血糖正常人群葡萄糖耐量试验2h血糖与冠心病发病风险关系的前瞻性队列研究

摘要

目的：探讨血糖正常人群葡萄糖耐量试验2 h 血糖与冠心病发病风险的关系。方法2000年2月，在我院门诊健康体检人群中共招募到2675例受试者（空腹血糖<6.1 mmol/ L，葡萄糖耐量试验2 h 血糖<7.8 mmol/ L），将葡萄糖耐量试验2 h 血糖≤空腹血糖者1239例纳入 A 组，葡萄糖耐量试验2 h 血糖>空腹血糖者1436例纳入 B 组。对两组受试者随访至2006年1月，观察其冠心病发病情况，同时记录其年龄、体质指数、空腹血糖、葡萄糖耐量试验2 h 血糖、血清空腹胰岛素及总胆固醇水平、吸烟及高血压情况等。结果随访结束时，2675例受试者共发生冠心病103例，其中男73例，女30例，冠心病年平均发病率6.4‰，男性受试者冠心病发病率高于女性（P <0.05）。根据性别进行亚组分析：A 组中男701例，女538例；B 组中男824例，女612例。A 组男性受试者体质指数、葡萄糖耐量试验2 h 血糖、血清空腹胰岛素水平、高血压发病率低于 B 组，空腹血糖、吸烟率高于 B 组（P <0.05）；A 组女性受试者年龄、葡萄糖耐量试验2 h 血糖、血清空腹胰岛素水平、高血压发病率低于 B 组，空腹血糖、吸烟率高于 B 组（P <0.05）。Cox 比例风险模型分析结果显示，在校正潜在影响因素后，B 组受试者冠心病发病风险高于 A 组〔校正 HR =1.17，95% CI（0.96，1.43）〕，其中 B 组男性受试者高于 A 组〔校正 HR =1.26，95% CI（0.92，1.45）〕，B 组女性受试者高于 A 组〔校正 HR =1.37，95% CI（0.85，2.21）〕（P <0.05）。结论血糖正常人群葡萄糖耐量试验2 h 血糖>空腹血糖会增加冠心病发病风险。%Objective To investigate the relationship between 2 h blood glucose of oral glucose tolerance test and onset risk of coronary heart disease in population with normal blood glucose. Methods A cohort including 2 675 cases was enlisted in February 2000,with fasting blood glucose < 6. 1 mmol/ L,2 h blood glucose of oral glucose tolerance test < 7. 8 mmol/ L. They were divided into groups A(2 h blood glucose of oral glucose tolerance test≤fasting blood glucose,n = 1 239) and B(2 h blood glucose of oral glucose tolerance test > fasting blood glucose,n = 1 436). The follow - up lasted to January 2006,and on-set of coronary heart disease was observed,age,BMI,fasting blood glucose,2 h blood glucose of oral glucose tolerance test, serum levels of fasting insulin and total cholesterol,smoking rate and incidence of hypertension recorded. Results A total of 103 cases occurred coronary heart disease,including 73 males and 30 females,the average annual incidence of coronary heart disease was 6. 4‰,and the incidence of males was higher than that of females(P < 0. 05). Subgroup analysis was carried out according to gender,there was 701 males and 538 females in A group,824 males and 612 females in B group. BMI,2 h blood glucose of oral glucose tolerance test,serum fasting insulin level,incidence of hypertension in males of A group were lower than those of B group,fasting blood glucose and smoking rate were higher(P < 0. 05);age,2 h blood glucose of oral glucose toler-ance test,serum fasting insulin level,incidence of hypertension in females of A group were lower than those of B group,fasting blood glucose and smoking rate were higher( P < 0. 05). Cox proportional hazard model showed that,onset risk of coronary heart disease of A group was higher than that of B group〔adjusted HR = 1. 17,95% CI(0. 96,1. 43)〕,so was in males〔ad-justed HR = 1. 26,95% CI(0. 92,1. 45)〕and females〔adjusted HR = 1. 37,95% CI(0. 85,2. 21)〕(P < 0. 05). Con-clusion In population with normal blood glucose,those people with 2 h blood glucose of oral glucose tolerance test > fasting blood glucose has a higher onset risk of coronary heart disease.