血脂异常与高血压对糖尿病患病的交互作用

Interaction of dyslipidemia and hypertension on morbidity of diabetes

目的了解血脂异常与高血压之间的交互作用对糖尿病患病的影响,为糖尿病防治提供科学依据。方法本研究数据来源于2017—2018年广州市开展的"国家心血管病高危人群早期筛查与综合干预项目",以35-75岁社区常住居民为研究对象,进行问卷调查、身体测量和实验室检测。共4 892名研究对象纳入分析。采用SAS 9.4分析软件进行χ^(2)检验、单因素和多因素logistic回归;运用相乘模型和相加模型分析血脂异常与高血压的交互作用对糖尿病患病的影响。当相乘交互项OR值95%CI不包含1表示具有相乘交互效应;当交互作用超额相对危险度(RERI)及交互作用归因百分比(AP)的95%CI不包含0且协同指数(SI)的95%CI不包含1时,表明存在相加交互效应。结果研究对象中,糖尿病患者791例(16.17%),血脂异常者1 993例(40.74%),高血压患者2 137例(43.68%)。血脂异常与高血压共患率为21.03%(1 029/4 892)。多因素logistic回归分析结果显示,调整性别、年龄、退休情况、文化程度、超重或肥胖、饮酒和心血管病史后,血脂异常(OR=1.71,95%CI:1.46-2.01)与高血压(OR=1.99,95%CI:1.68-2.36)均与糖尿病的高患病风险相关。糖尿病危险因素的交互作用分析显示,血脂异常与高血压之间不存在相乘交互效应(OR=1.16,95%CI:0.84-1.60),无统计学意义(P>0.05);但存在相加交互效应,有血脂异常且高血压者患糖尿病的风险高于血脂正常且无高血压者(OR=3.34,95%CI:2.67-4.18),相加交互效应评价指标RERI、AP和SI分别为0.94(95%CI:0.33-1.55)、0.28(95%CI:0.12-0.44)、1.67(95%CI:1.03-2.31)。结论血脂异常与高血压对于糖尿病患病可能具有协同作用。改善血脂与控制血压可能会协同预防糖尿病的发生。

Objective To explore the interaction of dyslipidemia and hypertension on morbidity of diabetes,and to provide the scientific bases for preventing and treating diabetes. Methods The data were from the database of Guangzhou city in China PEACE(Patient-centered Evaluative Assessment of Cardiac Events) Million Persons Project from 2017 to 2018. The permanent residents(35-75 years old) in communities served as the subjects. The investigation was performed by questionnaire,physical measurements and laboratory tests. A total of 4 892 subjects were included in the final analysis. The χ^(2) test,single factor logistic regression and multivariate logistic regression were used to analyze the data. Multiplicative and additive models were used to analyze the interaction of dyslipidemia and hypertension on diabetes. The used software was SAS 9.4. There was a multiplicative interaction effect when 95%CI of multiplicative interaction item did not contain 1;when the 95%CI of the relative excess risk due to interaction(RERI) and the attributable proportion due to interaction(AP) did not contain 0,and the 95%CI of the synergy index(SI) did not contain 1,there was an additive interaction effect. Results In the subjects there were 791 cases with diabetes(16.17%),1 993 cases with dyslipidemia(40.74%),and 2 137 cases with hypertension(43.68%). The morbidity of dyslipidemia plus hypertension was 21.03%(1 029/4 892). Multivariate logistic regression analysis showed that after adjusting sex,age,retirement,education level,overweight and obesity,drinking,cardiovascular disease,the dyslipidemia(OR:1.71,95%CI:1.46-2.01)and hypertension( OR : 1. 99, 95 % CI : 1. 68-2. 36) were related to high risk of diabetes. There was no multiplicative interaction effect between dyslipidemia and hypertension(OR=1.16,95%CI :0.84-1.60),P>0.05;but there was an additive interaction effect between dyslipidemia and hypertension,the diabetes risk in hypertension patients with dyslipidemia was significantly higher than that in residents without hypertension and dyslipidemia(OR=3.34,95%CI:2.67-4.18). RERI,AP and SI were 0.94(0.33-1.55),0.28(0.12-0.44) and 1.67(1.03-2.31),respectively. Conclusion There is a synergistic effect on morbidity of diabetes between dyslipidemia and hypertension. The improvement of blood lipid and control of blood pressure could prevent synergistically the diabetes.