2型糖尿病患者体质指数变化与心血管病其他危险因素的关联研究

胡如英; 何青芳; 潘劲; 王蒙; 周晓燕; 俞敏

Abstract

胡如英,何青芳,潘劲,王蒙,周晓燕,俞敏.2型糖尿病患者体质指数变化与心血管病其他危险因素的关联研究[J].Chinese journal of Epidemiology,2021,42(7):1194-1199

2型糖尿病患者体质指数变化与心血管病其他危险因素的关联研究

Association between body mass index changes and other risk factors for cardiovascular disease in patients with type 2 diabetes mellitus

Received:June 15, 2020

DOI：10.3760/cma.j.cn112338-20200615-00841

KeyWord: 糖尿病,2型体质指数心血管疾病危险因素队列研究

English Key Word: Diabetes mellitus, type 2 Body mass index Cardiovascular risk factors Cohort studies

FundProject:国家重点研发计划（2016YFC0901200，2016YFC0901205）；浙江省公益技术应用研究计划（2017C33090）

Author Name	Affiliation	E-mail
Hu Ruying	Department of Chronic and Non-communicable Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China	ryhu@cdc.zj.cn
He Qingfang	Department of Chronic and Non-communicable Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
Pan Jin	Department of Chronic and Non-communicable Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
Wang Meng	Department of Chronic and Non-communicable Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
Zhou Xiaoyan	Department of Chronic and Non-communicable Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
Yu Min	Department of Chronic and Non-communicable Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China

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Abstract:

目的分析2型糖尿病患者（T2DM）BMI变化与心血管病其他危险因素的关联。方法基于农村社区T2DM队列，基线和随访时测量研究对象的身高、体重、血压、糖化血红蛋白（HbA1c）、TC、TG、LDL-C和HDL-C。分析中剔除随访期间死亡及失访或信息不全者，共纳入8 953例研究对象。使用多重线性回归和Cox比例风险回归模型分析BMI变化和心血管病其他危险因素的关联。结果基线调查时，有40.97%的T2DM患者伴有超重肥胖。超重肥胖组的SBP、DBP、TG水平显著高于BMI正常组，HDL-C水平低于BMI正常组（P<0.01）。随访期间，患者血糖控制率上升了15%，不同BMI变化组的HbA1c水平均有不同程度下降；与BMI持续正常组相比，持续超重肥胖组的HbA1c水平下降幅度较小，SBP、DBP上升幅度较大；HbA1c、SBP、DBP、TG、HDL-C不达标比例分别比BMI持续正常组高1.142（1.057~1.233）倍、1.123（1.055~1.196）倍、1.220（1.128~1.320）倍、1.400（1.282~1.528）倍、1.164（1.069~1.267）倍；BMI转为异常组血压、血脂等相关指标变化与持续超重肥胖组相似；BMI转为正常组血糖、血压等变化值以及不达标比例与BMI持续正常组差异无统计学意义（P>0.05）。BMI变化值与SBP、DBP、TG和LDL-C的变化值呈正相关，与HDL-C呈负相关（P<0.05）。结论 BMI异常变化将伴随着血糖、血压、血脂等心血管疾病（CVD）危险因素的不利变化，BMI的正常化将有利于CVD不良因素的转归。

English Abstract:

Objectives To investigate the association between body mass index (BMI) changes and other risk factors for cardiovascular disease in patients with type 2 diabetes mellitus (T2DM). Methods Based on the T2DM cohort in rural communities of Zhejiang province, baseline and follow up information of height, weight, blood pressure, glycated hemoglobin (HbA1c), TC, TG, LDL-C and HDL-C of the T2DM patients were collected. After excluding those who died during the follow-up period, lost follow-up or had incomplete information, a total of 8 953 T2DM patients were included in the final analysis. Multiple linear regression and Cox proportional hazards regression models were used for analysis. Results At baseline survey, 40.97% of the T2DM patients were overweight and obese. Compared with those with normal BMI, the SBP, DBP and TG level were significantly higher, while HDL-C level was significantly lower in the overweight and obese T2DM patients (P<0.01). During the follow-up period, the blood glucose control rate in the patients increased by 15%, and the levels of HbA1c decreased in the patients with different BMI changes at different degrees. Compared with the patients who kept normal BMI, the HbA1c level decrease had a smaller range, while the SBP and DBP increase had a larger range in the patients with persistent overweight and obesity, and their substandard rates of HbA1c, SBP, DBP, TG, HDL-C levels were 1.142 (1.057-1.233) times, 1.123 (1.055-1.196) times, 1.220 (1.128-1.320) times, 1.400 (1.282-1.528) times and 1.164 (1.069-1.267) times higher. The changes of blood pressure, blood lipids and other related indicators in the patients whose BMI became abnormal were similar to those of the patients with persistent overweight and obesity; Compared with the patients whose BMI were kept normal, the differences in changes and substandard rate of blood glucose level, blood pressure level in the patients whose BMI became normal were not significant (P>0.05). The change value of BMI was positively correlated with the change value of SBP, DBP, TG and LDL-C, while negatively correlated with the change value of HDL-C (P<0.05). Conclusions Abnormal changes in BMI are associated with the adverse changes of blood glucose level, blood pressure, and blood lipids level and other cardiovascular disease risk factors. Keeping normal BMI would benefit the positive outcome of cardiovascular adverse factors.

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