甘油三酯可预测中国2型糖尿病患者的心血管死亡率及其与血糖和肥胖的关系。

Triglyceride predicts cardiovascular mortality and its relationship with glycaemia and obesity in Chinese type 2 diabetic patients.

作者信息

Chan W B, Tong P C Y, Chow C C, So W Y, Ng M C Y, Ma R C W, Osaki R, Cockram C S, Chan J C N

机构信息

Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong.

出版信息

Diabetes Metab Res Rev. 2005 Mar-Apr;21(2):183-8. doi: 10.1002/dmrr.497.

DOI:10.1002/dmrr.497

PMID:15386811

Abstract

BACKGROUND

To examine the lipid profile in Chinese type 2 diabetic patients and their relationship with anthropometric parameters, glycaemic control and cardiovascular mortality.

METHODS

A consecutive cohort of 562 newly referred patients with type 2 diabetes to a hospital-based diabetes centre were examined in 1996. Subjects treated with lipid lowering drugs at the time of referral were excluded. A total of 517 subjects were followed up over a mean (+/-SD) period of 4.6 +/- 0.9 years. Glycated haemoglobin (HbA1c), fasting insulin and lipid profile and anthropometric parameters were documented at the time of recruitment. Cardiovascular mortality, mainly due to coronary heart disease and stroke, was ascertained using death registry and review of hospital case notes in 2001.

RESULT

Of the 517 subjects (mean age of 54.0 +/- 14.0 years), 42.6% were men. In this cohort, 63.3% of subjects were either overweight (BMI > or = 23 kg/m2) or obese (BMI > or = 25 kg/m2) using Asian criteria. The mean (+/-SD) total cholesterol (TC), LDL-Cholesterol (LDL-C), HDL-Cholesterol (HDL-C) and geometric mean (x// antilog SD) of triglycerides (TG) were 5.6 +/- 1.3 mmol/L, 3.6 +/- 1.1 mmol/L, 1.3 +/- 0.3 mmol/L and 1.46x//1.90 mmol/L respectively. TC and LDL-C correlated positively with HbA1c, HDL-C negatively with BMI and WC (waist circumference), while TG positively with HbA1c, BMI, WC and HOMA (insulin resistance estimated using the homeostasis model assessment). During the 4.6 years follow-up period, there were 61 deaths giving a total mortality rate of 11.4%, of which 15 (25%) were because of cardiovascular events. Apart from age and disease duration, logarithm of TG was significantly associated with increased risk of cardiovascular mortality (p = 0.049, relative risk = 2.97, 95% CI 1.00-8.77).

CONCLUSIONS

Chinese type 2 diabetic patients had a lower prevalence of obesity, lower TG and higher HDL-C than Caucasian patients. Despite the low incidence of cardiovascular death, TG, which was closely associated with obesity indexes, was significantly associated with cardiovascular death in these patients.

摘要

背景

研究中国2型糖尿病患者的血脂谱及其与人体测量学参数、血糖控制和心血管死亡率的关系。

方法

1996年，对一家医院糖尿病中心连续收治的562例新确诊的2型糖尿病患者进行了研究。排除转诊时正在接受降脂药物治疗的患者。共517例受试者接受了平均（±标准差）4.6±0.9年的随访。招募时记录糖化血红蛋白（HbA1c）、空腹胰岛素、血脂谱和人体测量学参数。2001年，通过死亡登记和医院病历审查确定主要由冠心病和中风导致的心血管死亡率。

结果

517例受试者（平均年龄54.0±14.0岁）中，42.6%为男性。根据亚洲标准，该队列中63.3%的受试者超重（BMI≥23kg/m2）或肥胖（BMI≥25kg/m2）。总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）的平均（±标准差）水平以及甘油三酯（TG）的几何平均（x//反对数标准差）分别为5.6±1.3mmol/L、3.6±1.1mmol/L、1.3±0.3mmol/L和1.46x//1.90mmol/L。TC和LDL-C与HbA1c呈正相关，HDL-C与BMI和腰围（WC）呈负相关，而TG与HbA1c、BMI、WC和HOMA（使用稳态模型评估估算的胰岛素抵抗）呈正相关。在4.6年的随访期内，有61例死亡，总死亡率为11.4%，其中15例（25%）死于心血管事件。除年龄和病程外，TG的对数与心血管死亡风险增加显著相关（p = 0.049，相对风险 = 2.97，95%可信区间1.00 - 8.77）。