空腹血糖轨迹与新发颈部动脉斑块的相关性

A cohort study on the correlation between fasting plasma glucose trajectories and new-onset carotid plaque

目的探讨空腹血糖(fasting plasma glucose,FPG)轨迹与新发颈部动脉斑块的相关性。方法选取2017年1月—2019年12月在郑州大学第一附属医院健康管理中心连续3年进行健康体检且符合入选标准的953例被检者作为观察对象,依据观察对象2017、2018、2019年度健康体检的FPG数值,用潜类别轨迹模型确定4个不同的FPG轨迹组,分别为低稳定水平组,中稳定水平组,中高稳定水平组,高稳定水平组,随访各组人群至2020年度健康体检时颈部动脉斑块的发病情况。比较4组颈部动脉斑块发病率的差异,应用Cox比例风险回归模型分析不同FPG轨迹组与新发颈部动脉斑块的相关性。结果颈部动脉斑块的发病率随着FPG轨迹的升高而增加,分别为11.13%、19.70%、23.44%、23.81%(P<0.001)。用Cox比例风险回归模型校正性别、年龄、BMI等多种混杂因素后,FPG稳定中水平组、稳定中高水平组、稳定高水平组颈部动脉斑块发病风险分别为FPG稳定低水平组的1.895(95%CI:1.296~2.769)、2.273(95%CI:1.241~4.161)、2.527(95%CI:1.219~5.241)倍(均P<0.05)。结论长期高FPG水平是颈部动脉斑块发病的独立危险因素,控制血糖使其稳定在较低水平能够降低颈部动脉斑块发生风险。

Objective To investigate the correlation between fasting plasma glucose(FPG)and new-onset carotid plaque through latent class trajectory models.Methods A total of 953 observation objects came from the first affiliated hospital of Zhengzhou University in accordance with the inclusion criteria.According to the FPG values of the observed subjects during the annual physical examination from January 2017 to December 2019,the following four different FPG trajectories groups were determined by latent class trajectory modelling tools:the low-stable group,the medium stable group,the medium-high stable group,and the high stable group.Carotid plaque incidence in each group was followed up in 2020 to compare the differences of the cumulative incidences of the four groups.The Cox proportional risk regression model was used to analyze the correlation between different FPG trajectories and new-onset carotid plaque.Results The incidence of carotid plaque increased with the increase of FPG trajectories by 11.13%,19.70%,23.44%,23.81%,respectively,with significance(P<0.001).After adjusting gender,age,BMI and other confounding factors with the cox proportional risk regression model,the risk of carotid plaque in the FPG medium stable group,medium and high stable group,high-stable group was still 1.895(95%CI:1.296-2.769),2.273(95%CI:1.241-4.161),2.527(95%CI:1.219-5.241)times of the low stable group(all P<0.05).Conclusion The long-term high FPG levels are independent risk factors for the incidence of carotid plaque,and controlling FPG at a low level steadily can reduce the risk of carotid plaque.