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目的分析上海市浦东新区某社区居民糖代谢状况及糖代谢正常人群空腹胰岛素(FIns)水平与血糖、血压、血脂和肥胖的相关性,为2型糖尿病(T2DM)的防控提供依据。方法 2009年在浦东新区某社区高桥过多阶段随机抽样方法抽取1 317名居住满5年及以上的35~74岁社区居民进行横断面调查。上述调查对象于2012年进行复查,947名社区居民完成2次调查并资料完整,该研究对第2次调查结果进行了分析。调查对象均进行体格检测、血压、空腹血糖(FPG)、FIns及血脂等生化检测,并根据不同FIns水平将糖代谢正常人群分为高胰岛素血症组(NGT-HIns)和非高胰岛素血症组(NGT-NHIns),分别为588和49例。采用SPSS 22.0软件进行t检验、方差分析和χ2检验,采用logistic回归进行多因素分析。结果该社区居民T2DM患病率为18.16%,糖调节受损(IGR)患病率为14.57%。男性IGR和T2DM患病率高于女性,差异均有统计学意义(P<0.05)。T2DM患病率在75~岁达到峰值(40.00%),其次是65~74岁组(23.27%);65~74岁组调查对象的IGR患病率最高(20.13%),其次为35~44岁组(19.78%)。不同糖代谢人群的收缩压、舒张压、体质指数(BMI)、腰围、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、FPG和FIns水平差异均有统计学意义(P<0.05)。NGT-HIns人群的收缩压、舒张压、BMI、腰围、TG、FPG、稳态模型胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-B)均高于NGT-NHIns人群,HDL-C和胰岛素作用指数均低于NGT-NHIns人群,差异均有统计学意义(P<0.05)。多因素回归分析结果显示,收缩压上升(OR=1.023)、超重(OR=2.851)以及肥胖(OR=3.911)都是正常糖耐量人群中有高胰岛素血症的危险因素(P<0.05);年龄增长(OR=0.955)及HDL-C的升高(OR=0.056)能降低正常糖耐量人群中有高胰岛素血症的风险。结论应加强对上海市浦东新区某社区65~74岁以及35~44岁居民糖调节异常状况的关注,65岁以上居民是糖尿病高发人群。HDL-C水平降低、收缩压升高、超重以及肥胖均是糖代谢正常人群发生高胰岛素血症的危险因素,应尽早采取针对性的干预措施。
Objective To analyze the relationship between the level of fasting insulin (FIns) and the blood sugar, blood pressure, blood lipid and obesity in a community resident in Pudong New Area in Shanghai and provide the basis for the prevention and control of type 2 diabetes mellitus (T2DM). Methods A total of 1 317 community residents aged 35-74 who lived for 5 years and over were surveyed in a cross-sectional survey by using too many stages of random sampling in Takahashi, a community in the Pudong New Area in 2009. The survey respondents reviewed in 2012, 947 community residents completed two surveys and complete data, the study on the second survey results were analyzed. Subjects underwent physical examination, blood pressure, fasting blood glucose (FPG), FIns and blood lipids and other biochemical tests. According to different levels of FIns, normal glucose metabolism group were divided into hyperinsulinemia group (NGT-HIns) and non-hyperinsulinemia Groups (NGT-NHIns) were 588 and 49, respectively. SPSS 22.0 software was used t test, analysis of variance and χ2 test, using multivariate logistic regression analysis. Results The prevalence of T2DM was 18.16% and the prevalence of impaired glucose regulation (IGR) was 14.57%. The prevalence of IGR and T2DM was higher in males than in females, with significant differences (P <0.05). The prevalence of T2DM peaked at 75 to 40.00%, followed by 65-74 years (23.27%). The prevalence of IGR was highest in subjects aged 65-74 (20.13%), followed by 35-44 The age group (19.78%). Systolic blood pressure, diastolic blood pressure, body mass index (BMI), waist circumference, total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol -C), FPG and FIns levels were statistically significant (P <0.05). NGT-HIns population systolic blood pressure, diastolic blood pressure, BMI, waist circumference, TG, FPG, homeostasis model insulin resistance index (HOMA-IR), islet β cell function index (HOMA-B) were higher than NGT-NHIns crowd, HDL C and insulin index were lower than NGT-NHIns population, the differences were statistically significant (P <0.05). Multivariate regression analysis showed that systolic blood pressure (OR = 1.023), overweight (OR = 2.851), and obesity (OR = 3.911) were all risk factors for hyperinsulinemia in normal glucose tolerance population (P <0.05) Age (OR = 0.955) and elevated HDL-C (OR = 0.056) decreased the risk of hyperinsulinemia in normal glucose tolerance. Conclusion It is necessary to pay more attention to the abnormal glucose regulation among residents aged 65-74 years old and 35-44 years old in a certain community in Pudong New Area, Shanghai. People over 65 years old are predominantly diabetic. HDL-C levels decreased, elevated systolic blood pressure, overweight and obesity are risk factors for hyperinsulinemia in normal glucose metabolism, targeted interventions should be taken as soon as possible.