糖尿病临床研究

　　[摘要] 目的 研究社区人群不同糖代谢状态与动脉硬化的相关性。 方法 以臂-踝脉搏波传导速度(baPWV)反映动脉硬化程度。对北京市石景山区2个社区≥40岁居民行标准化问卷调查、实验室指标检测、踝臂指数(ABI)及baPWV测量。根据75 g OGTT结果及糖尿病史将研究对象分为NGT组、IFG组、IGT组、IFG+IGT组、新诊断糖尿病(NDM)组及已发糖尿病(DDM)组，分析不同糖代谢状态与动脉硬化的相关性。结果 随糖代谢异常的进展，从NGT→IFG→IGT→IFG+IGT→NDM→DDM组，baPWV呈逐渐增高的趋势[(1528±308cm/s→(1625±370)cm/s→(1644±351)cm/s→(1747±485)cm/s→(1799±485)cm/s→(1841±456)cm/s,P<0.001)]。除IFG与IGT组间比较差异无统计学意义外，其余各组间比较差异均有统计学意义(P<0.05);校正年龄、性别及BMI等混杂因素后，各组两两比较均具有统计学意义(P<0.001);且糖代谢异常程度、FPG、2 hPG及HbA1c水平与baPWV独立相关(r=0.125,0.124,0.141,0.112.P<0.001)。结论 社区人群糖代谢异常程度与动脉硬化程度相关。因此，早期发现糖代谢异常，并对动脉硬化进行评估和干预对预防心脑血管事件的发生有重要意义。

　　【关键词】 糖代谢;动脉硬化;臂-踝脉搏波传导速度

　　[Abstract] Objective To study the association between glucose tolerance status and arterial stiffness in community population. Methods People from two communities of ShiJingShan district in Beijing, aged 40 years or older ,underwent examinations of questionnaire interview, anthropometric measurements, biochemical indexes , HbA1c,75 g OGTT,ankle-brachial index(ABI) and brachial-ankle pulse wave velocity(baPWV) . 9185 cases were divided into 6 groups based on the result of OGTT and diabetes history : normal glucose tolerance(NGT)，impaired fasting glucose (IFG),impaired glucose tolerance(IGT),IFG+IGT, newly diagnosed DM (NDM) and diagnosed DM(DDM). The association between baPWV and glucose tolerance status was analyzed by multiple linear regression. Results baPWV gradually increased from NGT to DDM group(1528±308)cm/s,(1625±370)cm/s,(1644±351)cm/s,(1747±485)cm/s,1799±485cm/s,(1841±456)cm/s,P<0.001). Except for between IFG and IGT group, there were statistically significant differences in baPWV between any other two groups(P<0.05).After adjusting for confounding factors such as age, sex, BMI, there was significant difference among the six groups (1612.0±5.8)cm/s,(1643.0±7.7)cm/s,(1639.0±12.6)cm/s,(1690.0±9.3)cm/s,(1719.0±9.6)cm/s,(1725.0±9.3)cm/s,P<0.001). baPWV was positively correlated with glucose tolerance status, fasting plasma glucose,2 h plasma glucose and HbA1c(r=0.125,0.124,0.141,0.112.P<0.001). Conclusion The increasingly deranged glucose homeostasis is associated with increased arterial stiffness in community population.It is important to detect the abnormal glucose tolerance and intervene the arteries stiffness early for preventing cardiovascular and cerebrovascular events.

　　[Key words] Glucose tolerance status;Arterial stiffness;Brachial-ankle pulse wave velocity