摘要
目的探讨中国11个省2型糖尿病患者糖化血红蛋白(HbA1c)水平与糖尿病并发症发生的关联。方法选取2010年中国慢性病及其危险因素监测11个省60个监测点中4 832名2型糖尿病患者作为研究对象, 于2016-2017年进行随访调查, 实际随访3 516名, 排除数据异常或缺失等情况后, 共3 427名纳入分析。采用Cox比例风险回归模型评估HbA1c水平与糖尿病并发症(大血管病变、微血管病变和糖尿病足)发病风险的关联, 并按照年龄、性别、吸烟等基线特征进行亚组分析。结果研究对象共3 427名, 平均随访6.2年, 随访期间395名发生大血管病变, 226名发生微血管病变, 57名发生糖尿病足。调整相关混杂因素后, 以HbA1c<7.0%组为参照, HbA1c水平7.0%~、7.5%~、8.0%~8.4%组大血管病变发生风险未增加, ≥8.5%组大血管病变发生风险增加38%(HR=1.38, 95%CI:1.06~1.80);HbA1c水平7.5%~、8.0%~、≥8.5%组微血管病变发生风险分别增加131%(HR=2.31, 95%CI:1.46~3.65)、206%(HR=3.06, 95%CI:1.91~4.90)和208%(HR=3.08, 95%CI:2.20~4.30);HbA1c≥8.5%组糖尿病足发生风险增加253%(HR=3.53, 95%CI:1.89~6.59), 其他组糖尿病足发生风险未见增加。亚组分析发现, 不同糖尿病诊断情况(既往诊断和新诊断)对HbA1c水平与微血管病变发生风险存在效应修饰作用。结论 HbA1c≥7.5%会增加2型糖尿病患者微血管病变的发生风险, 且发生风险随HbA1c水平的升高而增加;HbA1c≥8.5%会增加大血管病变和糖尿病足的发生风险。应加强患者的健康教育, 提高血糖管理意识, 尽量将HbA1c控制在较低水平, 有效减少或延缓并发症的发生。
Objective To investigate the relationship between glycated hemoglobin(HbA1c)level and the occurrence of diabetes complications in patients with type 2 diabetes mellitus in 11 provinces in China.Methods A total of 4832 patients with type 2 diabetes mellitus from 60 surveillance sites in 11 provinces where national surveillance for chronic diseases and risk factors was conducted in 2010 were selected as the study participants,and a follow-up survey was conducted in 3516 persons from 2016 to 2017,finally 3427 patients were included in the analysis after excluding those data exception and incomplete data.Cox proportional risk regression model was used to evalaute the association between HbA1c level and the risk for diabetes complications(macroangiopathy,microangiopathy and diabetic foot),and subgroup analyses were conducted according to the baseline characteristics of the study participants,such as age,gender and smoking status.Results A total of 3427 study participants were included in final analysis of the follow up for an average of 6.2 years,in whom 395 suffered from macroangiopathy,226 suffered from microangiopathy,and 57 suffered from diabetic foot later during the follow-up period.After adjusting for relevant confounders,using the HbA1c<7.0%as a reference,there was no increased risk for macrovascular lesions in the those with HbA1c levels of 7.0%-,7.5%-,8.0%-8.4%,and the risk for macrovascular lesions increased by 38%in those with HbA1c≥8.5%(HR=1.38,95%Cl:1.06-1.80);the risk for microangiopathies increased by 131%(HR=2.31,95%Cl:1.46-3.65),206%(HR=3.06,95%CI:1.91-4.90)and 208%(HR=3.08,95%CI:2.20-4.30)in those with HbA1c levels of 7.5%-,8.0%-,≥8.5%,respectively;and the risk for diabetic foot increased by 253%(HR=3.53,95%CI:1.89-6.59)in those with HbA1c level≥8.5%.Subgroup analyses revealed an effect modifying effect of different diabetes diagnosis situations(previously diagnosed and newly diagnosed)on HbA1c level and the risk for microangiopathy.Conclusions HbA1c level≥7.5%would increase the risk for microangiopathy in patients with type 2 diabetes mellitus,the higher the level,the higher the risk,and HbA1c level≥8.5%would increase the risk for macrovascular lesions and diabetic foot.It is necessary to strengthen the health education in diabetic patients to improve their awareness of blood glucose management and the importance of HbA1c level control to effectively reduce or delay the diabetes complications.
作者
梅钰舒
毛凡
张润
由晓庆
李剑虹
Mei Yushu;Mao Fan;Zhang Run;You Xiaoqing;Li Jianhong(Division of Obesity and Metabolic Disease Control and Prevention,National Center for Chronic and Non-communicable Disease Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 100050,China)
出处
《中华流行病学杂志》
北大核心
2025年第7期1160-1167,共8页
Chinese Journal of Epidemiology
基金
四大慢病重大专项(2023ZD05086002023ZD0508603)。
