of urine arsenic in different urine arsenic level groups, and the difference between the high and the low level groups was statistically significant(P<0.05). With the increase of urine arsenic levels between the groups, the number of normal control group(HbA1 C<7.0%) decreased gradually, the number of abnormal control group(HbA1 C≥7.0%) increased gradually, the difference wasstatistically significant(P<0.05). Multivariate regression analyses show that urine arsenic was the influencingfactor of Hb A1 C, OR(95% CI) of the high arsenic group was 2.077(1.049, 4.110), the difference of Hb A1 Cbetween the high and the low level groups was statistically significant(P<0.05). CONCLUSION:Urine arsenicis related to the level of Hb A1 Cin patients with T2 DM,which may be the influencing factor of Hb A1 C,and itsmechanism needs to be further explored.