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正常糖耐量下空腹和2 h血糖水平与心脑血管疾病关联性

宁锋 张栋 任杰 张磊 高维国 汪韶洁 逄增昌 高汝钦

宁锋, 张栋, 任杰, 张磊, 高维国, 汪韶洁, 逄增昌, 高汝钦. 正常糖耐量下空腹和2 h血糖水平与心脑血管疾病关联性[J]. 中国公共卫生, 2018, 34(11): 1496-1500. doi: 10.11847/zgggws1118909
引用本文: 宁锋, 张栋, 任杰, 张磊, 高维国, 汪韶洁, 逄增昌, 高汝钦. 正常糖耐量下空腹和2 h血糖水平与心脑血管疾病关联性[J]. 中国公共卫生, 2018, 34(11): 1496-1500. doi: 10.11847/zgggws1118909
Feng NING, Dong ZHANG, Jie REN, . Association of two-hour post-load and fasting plasma glucose with cardiovascular diseases among people with normal glucose tolerance[J]. Chinese Journal of Public Health, 2018, 34(11): 1496-1500. doi: 10.11847/zgggws1118909
Citation: Feng NING, Dong ZHANG, Jie REN, . Association of two-hour post-load and fasting plasma glucose with cardiovascular diseases among people with normal glucose tolerance[J]. Chinese Journal of Public Health, 2018, 34(11): 1496-1500. doi: 10.11847/zgggws1118909

正常糖耐量下空腹和2 h血糖水平与心脑血管疾病关联性

doi: 10.11847/zgggws1118909
基金项目: 世界糖尿病基金会(WDF05-10807-308);中国博士后面上基金(2016M590623);青岛市科技局基金(15-9-1-24-jch);青岛市医疗卫生优秀人才培养项目
详细信息
    作者简介:

    宁锋(1980 – ),男,山东青岛人,主管技师,博士,主要从事慢性病防控工作

    通信作者:

    高汝钦,E-mail: gaoruqin@sohu.com

  • 中图分类号: R541.9;R743

Association of two-hour post-load and fasting plasma glucose with cardiovascular diseases among people with normal glucose tolerance

  • 摘要:   目的  探讨正常糖耐量范围内,空腹和2 h血糖与中国成人心脑血管疾病关联性,为心脑血管疾病危险因素的早期防控提供依据。  方法  以4 307名35~74岁成年人中空腹血糖(FPG)< 6.1 mmol/L且2 h血糖(2hPG) < 7.8 mmol/L糖耐量正常者为对象,采用多因素logistic回归分析评估2hPG > FPG组与2hPG≤FPG组人群心脑血管疾病患病率的风险比。  结果  4 307名成年人中确诊心脑血管疾病患者1 815例,2hPG > FPG组人群心脑血管病患病率(42.4 %)高于2hPG≤FPG组(36.2 %)(P < 0.01);与2hPG≤FPG组比较,2hPG > FPG组人群年龄偏大、体质指数、舒张压、总胆固醇、甘油三酯和胰岛素水平较高(P < 0.01)。多因素logistic回归分析显示,2hPG > FPG、年龄、体质指数、甘油三酯和饮酒状况可增加心脑血管病风险,OR值及其95 % CI分别为1.210(1.042~1.405)、1.073(1.064~1.082)、1.170(1.144~1.196)、1.396(1.127~1.729)和1.269(1.154~1.396)。分层分析结果显示,在女性、年龄 < 60岁及FPG < 5.6 mmol/L亚组中,2hPG > FPG组人群心脑血管疾病患病风险较高;调整蔬菜、水果摄入、胰岛素抵抗和胰岛分泌水平后,2hPG > FPG组人群心脑血管病患病风险降低。  结论  正常血糖下,较高的2 h血糖可能增加心脑血管疾病患病风险。
  • 表  1  2hPG≤FPG与2hPG > FPG组人群不同人口学特征比较(%)

