糖尿病家族史与高血压对糖代谢异常的影响及交互作用

Effect and interaction of family history of diabetes mellitus and hypertension on abnormal glucose metabolism

目的探讨糖尿病家族史与高血压对糖代谢异常患病的影响及交互作用。方法为病例对照研究。选取2011年8—12月间大连地区参加中国2型糖尿病患者恶性肿瘤发生风险的流行病学(REACTION)研究的基线血糖正常人群为研究对象,2014年7—12月间对研究对象进行随访。收集研究对象基线时糖尿病家族史及高血压情况,所有研究对象均行口服葡萄糖耐量试验,依据随访时研究对象糖代谢状态将其分为病例组和对照组。采用多因素logistic回归模型分析糖尿病家族史、高血压对糖代谢异常患病的影响及交互作用。计算交互作用的相对超额危险度(RERI)、交互作用归因比(AP)、交互作用指数(SI),以评估加法量表上的相互作用效应。结果共纳入2597例研究对象。其中,病例组526例,对照组2071例。多因素logistic回归分析结果显示,糖尿病家族史(OR=1.387,95%CI 1.133~1.699,P=0.002)和高血压(OR=1.553,95%CI 1.134~2.126,P=0.006)是糖代谢异常患病的独立影响因素。糖尿病家族史与高血压相乘对糖代谢异常患病风险的OR值为1.020(95%CI 0.639~1.433,P=0.957)。以无糖尿病病史且无高血压者为对照,无糖尿病家族史有高血压糖代谢异常者患病风险增加了0.443倍(OR=1.443,95%CI 1.111~1.874,P<0.001),有糖尿病家族史无高血压者糖代谢异常患病风险增加了0.379倍(OR=1.379,95%CI 1.042~1.824,P=0.024),同时合并糖尿病家族史及高血压者糖代谢异常患病风险更高,增加了0.998倍(OR=1.998,95%CI 1.467~2.722,P<0.001)。交互作用定量分析结果显示,RERI=0.180(95%CI-0.446~0.805),SI=1.222(95%CI 0.595~2.509),AP=0.090(95%CI-0.212~0.393)。结论糖尿病家族史、高血压与糖代谢异常患病独立相关,且两者同时存在时糖代谢异常的患病风险增加,但两者对糖代谢异常患病无相乘或相加交互作用。

Objective To explore the effect of family history of diabetes millitus and hypertension on abnormal glucose metabolism and their interaction.Methods This study was a case-control study.The community residents with normal blood glucose who participated in the risk evaluation of cancers in Chinese diabetic individuals:a longitudinal(REACTION)study in Dalian from August to December 2011 were selected as the study subjects,and the subjects were followed up from July to December 2014.Family history of diabetes and hypertension at baseline were collected.All subjects who underwent oral glucose tolerance test were divided into case group and control group according to their glucose metabolism status at follow-up.Based on the multivariate logistic regression models,the effects of family history of diabetes and hypertension on the prevalence of abnormal glucose metabolism and their interactions were analyzed.The relative excess risk(RERI),attributable proportion of interactin(AP),and the synergy index(SI)of the interaction were calculated to evaluate the interaction effect on the addition scale.Results A total of 2597 subjects were included in the study.There were 526 cases in the case group and 2071 cases in the control group.Multivariate logistic regression analysis showed that family history of diabetes(OR=1.387,95%CI 1.133-1.699,P=0.002)and hypertension(OR=1.553,95%CI 1.134-2.126,P=0.006)were still the independent influencine factors for abnormal glucose metabolism.The OR value of family history of diabetes multiplied by hypertension on the risk of abnormal glucose metabolism was 1.020(95%CI 0.639-1.433,P=0.957).Taking patients without history of diabetes and hypertension as control group,the risk of abnormal glucose metabolism in those with hypertension but without a family history of diabetes was increased by 0.443(OR=1.443,95%CI 1.111-1.874,P<0.001).The risk of abnormal glucose metabolism in those with a family history of diabetes without hypertension increased by 0.379(OR=1.379,95%CI 1.042-1.824,P=0.024),and the risk of abnormal glucose metabolism in those with a family history of diabetes and hypertension increased by 0.998(OR=1.998,95%CI 1.467-2.722,P<0.001).Quantitative analysis of interaction showed that RERI=0.180(95%CI-0.446-0.805),SI=1.222(95%CI 0.595-2.509),AP=0.090(95%CI-0.212-0.393).Conclusions Family history of diabetes,hypertension were independently associated with the prevalence of abnormal glucose metabolism,and the risk of abnormal glucose metabolism increased when both were present,but there was no significant multiplicative or additive interaction on abnormal glucose metabolism.