胰岛素抵抗代谢评分与中老年人糖调节受损及糖尿病的相关性研究

目的 分析胰岛素抵抗代谢评分(metabolic score for insulin resistance, METS-IR)与糖调节受损(impairedglucose regulation, IGR)及糖尿病(diabetes mellitus, DM)患病风险的相关性。方法 研究筛选了2019 年1~3 月在陕西省人民医院健康管理中心参加体检的40 岁以上的1 363 例受试者，其中男性609 例，女性754 例，298 例诊断为IGR，占比21.9%，131 例诊断为DM，占比9.6%。对所有受试者进行病史采集、体格检查及实验室检查。应用Logistic 回归分析METS-IR 水平与IGR 及DM 患病风险的相关性。结果 随着METS-IR 水平的升高，研究对象腰围、收缩压、舒张压、体质指数、三酰甘油、低密度脂蛋白胆固醇、糖化血红蛋白和空腹血糖逐渐升高(F/χ2=10.75~878.79，均P< 0.05)，高密度脂蛋白胆固醇逐渐降低(F=272.39，P<0.001)，两组比较差异有统计学意义。从METS-IR 最低四分位至最高四分位，IGR 的患病率分别为17.3%,18.2%,23.8% 及28.2%(χ2=29.77, P<0.001), DM 的患病率分别为3.5%, 4.7% ,10.9% 和19.4% (χ2 =61.85, P<0.001)。在多因素logistic 回归分析模型中，在校正相关混杂因素后，与处于METS-IR 最低四分位的受试者相比，处于METS-IR最高四分位的受试者IGR和DM的OR(95%CI)分别为2.45(1.69~3.57)及7.93(3.12~20.12)，其患病风险明显增加(均P ＜ 0.001)。分层分析显示，不论是男性还是女性，正常体重还是超重及肥胖受试者以及不同年龄层的受试者，随着METS-IR 的升高，IGR 及DM的患病风险均升高。在男性和女性中，IGR 患病风险的OR(95%CI)分别为1.03 (1.00~1.07) 和1.07 (1.02~1.12)，DM 患病风险的OR(95%CI)分别为1.13 (1.08~1.18) 和1.14 (1.09~1.18)。在＜ 60 岁和≥ 60 岁组，IGR 患病风险的OR(95%CI)分别为1.09 (1.06~1.11) 和1.06 (1.02~1.09)，DM 患病风险的OR(95%CI)分别为1.16 (1.09~1.23) 和1.11 (1.06~1.16)。在BMI ＜ 24kg/m2 和≥ 24kg/m2 组IGR 患病风险的OR(95%CI)分别为1.06 (1.03~1.09) 和1.06 (1.03~1.10)。DM 患病风险的OR(95%CI)分别为1.17(1.06~1.29) 和1.15 (1.09~1.21)。结论 在中老年人群中，METS-IR 与IGR 及DM 患病风险相关，随着METS-IR 水平升高，IGR 及DM 的患病风险增加。

Study on the Correlation between Insulin Resistance Metabolic Score and Impaired Glucose Regulation and Diabetes in Middle-aged and Eldeerly People

Objective To investigate the correlation between metabolic score for insulin resistance (METS-IR) and the risk of impaired glucose regulation (IGR) and newly diagnosed diabetes mellitus (DM). Methods In this study, 1 363 subjects aged 40 and above who attended physical examination in the Health Management Center of Shaanxi Provincial People’s Hospital from January to March 2019 were screened. Among them, 609 were males and 754 were females. 298 were diagnosed with IGR, accounting for 21.9%, and 131 were newly diagnosed DM, accounting for 9.6%. History collection, physical examination and laboratory examination were performed for all subjects. Logistic regression analysis was used to analyze the correlation between METS-IR levels and the risk of IGR and DM. Results With the increase of METS-IR level, the main metabolic indicators of the subjects gradually deteriorated, and the waist circumference, systolic blood pressure, diastolic blood pressure, body mass index, triglycerol, LDL cholesterol, glycosylated hemoglobin, fasting blood glucose gradually increased (F/χ2 =10.75~ 878.79, all P < 0.05), and HDL cholesterol gradually decreased(F=272.39，P<0.001), the differences between the groups were statistically significant. From the first quartile to the fourth quartile of METS-IR, the prevalence of IGR were 17.3%,18.2%,23.8% and 28.2%, respectively (χ2==29.77, P<0.001), the prevalence of DM were 3.5%, 4.7%, 10.9% and 19.4%, respectively (χ2==61.85, P<0.001). In the multivariate logistic regression analysis model, after adjusting for correlated confounding factors, the risk of IGR2.45(1.69~3.57)] and DM7.93(3.12~20.12)] in the highest quartile of METS-IR was significantly increased compared with subjects at the lowest quartile of METS-IR (all P ＜ 0.001). Stratified analysis showed that METS-IR was positively associated with the risk of IGR and DM in both male and female subjects, normal-weight and overweight and obese subjects, and subjects of different ages. In males and females, the OR (95%CI) of IGR risk were 1.03 (1.00~1.07) and 1.07 (1.02~1.12), and the OR (95%CI) of DM risk were 1.13 (1.08~1.18) and 1.14 (1.09~1.18), respectively. In subjects aged ＜ 60 years and ≥ 60 years, the OR (95%CI) of IGR risk were 1.09 (1.06~1.11) and 1.06 (1.02~1.09), respectively. The OR (95%CI) of DM were 1.16 (1.09~1.23) and 1.11 (1.06~1.16), respectively. In subjects with BMI ＜ 24kg/m2 and ≥ 24kg/m2, the OR (95%CI) of IGR risk were 1.06 (1.03~1.09) and 1.06 (1.03~1.10), respectively. The OR (95%CI) of DM were 1.17 (1.06~1.29) and 1.15 (1.09~1.21). Conclusion In the middle-aged and elderly population, METS-IR was associated with the risk of IGR and DM, and elevated METS-IR levels increased the risk of IGR and DM.