    人口学特征 2hPG ≤ FPG
    n = 1 383)
    2hPG > FPG
    n = 2 924)
    χ2 P
    性别 男性 41.0 59.0 100.479 0.000
    女性 26.4 73.6
    中心性肥胖 13.7 18.7 17.053 0.000
    86.3 81.3
    心脑血管病 36.2 42.4 15.253 0.000
    63.8 57.6
    教育水平 文盲/小学 28.9 29.2 0.540 0.763
    初中/高中 59.9 60.4
    大专及以上 11.2 10.4
    个人月收入 45.6 48.7 5.275 0.072
    44.9 43.4
    9.5 7.9
    吸烟情况 现在吸烟 32.2 20.5 70.208 0.000
    不吸烟或戒烟 67.8 79.5
    现在饮酒 现在饮酒 22.4 15.4 35.422 0.000
    不饮酒或戒酒 77.6 84.6
    蔬菜摄入(次/周)a < 7 20.1 21.7 6.690 0.035
    7~13 15.2 17.9
    ≥ 14 64.7 60.4
    水果摄入(次/周)a < 7 58.3 55.3 11.106 0.004
    7~13 26.4 24.8
    ≥ 14 15.3 19.9
    体力活动(步/天)b < 4 000 29.3 34.5 10.273 0.006
    4 000~7 000 13.2 15.0
    > 7 000 57.5 50.5
      注:a n = 3 517,b n = 2 284。
    下载: 导出CSV

    表  2  2hPG≤FPG与2hPG > FPG组人群生理指标比较($\bar x \pm s$

    生理指标 2hPG ≤ FPG
    n = 1 383)
    2hPG > FPG
    n = 2 924)
    t P
    年龄(岁) 47.9 ± 0.26 48.9 ± 0.18 9.667 0.000
    体质指数(kg/m2 24.4 ± 0.09 25.0 ± 0.06 28.400 0.000
    腰围(cm) 81.9 ± 0.27 82.3 ± 0.19 1.408 0.235
    收缩压(mm Hg) 127.9 ± 0.50 128.3 ± 0.34 0.474 0.491
    舒张压(mm Hg) 81.5 ± 0.31 82.3 ± 0.22 4.671 0.031
    总胆固醇(mmol/L) 5.16 ± 0.03 5.09 ± 0.02 4.987 0.026
    甘油三酯(mmol/L) 1.20 ± 0.02 1.24 ± 0.02 1.878 0.171
    HDL-C(mmol/L) 1.69 ± 0.01 1.66 ± 0.01 5.007 0.025
    FPG(mmol/L) 5.42 ± 0.01 5.18 ± 0.01 0.229 0.000
    2 h血糖(mmol/L) 4.68 ± 0.02 6.34 ± 0.01 5 020.500 0.000
    胰岛素(pmol/L) 25.8 ± 0.97 26.8 ± 0.61 0.681 0.409
    HOMA-IR a 0.90 ± 0.03 0.88 ± 0.02 0.229 0.632
    HOMA-β a 42.05 ± 3.24 59.39 ± 2.05 20.421 0.000
      注:a n = 2 284。
    下载: 导出CSV

