大动脉僵硬度与高血压人群新发糖尿病的关系

目的研究大动脉僵硬度与高血压人群新发糖尿病的关系。方法本研究对象均来自开滦研究人群,用肱踝动脉脉搏波传导速度(baPWV)评价动脉僵硬度。以参加2010-2011、2012-2013、2014-2015年度开滦集团体检的高血压非糖尿病员工为观察对象,以baPWV检测时间为观察起点,以新发糖尿病为终点事件,以2016-2017年度体检时间为观察终点,最终有8 061例纳入研究队列。按baPWV四分位分组,采用Cox比例风险模型分析baPWV对终点事件的影响,按体质量指数(BMI)分层做敏感性分析。结果观察对象平均随访(4.22±2.10)年,随访期间新发糖尿病874例(10.8%),平均发病密度25.71/千人年。按baPWV四分位分组,第1~4四分位组新发糖尿病的发病密度分别为14.60/千人年、23.77/千人年、27.15/千人年、37.70/千人年(P<0.001)。以是否新发糖尿病为因变量进行多因素Cox比例风险模型分析,以baPWV第1四分位组作对照,校正年龄、性别、平均动脉压、基线空腹血糖、高敏C反应蛋白等混杂因素后,第2、3、4四分位组发生糖尿病的HR及95%CI分别为1.57(1.24~1.98)、1.74(1.37~2.20)、2.38(1.87~3.03)。baPWV每增加1个标准差,发生糖尿病的HR及95%CI为1.32(1.24~1.42)。结论大动脉僵硬度与高血压人群新发糖尿病的发病风险增高相关。

Relationship between arterial stiffness and new-onset diabetes mellitus in hypertensive population

Objective To investigate the relationship between arterial stiffness and new-onset diabetes mellitus in hypertensive population. Methods The subjects of this study were from the Kailuan Study population. Arterial stiffness was evaluated by brachial-ankle pulse wave velocity(baPWV). A total of 8 061 hypertensive and non-diabetic employees who participated in the 2010-2011, 2012-2013 and 2014-2015 year physical examination of the Kailuan Study were eligible for this study. Baseline was set at the first baPWV measurement, while follow-up ended at the first incident of diabetes mellitus or until the last examination(2016-2017 year). According to baPWV quartile,the effect of baPWV on new-onset diabetes mellitus was analyzed by Cox proportional hazard model, a sensitivity test was analyzed by body mass index(BMI) stratification. Results The mean follow-up time was(4.22±2.10) years. During the follow-up period, 874(10.8%) participants developed diabetes, with an average incidence rate of 25.71 per 1 000 person-years. The incidence rate(per 1 000 person-years) of new-onset diabetes in the first to fourth quartile of baPWV were 14.60, 23.77, 27.15 and 37.70, respectively(P<0.001). Compared with the first quartile of baPWV, after adjustment for age, gender, mean arterial pressure, baseline fasting glucose, hypersensitive C-reactive protein and other confounding factors, the HR and 95% CI for new-onset diabetes of the second, third and fourth quartile were 1.57(1.24-1.98), 1.74(1.37-2.20) and 2.38(1.87-3.03), respectively. For each standard deviation increase of baPWV, the HR and 95% CI was 1.32(1.24-1.42). Conclusion Arterial stiffness is associated with new-onset diabetes mellitus in hypertensive population.