江苏省社区人群中代谢综合征和吸烟对糖尿病发病的综合作用分析

目的 探讨代谢综合征和吸烟与糖尿病之间的关系及前两者之间的交互作用.方法 以江苏省多代谢异常和代谢综合征综合防治研究中随访时间满5年的人群为研究对象,对符合纳入标准且资料完整的3598名35～74岁基线非糖尿病患者,其中男1451名,女2147名,观察并分析其发展为糖尿病的危险与代谢综合征和吸烟之间的关系,并通过Logistic回归模型计算相乘交互作用指标和相加交互作用指标,用于评价代谢综合征和吸烟之间的交互作用.结果 在调整年龄、性别、家族史及吸烟、饮酒后,代谢综合征患者与非代谢综合征患者发生糖尿病的调整相对危险度为2.79(95%Cl:2.03～3.83),代谢综合征组分中高甘油三酯与高空腹血糖对糖尿病有显著影响,调整相对危险度分别为1.78(1.28～2.50)和3.72(2.70～5.13).代谢综合征组与非代谢综合征组中现吸烟者与不吸烟者相比发生糖尿病的调整相对危险度分别为3.03(1.69～5.45)和5.45(2.12～14.03).交互作用分析结果显示,相对超危险度比为5.57(0.37～11.50),归因比为0.44(0.16～0.72),交互作用指数为1.90(1.09～3.32).结论 代谢综合征和吸烟均为糖尿病的危险因素,当代谢综合征和吸烟同时存在时发生糖尿病的危险性明显增加,两者之间存在明显的相加交互作用.

Analysis of combined effect of metabolic syndrome and smoking on diabetes mellitus

Objective To explore the association between diabetes mellitus and metabolic syndrome, smoking, and the interaction between metabolic syndrome and smoking. Methods Subjects were recruited from the prospective cohort study on the prevention of multiple metabolic disorders and metabolic syndrome in Jiangsu province of China. A total of 3598 subjects ( 1451 men and 2147 women)were enrolled and followed for at least 5 years. Logistic regression models were used to calculate the indices of interaction between metabolic syndrome and smoking. Results After adjustment for age, sex, smoking,drinking, family history, subjects with metabolic syndrome had a 2.79 (95% CI 2.03 -3.83 ) adjusted relative risk(aRR) of developing diabetes mellitus when compared with those individuals without metabolic syndrome at baseline. The aRR of metabolic syndrome components were 1.78(95% CI 1.28 -2.50) for elevated triglyceride and 3.72(2.70 -5.13 ) for impaired fasting glucose respectively. Compared with nonsmokers, the aRR of smokers were 3.03 ( 1.69 - 5.45 ) and 5.45 (2.12 - 14.03 ) respectively in individuals with or without metabolic syndrome. The results of interaction analysis were RERI = 5.57 (0.37 - 11.50),AP=0.44(0.16-0.72) ,S1=1.90(1.09 -3.32). Conclusions Both metabolic syndrome and smoking are risk factors for diabetes mellitus. Combining effects of metabolic syndrome and smoking may contributed to addictive increase the risk for diabetes mellitus, the combined risk is more serious than the sum of the effects of metabolic syndrome and smoking.