    表  3  多因素非条件logistic回归分析

    因素 β $S_{\overline x}$ Wald χ2 P ORa 95 % CI a
    性别 男性 0.135 0.109 1.524 0.217 1.144 0.924~1.417
    女性 0.252 0.107 5.486 0.019 1.286 1.042~1.588
    年龄(岁) < 60 0.238 0.084 8.104 0.004 1.268 1.077~1.494
    ≥ 60 – 0.050 0.197 0.065 0.799 0.951 0.646~1.400
    FPG(mmol/L) < 5.6 0.139 0.098 2.010 0.156 1.149 0.948~1.393
    ≥ 5.6 0.260 0.127 4.175 0.041 1.297 1.011~1.665
      注:a调整年龄、性别、研究队列、居住地、教育和收入水平、体质指数、甘油三酯、总胆固醇、HDL-C、吸烟和饮酒情况;以2hPG ≤ FPG为参照组。
    下载: 导出CSV
  • [1] Yang ZJ, Liu J, Ge JP, et al. Prevalence of cardiovascular disease risk factor in the Chinese population: the 2007 – 2008 China National Diabetes and Metabolic Disorders Study[J]. Eur Heart J, 2012, 33(2): 213 – 220.
    [2] Xu Y, Wang L, He J, et al. Prevalence and control of diabetes in Chinese adults[J]. JAMA, 2013, 310(9): 948 – 959.
    [3] Sarwar N, Gao P, Seshasai SR, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies[J]. Lancet, 2010, 375(9733): 2215 – 2222.
    [4] Huang Y, Cai X, Mai W, et al. Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis[J]. BMJ, 2016, 355(1): 5953.
    [5] DECODE study group. Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria[J]. Arch Intern Med, 2001, 161(3): 397 – 405.
    [6] Barr EL, Botko EJ, Zimmet PZ, et al. Continuous relationships between non-diabetic hyperglycaemia and both cardiovascular disease and all-cause mortality: the Australian Diabetes, Obesity, and Lifestyle (AusDiab) study[J]. Diabetologia, 2009, 52(3): 415 – 424.
    [7] No authors listed. Asymptomatic hyperglycemia and coronary heart disease. A series of papers by the International Collaborative Group, based on studies in fifteen populations. Introduction[J]. J Chronic Dis, 1979, 32(11 – 12): 681 – 837.
    [8] Bonora E, Kiechl S, Willeit J, et al. Plasma glucose within the normal range is not associated with carotid atherosclerosis: prospective results in subjects with normal glucose tolerance from the Bruneck Study[J]. Diabetes Care, 1999, 22(8): 1339 – 1346.
    [9] Qiao Q, Jousilahti P, Eriksson J, et al. Predictive properties of impaired glucose tolerance for cardiovascular risk are not explained by the development of overt diabetes during follow-up[J]. Diabetes Care, 2003, 26(10): 2910 – 2914.
    [10] Ray KK, Seshasai SR, Wijesuriya S, et al. Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials[J]. Lancet, 2009, 373(9677): 1765 – 1772.
    [11] Levitan EB, Song Y, Ford ES, et al. Is nondiabetic hyperglycemia a risk factor for cardiovascular disease? A meta-analysis of prospective studies[J]. Arch Intern Med, 2004, 164(19): 2147 – 2155.
    [12] Qiao Q, Pyorala K, Pyorala M, et al. Two-hour glucose is a better risk predictor for incident coronary heart disease and cardiovas-cular mortality than fasting glucose[J]. Eur Heart J, 2002, 23(16): 1267 – 1275.
    [13] Succurro E, Marini MA, Grembiale A, et al. Differences in cardiovascular risk profile based on relationship between post-load plasma glucose and fasting plasma levels[J]. Diabetes Metab Res Rev, 2009, 25(4): 351 – 356.
    [14] Abdul-Ghani MA, Williams K, DeFronzo R, et al. Risk of progression to type 2 diabetes based on relationship between postload plasma glucose and fasting plasma glucose[J]. Diabetes Care, 2006, 29(7): 1613 – 1618.
    [15] Ning F, Zhang L, Dekker JM, et al. Development of coronary heart disease and ischemic stroke in relation to fasting and 2-hour plasma glucose levels in the normal range[J]. Cardiovasc Diabetol, 2012, 11: 76.
    [16] Ning F, Tuomilehto J, Pyörälä K, et al. Cardiovascular disease mortality in Europeans in relation to fasting and 2-h plasma glucose levels within a normoglycemic range[J]. Diabetes Care, 2010, 33(10): 2211 – 2216.
    [17] Qiao Q, Pang Z, Gao W, et al. A large-scale diabetes prevention program in real-life settings in Qingdao of China (2006-2012)[J]. Prim Care Diabetes, 2010, 4(2): 99 – 103.
    [18] Ning F, Pang ZC, Dong YH, et al. Risk factors associated with the dramatic increase in the prevalence of diabetes in the adult Chinese population in Qingdao, China[J]. Diabet Med, 2009, 26(9): 855 – 863.
