糖尿病前期人群血脂特点及其对糖尿病前期转归的影响研究

摘要

目的 了解糖尿病前期人群的血脂特点, 并探讨血脂对糖尿病前期人群血糖转归的影响. 方法 采用整群随机抽样法, 选取2011年4—11月泸州市区内茜草、 大山坪、 龙马潭3个社区居民4 000名, 从中筛选出糖尿病前期人群1 090名, 根据不同血糖状态分为单纯空腹血糖受损 (IFG) (n=79)、 单纯糖耐量异常 (IGT) (n=856) 和空腹血糖受损+糖耐量异常 (IFG+IGT) (n=155) 3组. 对糖尿病前期人群进行基线调查和为期3年的随访, 比较3组基线血脂水平及血脂异常患病率、 随访3年后的血糖转归情况、 不同转归患者的基线资料, 并分析血脂对糖尿病前期血糖转归的影响. 结果 IFG+IGT组总胆固醇 ( TC) 水平高于IGT组, 三酰甘油 ( TG) 水平高于IFG、 IGT组, 高密度脂蛋白胆固醇 (HDL-C) 水平低于IFG组, 差异均有统计学意义 (P<0.05); 而且IFG+IGT组高TG血症患病率高于IFG、 IGT组, 差异亦有统计学意义 ( P<0.016 7). 随访3年后, 1 090名糖尿病前期人群转归为正常糖耐量395人、 IFG 32人、 IGT 419人、 IFG+IGT 56人、 糖尿病188人, 3组血糖转归分布间差异有统计学意义 (χ2 =41.579, P<0.001); 其中IFG、 IGT、 IFG+IGT转变为糖尿病的年转变率分别为4.2%、 5.0%、 10.5%. 转归为糖尿病的患者基线年龄、 BMI、 腰围、 臀围、 收缩压、 糖化血红蛋白、 空腹血糖、 口服葡萄糖耐量试验 ( OGTT) 2 h血糖、 TG水平及糖尿病家族史、 饮酒史比例均高于转归为正常糖耐量的患者, 差异有统计学意义 ( P<0.05 ). TG为糖尿病前期转归为糖尿病的危险因素, 在调整性别、 年龄、 BMI、 腰围、 臀围、 糖尿病家族史、 吸烟史、 饮酒史、 收缩压、 糖化血红蛋白、 空腹血糖、 OGTT2 h血糖后, 与TG1水平 (0.35~0.98 mmol/L) 相比, TG4水平 (2.08~11.70 mmol/L) 的OR (95%CI) 为1.285 (1.067, 2.151), P=0.045. 结论 糖尿病前期人群合并有不同程度的脂代谢异常, 其中以高TG血症为主; IFG +IGT人群糖尿病的转变率最高; TG对糖尿病前期人群的转归有影响, 或可成为糖尿病前期人群糖尿病转归的预测指标.%Objective To investigate the characteristics of blood lipid level of patients with prediabetes and explore the influence of blood lipid level on patients′outcome.Methods Using cluster random sampling method , we enrolled 4 000 residents in Qiancao, Dashanping and Longmatan communities from April to November in 2011.A total of 1 090 residents were detected with prediabetes, and these patients were divided into three groups: pure impaired fasting glucose (IFG) group (n=79), pure impaired glucose tolerance (IGT) group (n=856) and IFG+IGT group (n=155) .Baseline data and three -year follow-up were conducted on patients with prediabetes , and comparison was made among the three groups in blood lipid level , prevalence of dyslipidemia , outcome after three -year follow -up and baseline data of patients with different outcomes .The influence of blood lipid on the outcome of patients with prediabetes was also analyzed .Results IFG+IGT group was higher than IGT group in TC level, and was higher than IFG group and IGT group in TG level and lower in HDL-C level than IFG group (P<0.05); IFG+IGT group was higher in the prevalence of high TG level than IFG group and IGT group (P<0.016 7).After three -year follow-up, the numbers of patients who had an outcome of normal sugar tolerance , IFG, IGT, IFG+IGT and diabetes were 395, 32, 419, 56 and 188.The three groups were significantly different in outcome (χ2 =41.579, P<0.001), the yearly conservation rates to diabetes from IFG , IGT and IFG+IGT were 4.2%, 5.0% and 10.5% respectively.The patients with an outcome of diabetes were higher than the patients with an outcome of normal glucose tolerance in baseline age , BMI, waistline, hipline, systolic pressure, glycosylated hemoglobin, fasting blood glucose, OGTT 2 h blood glucose, TG level and family history of diabetes proportin , history of alcoholic consumption proportion ( P<0.05 ) .TG level was a risk factor for diabetes outcome from prediabetes.After the adjustment of gender , age, BMI, waistline, hipline, the family history of diabetes , the history of smoking , the history of alcoholic consumption , systolic pressure , glycosylated hemoglobin , fasting blood glucose and OGTT 2 h blood glucose and compared with the minimum interquartile range (TG1 0.35~0.98 mmol/L), the OR (95%CI) of the maximum interquartile range (TG4 2.08~11.70 mmol/L) was 1.285 (1.067, 2.151), P =0.045.Conclusion Patients with prediabetes have different degrees of dyslipidemia , mainly in the form of high TG level .Patients with IFG+IGT have high conversation rate to diabetes; TG has influence on the outcome of patients with prediabetes and may be a potential predictor for the diabetes outcome of prediabetes patients .