青藏高原高海拔地区居民中与缺氧相关的葡萄糖不耐受。
Glucose intolerance associated with hypoxia in people living at high altitudes in the Tibetan highland.
作者信息
Okumiya Kiyohito, Sakamoto Ryota, Ishimoto Yasuko, Kimura Yumi, Fukutomi Eriko, Ishikawa Motonao, Suwa Kuniaki, Imai Hissei, Chen Wenling, Kato Emiko, Nakatsuka Masahiro, Kasahara Yoriko, Fujisawa Michiko, Wada Taizo, Wang Hongxin, Dai Qingxiang, Xu Huining, Qiao Haisheng, Ge Ri-Li, Norboo Tsering, Tsering Norboo, Kosaka Yasuyuki, Nose Mitsuhiro, Yamaguchi Takayoshi, Tsukihara Toshihiro, Ando Kazuo, Inamura Tetsuya, Takeda Shinya, Ishine Masayuki, Otsuka Kuniaki, Matsubayashi Kozo
机构信息
Research Department, Research Institute for Humanity and Nature, Kyoto, Japan Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan.
Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan Hakubi Center for Advanced Research, Kyoto University, Kyoto, Japan.
出版信息
BMJ Open. 2016 Feb 23;6(2):e009728. doi: 10.1136/bmjopen-2015-009728.
OBJECTIVES
To clarify the association between glucose intolerance and high altitudes (2900-4800 m) in a hypoxic environment in Tibetan highlanders and to verify the hypothesis that high altitude dwelling increases vulnerability to diabetes mellitus (DM) accelerated by lifestyle change or ageing.
DESIGN
Cross-sectional epidemiological study on Tibetan highlanders.
PARTICIPANTS
We enrolled 1258 participants aged 40-87 years. The rural population comprised farmers in Domkhar (altitude 2900-3800 m) and nomads in Haiyan (3000-3100 m), Ryuho (4400 m) and Changthang (4300-4800 m). Urban area participants were from Leh (3300 m) and Jiegu (3700 m).
MAIN OUTCOME MEASURE
Participants were classified into six glucose tolerance-based groups: DM, intermediate hyperglycaemia (IHG), normoglycaemia (NG), fasting DM, fasting IHG and fasting NG. Prevalence of glucose intolerance was compared in farmers, nomads and urban dwellers. Effects of dwelling at high altitude or hypoxia on glucose intolerance were analysed with the confounding factors of age, sex, obesity, lipids, haemoglobin, hypertension and lifestyle, using multiple logistic regression.
RESULTS
The prevalence of DM (fasting DM)/IHG (fasting IHG) was 8.9% (6.5%)/25.1% (12.7%), respectively, in all participants. This prevalence was higher in urban dwellers (9.5% (7.1%)/28.5% (11.7%)) and in farmers (8.5% (6.1%)/28.5% (18.3%)) compared with nomads (8.2% (5.7%)/15.7% (9.7%)) (p=0.0140/0.0001). Dwelling at high altitude was significantly associated with fasting IHG+fasting DM/fasting DM (ORs for >4500 and 3500-4499 m were 3.59/4.36 and 2.07/1.76 vs <3500 m, respectively). After adjusting for lifestyle change, hypoxaemia and polycythaemia were closely associated with glucose intolerance.
CONCLUSIONS
Socioeconomic factors, hypoxaemia and the effects of altitudes >3500 m play a major role in the high prevalence of glucose intolerance in highlanders. Tibetan highlanders may be vulnerable to glucose intolerance, with polycythaemia as a sign of poor hypoxic adaptation, accelerated by lifestyle change and ageing.
目的
阐明藏族高原居民在缺氧环境中（海拔2900 - 4800米）葡萄糖耐量异常与高海拔之间的关联，并验证以下假设：高海拔居住会增加因生活方式改变或衰老而加速患糖尿病（DM）的易感性。
设计
对藏族高原居民进行的横断面流行病学研究。
参与者
我们招募了1258名年龄在40 - 87岁之间的参与者。农村人口包括多玛尔（海拔2900 - 3800米）的农民以及海晏（3000 - 3100米）、玉霍（4400米）和羌塘（4300 - 4800米）的牧民。城市地区的参与者来自列城（3300米）和结古（3700米）。
主要观察指标
参与者被分为基于葡萄糖耐量的六个组：糖尿病（DM）、中间高血糖（IHG）、血糖正常（NG）、空腹糖尿病、空腹中间高血糖和空腹血糖正常。比较农民、牧民和城市居民中葡萄糖耐量异常的患病率。使用多因素逻辑回归分析高海拔居住或缺氧对葡萄糖耐量异常的影响，并考虑年龄、性别、肥胖、血脂、血红蛋白、高血压和生活方式等混杂因素。
结果
在所有参与者中，糖尿病（空腹糖尿病）/中间高血糖（空腹中间高血糖）的患病率分别为8.9%（6.5%）/25.1%（12.7%）。与牧民（8.2%（5.7%）/15.7%（9.7%））相比，城市居民（9.5%（7.1%）/28.5%（11.7%））和农民（8.5%（6.1%）/28.5%（18.3%））的该患病率更高（p = 0.0140/0.0001）。高海拔居住与空腹中间高血糖 + 空腹糖尿病/空腹糖尿病显著相关（海拔>4500米和3500 - 4499米的比值比分别为3.59/4.36和2.07/1.76，而海拔<3500米）。在调整生活方式改变后，低氧血症和红细胞增多症与葡萄糖耐量异常密切相关。
结论
社会经济因素、低氧血症以及海拔高于3500米的影响在高原居民葡萄糖耐量异常的高患病率中起主要作用。藏族高原居民可能易患葡萄糖耐量异常，红细胞增多症是低氧适应不良的标志，生活方式改变和衰老会加速这种情况。
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