    [19] Qie LY, Sun JP, Ning F, et al. Cardiovascular risk profiles in relation to newly diagnosed type 2 diabetes diagnosed by either glucose or HbA1c criteria in Chinese adults in Qingdao,China[J]. Diabet Med, 2014, 31(8): 920 – 926.
    [20] 中国肥胖问题工作组数据汇总分析协作组. 我国成人体重指数和腰围对相关疾病危险因素异常的预测价值:适宜体重指数和腰围切点的研究[J]. 中华流行病学杂志, 2002, 23(1): 10 – 15.
    [21] No authors listed. 1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee[J]. Clinical and Experimental Hyperten-sion, 1999, 21(5 – 6): 1009 – 1060.
    [22] Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man[J]. Diabetologia, 1985, 28(7): 412 – 419.
    [23] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2013年版)[J].中国糖尿病杂志, 2014, 22(8):2 – 42.
    [24] Park C, Guallar E, Linton JA, et al. Fasting glucose level and the risk of incident atherosclerotic cardiovascular diseases[J]. Diabetes Care, 2013, 36(7): 1988 – 1993.
    [25] Bragg F, Li L, Smith M, et al. Associations of blood glucose and prevalent diabetes with risk of cardiovascular disease in 500 000 adult Chinese: the China Kadoorie Biobank[J]. Diabet Med, 2014, 31(5): 540 – 551.
    [26] Yang Z, Xing X, Xiao J, et al. Prevalence of cardiovascular disease and risk factors in the Chinese population with impaired glucose regulation: the 2007 – 2008 China national diabetes and metabolic disorders study[J]. Exp Clin Endocrinol Diabetes, 2013, 121(6): 372 – 374.
    [27] Bragg F, Li L, Bennett D, et al. Association of random plasma glucose levels with the risk for cardiovascular disease among Chinese adults without known diabetes[J]. JAMA Cardiol, 2016, 1(7): 813 – 823.
    [28] Chien KL, Hsu HC, Su TC, et al. Fasting and postchallenge hyperglycemia and risk of cardiovascular disease in Chinese: the Chin-Shan Community Cardiovascular Cohort study[J]. Am Heart J, 2008, 156(5): 996 – 1002.
    [29] Chien KL, Lee BC, Lin HJ, et al. Association of fasting and post-prandial hyperglycemia on the risk of cardiovascular and all-cause death among non-diabetic Chinese[J]. Diabetes Res Clin Pract, 2009, 83(2): 47 – 50.
    [30] Lawes CM, Parag V, Bennett DA, et al. Blood glucose and risk of cardiovascular disease in the Asia Pacific region[J]. Diabetes Care, 2004, 27(12): 2836 – 2842.
    [31] DeFronzo RA, Ferrannini E, Simonson DC. Fasting hyperglycemia in non-insulin-dependent diabetes mellitus: contributions of excessive hepatic glucose production and impaired tissue glucose uptake[J]. Metabolism, 1989, 38: 387 – 395.
    [32] Bogardus C, Lillioja S, Howard BV, et al. Relationships between insulin secretion, insulin action, and fasting plasma glucose concentration in nondiabetic and noninsulin-dependent diabetic subjects[J]. J Clin Invest, 1984, 74(4): 1238 – 1246.
    [33] Wei SH, Lin JD, Hsu CH, et al. Higher normal range of fasting plasma glucose still has a higher risk for metabolic syndrome: a combined cross-sectional and longitudinal study in elderly[J]. Int J Clin Pract, 2015, 69(8): 863 – 870.
    [34] O′Malley G, Santoro N, Northrup V, et al. High normal fasting glucose level in obese youth: a marker for insulin resistance and beta cell dysregulation[J]. Diabetologia, 2010, 53(6): 1199 – 1209.
    [35] Piche ME, Lemieux S, Perusse L, et al. High normal 2-hours plasma glucose is associated with insulin sensitivity and secretion that may predispose to type 2 diabetes[J]. Diabetologia, 2005, 48(4): 732 – 740.
    [36] Lin Z, Zhou J, Li X, et al. High-normal 2h glucose is associated with defects of insulin secretion and predispose to diabetes in Chinese adults[J]. Endocrine, 2015, 48(1): 179 – 186.
    [37] Stevens JW, Khunti K, Harvey R, et al. Preventing the progression to type 2 diabetes mellitus in adults at high risk: a systematic review and network meta-analysis of lifestyle, pharmacological and surgical interventions[J]. Diabetes Res Clin Pract, 2015, 107(3): 320 – 331.
    [38] Li G, Zhang P, Wang J, et al. Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: a 23-year follow-up study[J]. Lancet Diabetes Endocrinol, 2014, 2(6): 474 – 480.
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  • 接收日期:  2018-03-09
  • 刊出日期:  2018-11-01

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