BMJ：糖尿病前期与心血管疾病风险和全因死亡率之间的关系

2016-11-24 haofan MedSci原创

糖尿病前期，被定义为糖耐量受损、空腹血糖受损或升高的HbA1c，与增加的心血管疾病风险相关。空腹血糖浓度低于5.6 mmol/L或HbA1c低于39mmol/mol的个人健康风险也可能增加。

最近，顶级医学杂志BMJ上发表了一篇来自中国南方医科大学附属医院顺德市第一人民医院心内科医生的荟萃分析文章，旨在评估糖尿病前期的不同定义与心血管疾病风险和全因死亡率之间的关系。

研究人员对前瞻性队列研究进行荟萃分析，对PubMed、EMBASE、Google Scholar等源电子数据库行进检索。来源于一般人群的前瞻性队列研究被纳入进行荟萃分析，这些纳入的研究都报告了糖尿病前期和复合心血管疾病、冠心病、卒中以及全因死亡率之间调整后的相对风险和95%置信区间。

在该荟萃分析中，两位作者根据预定的选择标准进行独立审查和选择符合条件的研究。糖尿病前期被定义为空腹血糖受损根据美国糖尿病协会(ADA)的标准（IFG-ADA；空腹血糖5.6-6.9 mmol/L）、WHO专家组的标准（IFG-ADA；空腹血糖6.1-6.9 mmol/L）；糖耐量受损（在口服葡萄糖耐量试验中2小时血浆葡萄糖浓度7.8-11.0 mmol/L）；或升高的糖化血红蛋白（HbA1c）根据ADA标准为39-47mmol/mol（5.7-6.4%）或根据NICE指南为42-47mmol/mol（6.0-6.4%）。研究人员计算了全因死亡率和心血管事件的相对风险并报告了95%的可信区间。

在53个前瞻性队列研究中共有1,611,339名研究对象被纳入进行分析。中位随访时间为9.5年。相比于血糖正常者，糖尿病前期（根据IFG-ADA或IFG-WHO标准确定的空腹血糖受损或糖耐量受损）与复合心血管疾病（IFG-ADA、IFG-WHO及葡萄糖耐量受损的相对风险分别为1.13、1.26和1.30）、冠心病（IFG-ADA、IFG-WHO及葡萄糖耐量受损的相对风险分别为1.10、1.18和1.20）、卒中（IFG-ADA、IFG-WHO及葡萄糖耐量受损的相对风险分别为1.06、1.17和1.20）和全因死亡率（IFG-ADA、IFG-WHO及葡萄糖耐量受损的相对风险分别为1.13、1.13和1.32）风险增加相关。升高的HbA1c位于39-47 mmol/mol或位于42-47 mmol/mol之间均与心血管疾病（相对风险分别为1.21和1.25）和冠心病（相对风险分别为1.15和1.28）风险增加有关，但与增加的卒中和全因死亡率风险无关。

由此可见，糖尿病前期，被定义为糖耐量受损、空腹血糖受损或升高的HbA1c，与增加的心血管疾病风险相关。空腹血糖浓度低于5.6 mmol/L或HbA1c低于39mmol/mol的个人健康风险也可能增加。

原始出处：

Yuli Huang, et al. Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis. BMJ.23 November 2016.

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2017-10-09 gaoxiaoe

#BMJ#

72 0
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2016-12-04 1e0ece0dm09(暂无匿称)

谢谢分享谢谢

83 0
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2016-11-27 虈亣靌

讲的好，学习了

118 0
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2016-11-26 lvliquan

#全因死亡率#

0 0
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2016-11-26 花花1368

#疾病风险#

67 0
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2016-11-26 andy2090

#血管疾病#

65 0
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2016-11-26 1771ae4158m

不错，学习下

91 0
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encryptionId=874529332ba, topicName=全因死亡率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=796422, createdName=lvliquan, createdTime=Sat Nov 26 02:05:00 CST 2016, time=2016-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1473033, encodeId=265f14e30331a, content=<a href='/topic/show?id=862be0746bc' target=_blank style='color:#2F92EE;'>#疾病风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70746, encryptionId=862be0746bc, topicName=疾病风险)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3c757221906, createdName=花花1368, createdTime=Sat Nov 26 02:05:00 CST 2016, time=2016-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1498094, encodeId=463d149809414, content=<a href='/topic/show?id=bb6f89e145a' target=_blank style='color:#2F92EE;'>#血管疾病#</a>, beContent=null, objectType=article, 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level=null, likeNumber=144, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Fri Nov 25 12:03:23 CST 2016, time=2016-11-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=158037, encodeId=fa8515803e40, content=不管怎样研究，表达的就是预防为主, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2dcf1613323, createdName=xiehhtt, createdTime=Fri Nov 25 07:49:34 CST 2016, time=2016-11-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=158026, encodeId=219d15802611, content=不同视角，不一样的结论。临床指导，值得深思, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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2016-11-25 忠诚向上

继续学习

144 0
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level=null, likeNumber=144, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Fri Nov 25 12:03:23 CST 2016, time=2016-11-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=158037, encodeId=fa8515803e40, content=不管怎样研究，表达的就是预防为主, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2dcf1613323, createdName=xiehhtt, createdTime=Fri Nov 25 07:49:34 CST 2016, time=2016-11-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=158026, encodeId=219d15802611, content=不同视角，不一样的结论。临床指导，值得深思, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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2016-11-25 xiehhtt

不管怎样研究，表达的就是预防为主

100 0
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level=null, likeNumber=144, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Fri Nov 25 12:03:23 CST 2016, time=2016-11-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=158037, encodeId=fa8515803e40, content=不管怎样研究，表达的就是预防为主, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2dcf1613323, createdName=xiehhtt, createdTime=Fri Nov 25 07:49:34 CST 2016, time=2016-11-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=158026, encodeId=219d15802611, content=不同视角，不一样的结论。临床指导，值得深思, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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2016-11-25 ren1mw

不同视角，不一样的结论。临床指导，值得深思

62 0

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