大连地区正常糖耐量人群进展至糖尿病前期影响因素的巢式病例对照研究

Nested case-control study on influencing factors of normal glucose tolerance population progressing to pre-diabetes in Dalian

目的应用巢式病例对照研究探讨正常糖耐量人群进展至糖尿病前期的影响因素。方法依托中国2型糖尿病患者恶性肿瘤发生风险的流行病学(REACTION)研究,选取2011年8至12月大连分中心参加流行病学调查,并在2014年7至12月参加随访的基线糖耐量正常的受试者共2649例作为研究对象。对研究对象进行问卷调查,收集其年龄、进食牛羊肉习惯、高血压病史、脂肪肝病史、糖尿病家族史等情况,测量收缩压(SBP),检测空腹血糖(FPG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)并计算稳态模型评估胰岛素抵抗指数(HOMA-IR)。按照巢式病例对照方法将随访时新诊断为糖尿病前期的401例患者纳入病例组,按照1∶5的配比将同期糖耐量仍正常,性别相同、年龄相差3岁以内的2005例受试者纳入对照组。采用t检验进行组间比较,采用多因素条件logistic回归模型(前进LR法)分析糖尿病前期的危险因素。结果与对照组相比,病例组的SBP、HbA1c、HOMA-IR均更高,进食牛羊肉习惯、高血压病史、脂肪肝病史、糖尿病家族史的比例均更高(P<0.05),2组的年龄差异无统计学意义(P>0.05)。多因素条件logistic回归分析(前进LR法)结果显示,年龄(OR=1.284,95%CI 1.173~1.405,P<0.001)、SBP(OR=1.010,95%CI 1.005~1.014,P<0.001)、HbA1c(OR=2.810,95%CI 2.259~3.495,P<0.001)、HOMA-IR(OR=1.200,95%CI 1.098~1.311,P<0.001)、进食牛羊肉习惯(OR=1.627,95%CI 1.203~2.200,P=0.002)、高血压病史(OR=1.257,95%CI 1.014~1.559,P=0.037)、脂肪肝病史(OR=1.632,95%CI 1.200~2.218,P=0.002)、糖尿病家族史(OR=1.340,95%CI 1.165~1.540,P<0.001)均是发生糖尿病前期的危险因素。结论大连地区居民年龄、SBP、HbA1c、HOMA-IR越高,其患糖尿病前期的风险越高。进食牛羊肉习惯、高血压病史、脂肪肝病史及糖尿病家族史是大连地区居民糖尿病前期发生的危险因素。

Objective To investigate the factors influencing the progression to pre-diabetes in a population with normal glucose tolerance using a nested case-control study.Methods Based on the Risk Evaluation of Cancers in Chinese Diabetic Individuals:a longitudinal(REACTION)study,a total of 2649 subjects with normal baseline glucose tolerance who participated in the epidemiological survey from August to December 2011 in Dalian and branch and were followed up from July to December 2014 were selected as the study subjects.Questionnaire survey was conducted to collect the age,eating habits of beef and mutton,hypertension history,fatty liver history,diabetes family history and other information of the subjects,measure systolic blood pressure(SBP),detect fasting plasma glucose(FPG),fasting insulin(FINS),glycosylated hemoglobin(HbA1c)and calculate the homeostasis model assessment of insulin resistance(HOMA-IR).Finally,2649 subjects with normal baseline glucose tolerance were included.According to the nested case-control method,401 patients newly diagnosed with pre-diabetes at the time of follow-up were included in the case group,and 2005 subjects with normal glucose tolerance,of the same sex,and with an age difference of less than 3 years at the same time were included in the control group according to the ratio of 1∶5.The t-test was used for inter group comparison,and the multifactor conditional logistic regression model(forward LR method)was used to analyze the risk factors for pre-diabetes.Results Compared with the control group,the case group had higher SBP,HbA1c,and HOMA-IR,and a higher proportion of beef and mutton eating habits,history of hypertension,history of fatty liver disease,and family history of diabetes mellitus(P<0.05),and the difference in age between the 2 groups was not statistically significant(P>0.05).The results of multivariate conditional logistic regression analysis(forward LR method)showed that age(OR=1.284,95%CI 1.173-1.405,P<0.001),SBP(OR=1.010,95%CI 1.005-1.014,P<0.001),HbA1c(OR=2.810,95%CI 2.259-3.495,P<0.001),HOMA-IR(OR=1.200,95%CI 1.098-1.311,P<0.001),eating habits of beef and mutton(OR=1.627,95%CI 1.203-2.200,P=0.002),hypertension history(OR=1.257,95%CI 1.014-1.559,P=0.037),fatty liver history(OR=1.632,95%CI 1.200-2.218,P=0.002),and diabetes family history(OR=1.340,95%CI 1.165-1.540,P<0.001)were all risk factors for pre-diabetes.Conclusions The higher the age,SBP,HbA1c,HOMA-IR of Dalian residents,the higher the risk of pre-diabetes.The habit of eating beef and mutton,history of hypertension,history of fatty liver disease and family history of diabetes are the risk factors of pre-diabetes in Dalian residents.