中国8省市成人血脂与糖尿病前期及糖尿病发病关系的前瞻性队列研究

A prospective cohort study on the relationship between serum lipids and prediabetes and diabetes

目的探讨我国成人血脂水平与糖尿病前期及糖尿病的发病关系。方法将2010年中国慢性病及其危险因素监测数据作为基线数据,从2010年监测点中选取8个省,每个省选择2个点作为随访点,排除糖尿病前期及糖尿病者,共7046人进入随访队列,并于2016—2017年进行随访调查,共随访到4886人。采用Cox比例风险回归模型分析总人群及不同性别下血脂水平与糖代谢异常发病关系。结果共纳入4759名研究对象,随访期间糖尿病前期发病密度为26.1/1000人年,糖尿病发病密度为10.4/1000人年。多因素Cox分析结果显示,在总人群中,与TG<0.77 mmol/L相比,0.77≤TG<1.08 mmol/L糖尿病前期发病风险增加32%(HR=1.32,95%CI:1.11~1.94,P<0.05)。与HDL-C<0.91 mmol/L相比,HDL-C≥1.31 mmol/L糖尿病前期发病风险降低30%(HR=0.70,95%CI:0.54~0.90,P<0.05),P趋势检验<0.05。与TG<0.77 mmol/L相比,TG≥1.57 mmol/L糖尿病发病风险增加75%(HR=1.75,95%CI:1.07~2.52,P<0.05),糖尿病发病风险随TC和TG的升高而显著上升。在男性中,糖尿病前期发病风险与TG、HDL-C呈剂量反应关系,糖尿病发病风险随TC升高而上升,均P趋势检验<0.05。结论 TG升高、HDL-C降低可增加糖尿病前期发病风险,TC、TG升高可增加糖尿病发病风险,应采取针对性措施加强血脂异常和糖尿病的综合防治。

Objective To explore relationships between serum lipids and incidence of prediabetes and diabetes in Chinese adults.Methods Baseline information was obtained from the Chinese Chronic Disease and Risk Factor Surveillance(CCDRFS) in 2010.Eight provinces were selected from the CCDRFS study,then two surveillance spots in each of the eight provinces were sampled for follow up investigation.Finally,7046 subjects who were free of prediabetes and diabetes were recruited.In the follow up evaluation carried out in 2016-1017,4886 participants received re-investigation.Cox proportional hazards models were used to analyze the relationships between serum lipids and diabetes and prediabetes incidences in total population and by gender groups.Results A total of 4759 individuals were included for final analysis,after a 6-year of follow up,prediabetes incidence was 26.1 per 1000 person years,and diabetes incidence was 10.4 per 1000 person years.Multivariate Cox regression analysis showed in total population prediabetes risk increased by 32%(HR=1.32,95% CI:1.11-1.94) in participants with 0.77≤TG <1.08 mmol/L compared with group TG <0.77 mmol/L.Prediabetes risk decreased by 30%(HR=0.70,95% CI:0.54-0.90) in participants with HDL-C≥1.31 mmol/L compared with group HDL-C<0.91 mmol/L,and decreased with increasing HDL-Clevel(trend P <0.05).Diabetes risk increased by 75%(HR=1.75,95% CI:1.07-2.52) in individuals with TG≥1.57 mmol/L compared with group TG <0.77 mmol/L,and increased with increasing TG and TC level(trend P<0.05).Gender-stratified analysis revealed that prediabetes risk increased with increasing TG and decreasing HDL-C level,and diabetes risk increased with increasing TC level(trend P <0.05) in the male population.Conclusion Increased TG and decreased HDL-C exert greater impact on prediabetes,and increased TC and TG contribute to higher risk of diabetes.Targeted intervention and program need to be developed towards comprehensive prevention and management of diabetes and dyslipidemia.