河南省郑州市40岁以上人群单一或综合糖尿病危险因素与糖尿病发病关系的前瞻性队列研究

Individual and combined diabetic risk factors and the subsequent risk of diabetes mellitus in the population aged over 40 years in Zhengzhou city,Henan province:a prospective cohort study

目的探讨河南省郑州市40岁以上人群单一或综合糖尿病危险因素与糖尿病发病的相关性。方法本研究依托于中国心脏代谢疾病及肿瘤队列(4C)研究,研究对象来源于4C研究河南分中心。自2011年10月至2012年5月采用多阶段分层整群随机抽样法抽取年龄≥40岁的河南郑州常住人口为研究对象,收集腰围、血压以及血糖、血脂等代谢相关指标。2014年8月至2015年12月对所有受试者进行随访。采用t检验、非参数检验、χ^(2)检验比较不同性别受试者的基线资料,使用Cox回归分析法分析糖尿病发生的危险因素。结果共3 028名受试者纳入本研究,其中男952例、女2 076例。仅有糖耐量减低(HR=4.16,95%CI 2.58~6.71,P<0.05)、仅有高血压的受试者(HR=2.25,95%CI 1.15~4.42,P<0.05)发生糖尿病的风险显著增加,仅有腹型肥胖(HR=1.27,95%CI 0.70~2.32,P>0.05)的受试者发生糖尿病的风险无明显增加;糖耐量减低合并高血压(HR=5.33,95%CI 2.95~9.62,P<0.05)、糖耐量减低合并腹型肥胖(HR=4.86,95%CI 2.94~8.03,P<0.05)、高血压合并腹型肥胖(HR=3.70,95%CI 1.95~7.00,P<0.05)的受试者发生糖尿病的风险均显著增加,糖耐量减低同时合并高血压和腹型肥胖的受试者发生糖尿病的风险最高(HR=7.76,95%CI 4.49~13.44,P<0.05)。结论糖耐量减低、高血压、腹型肥胖对于糖尿病的发生具有叠加效应。

Objective To investigate the associations between individual and combined diabetic risk factors and diabetes mellitus in the population aged over 40 years in Zhengzhou city,Henan province.Methods This study was based on the Chinese Cardiometabolic Disease and Cancer Cohort(4C)study,a resident population aged≥40 years with complete information at baseline during October 2011 to May 2012,who were invited to an in-person visit between August 2014 and December 2015.Waist circumference,blood pressure and other metabolic indicators such as blood glucose,blood lipids were measured.The participants were from Henan Branch Center of 4C study.The t-test,nonparametric test and χ^(2) test were used to compare the baseline data between subjects of different sexes.Cox proportional hazards models were used to analyze the risk factors of diabetes mellitus.Results A total of 3028 participants(952 men and 2076 women)were included in the study.Compared with participants without prediabetes,hypertension and central obesity,participants with prediabetes only(HR=4.16,95%CI 2.58-6.71,P<0.05)or hypertension only(HR=2.25,95%CI 1.15-4.42,P<0.05)had a significantly higher risk of diabetes,whereas participants with central obesity only(HR=1.27,95%CI 0.70-2.32,P>0.05)did not have a significantly higher risk of diabetes mellitus.When analyzed collectively,participants with prediabetes plus hypertension(HR=5.33,95%CI 2.95-9.62,P<0.05),prediabetes plus central obesity(HR=4.86,95%CI 2.94-8.03,P<0.05),and hypertension plus central obesity(HR=3.70,95%CI 1.95-7.00,P<0.05)had a significantly higher risk of diabetes.Moreover,participants with the combination of prediabetes,hypertension and central obesity exhibited the highest risk for diabetes mellitus(HR=7.76,95%CI 4.49-13.44,P<0.05).Conclusion Prediabetes,hypertension and central obesity showed additive associations with the risk of diabetes in middle-aged and older adults in Henan.