糖耐量正常人群糖负荷后血糖变化幅度大是代谢性疾病的危险因素并可预测糖尿病的发生

The large change amplitude of glycemic after glucose load was a risk factor for metabolic diseases and could predict the occurrence of diabetes in normal glucose tolerance people

目的探讨糖耐量正常(NGT)人群在糖负荷后血糖变化幅度与代谢综合征(MS)的关系。方法从2007至2008年中国糖尿病和代谢紊乱研究(CNDMDS)中,根据世界卫生组织关于糖尿病的诊断标准,筛选出血糖资料齐全的NGT人群22302人,以口服葡萄糖耐量试验负荷后2 h血糖(2hPG)和空腹血糖的差值绝对值反映血糖变化幅度,比较不同变化幅度之间代谢指标的差异及MS的患病率。作为CNDMDS的一部分,陕西省共3247人在2007至2008年完成了基线调查,在回顾性队列中到2016至2017年,共有资料齐全的NGT人群678人纳入验证分析。依据横断面研究数据中受试者工作特征曲线(ROC)所得与代谢性疾病相关的血糖变化幅度的切点结果将人群二分组,比较两组随访9年后糖尿病的发病风险。采用t检验、方差分析、χ^(2)检验比较不同组别临床特征和代谢指标的差异,采用logistic回归分析评估不同分组对MS患病率及糖尿病发病率的影响。结果将22302人糖负荷后血糖变化幅度进行4分位分组,其中Q1组(<0.45 mmol/L,5593名)、Q2组(0.45~0.93 mmol/L,5603名)、Q3组(0.94~1.60 mmol/L,5636名)、Q4组(>1.60 mmol/L,5470名),体重指数(BMI)、腰围、血压、总胆固醇、甘油三酯(TG)和低密度脂蛋白胆固醇(LDL-C)随着血糖变化幅度的增大显著升高,高密度脂蛋白胆固醇(HDL-C)显著降低,MS患病率和10年冠心病为中高风险的人群比例也显著升高;logistic回归分析结果显示,糖负荷后血糖变化幅度大是患MS的危险因素。以MS和10年冠心病为中高风险作为结局变量,以糖负荷后血糖变化幅度作为自变量,血糖变化幅度的切点均为1.09 mmol/L。在回顾性队列678名NGT人群中,血糖变化幅度较小组(血糖变化幅度≤1.09 mmol/L)和血糖变化幅度较大组(血糖变化幅度>1.09 mmol/L)糖尿病发病率分别为7.2%(28/388)和13.1%(38/290),差异有统计学意义(P=0.011)。logistic回归分析显示,糖负荷后血糖变化幅度>1.09 mmol/L是糖尿病发病的危险因素,在校正年龄、性别、BMI、吸烟、饮酒、运动和糖尿病家族史后,RR值为1.829(95%CI为1.079~3.101,P=0.025)。结论NGT人群中,糖负荷后血糖变化幅度大,是患代谢性疾病的危险因素,并可预测糖尿病的发生。

Objective We aimed to explore the relationship between the change amplitude of glycemic and metabolic syndrome after glucose load in normal glucose tolerance(NGT)people.Methods According to the World Health Organization diabetes diagnostic criteria,a total of 22302 NGT subjects with complete data were screened from the China National Diabetes and Metabolic Disorders Study(CNDMDS)from 2007 to 2008.The absolute difference between 2 h post-load glucose(2hPG)and fasting plasma glucose(FPG)during oral glucose tolerance test(OGTT)was used to reflect the change amplitude of glycemic,and compare the differences of metabolic indices and the prevalence of metabolic syndrome between different change amplitude.As a part of CNDMDS,3247 subjects completed the baseline survey from 2007 to 2008 in Shaanxi Province,in the retrospective cohort to 2016 and 2017,a total of 678 NGT subjects with complete data were included in the confirmatory analysis.According to the cut-off point of the change amplitude of glycemic related to metabolic diseases from the receiver operating characteristic curve(ROC)in the cross-sectional analysis,subjects were divided into two groups to compare the incidence risk of diabetes after 9 years of follow-up.The t test,analysis of variance and chi-square test were used to compare the differences in clinical characteristics and metabolic indices among different groups,and Logistic regression analysis was used to evaluate the influence of different groups on the prevalence of MS and the incidence of diabetes.Results We divided the change amplitude of glycemic after glucose load of 22302 subjects into quartiles,among which the change amplitude were as follows:Q1 group(<0.45 mmol/L,5593 subjects),Q2 group(0.45 to 0.93 mmol/L,5603 subjects),Q3 group(0.94 to 1.60 mmol/L,5636 subjects),Q4 group(>1.60 mmol/L,5470 subjects);the body mass index(BMI),waist circumference,blood pressure,total cholesterol,triglycerides(TG)and low-density lipoprotein cholesterol(LDL-C)were increased significantly with the increasement of the change amplitude of glycemic,while high-density lipoprotein cholesterol(HDL-C)decreased significantly,the prevalence of metabolic syndrome(MS)and the proportion of subjects with middle or high risk for developing coronary heart disease in 10 years[Framingham risk score(FRS)≥10%]were increased significantly.Logistic regression analysis showed that the large change amplitude of glycemic after glucose load was a risk factor for MS.Use MS and FRS≥10%as the outcome variables,the change amplitude of glycemic as the independent variable,the cut-off point of the change amplitude of glycemic both were 1.09.Among 678 NGT subjects in the retrospective cohort,the incidence of diabetes in the group with small change amplitude of glycemic(the change amplitude of glycemic≤1.09 mmol/L)and large change amplitude of glycemic(the change amplitude of glycemic>1.09 mmol/L)were 7.2%(28/388)and 13.1%(38/290),respectively,the difference was statistically significant(P=0.011).Logistic regression analysis showed that the change amplitude of glycemic after glucose load>1.09 mmol/L was a risk factor for diabetes,after adjusting for age,gender,BMI,smoking,drinking,exercise and family history of diabetes,the risk ratio was 1.829(95%CI 1.079 to 3.101,P=0.025).Conclusion In NGT people,the large change amplitude of glycemic after glucose load was a risk factor for metabolic diseases and could predict the occurrence of diabetes.