山西中部地区成人血脂异常伴糖代谢异常的现状及特点

目的揭示山西中部地区20岁以上血脂异常人群中糖代谢异常者的患病情况及其特点。方法资料完整的3348例纳入本次分析,据1999年世界卫生组织糖尿病诊断标准及2007年中国成人血脂异常防治指南分为无代谢异常组(1488例)、单纯血脂边缘异常及异常组(1599例)、血脂边缘异常及异常伴糖调节异常(IGR)组(150例)及血脂边缘异常及异常伴糖尿病(DM)组(111例),比较各组临床特征。结果①血脂边缘异常及异常人群的IGR和糖尿病(DM)的患病率均高于血脂正常人群,血糖表现类型以单纯餐后2h血糖(2hPG)升高者居多,在IGR和DM者中占70.67%和53.54%。②在不同血脂异常类型中,糖代谢异常患病率最高的是高胆固醇(TC)/低密度脂蛋白胆固醇(LDL-C)合并高甘油三酯(TG)及低高密度脂蛋白胆固醇(HDL-C)亚组,为26.32%,其次为高TC/LDL-C合并高TG亚组,为25.53%。③单纯血脂边缘异常及异常组的体质量指数(BMI)、腰围(W)、腰臀比(WHR)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、2hPG、血尿酸(UA)、稳态模式评估法的胰岛素抵抗指数(HOMA-IR)均显著高于无代谢异常组(P值均<0.05)。除血脂和血糖外,血脂边缘异常及异常伴IGR组、血脂边缘异常及异常伴DM组的BMI、W、WHR、SBP、UA及HOMA-IR均显著高于无代谢异常组及单纯血脂边缘异常及异常组(P值分别<0.05、0.01)。血脂边缘异常及异常伴糖尿病组的HOMA-IR显著高于单纯血脂边缘异常及异常组伴IGR组(P值均<0.05)。结论①血脂边缘异常及异常人群伴发糖代谢异常的患病率增加,其中高TC/LDL-C合并高TG及低HDL-C者高血糖的患病率最高;②血脂边缘异常及异常伴发高血糖人群中,无论伴发IGR或DM,其血糖表现类型以单纯餐后2hPG升高者居多;③与无代谢异常组相比,血脂异常者无论是否伴发糖代谢异常,其总体脂、局部体脂、血压、血尿酸及胰岛素抵抗程度均显著增高,发生高血糖后各代谢紊乱及胰岛素抵抗程度更为显著。

Current conditions and features of adults with dyslipidemia and impaired glucose regulation in middle regions of Shanxi province

Objective To investigate the prevalence and features of impaired glucose regulation in individuals with dyslipidemia who aged 〉20 years in the middle regions of Shanxi province. Methods A total of 3348 individu- als with intact profiles were surveyed and allocated into normal group （n=1448）, simple borderline and dyslipidemia group （n=1599）, borderline dyslipidemia and dyslipidemia with impaired glucose regulation （IGR） group （n=150）, as well as borderline dyslipidemia and dyslipidemia with diabetes mellitus （DM） group （n=111）, based on the World Health Organization 1999 Diagnostic Criteria for Diabetes Mellitus and 2007 Chinese Guidelines for Prevention and Treatment of Adult Dyslipidemia, for comparison on between-group difference in clinical characteristics. Results The prevalence of IGR and DM was significantly higher in subjects with borderline dyslipidemia and dyslipidemia than those with normolipidemia （both P〈0.05）. Postprandial hyperglycemia at hour 2 was the dominant type of hyper- glycemia, with the prevalence of 70.67% for IGR and 53.54% for DM. Of all types of dyslipidemia, the highest preva- lence of IGR （26.32%） was reported in those with combined hypercholesterolemia （h-TC）/high low-density lipoprotein cholesterol （h-LDL-C） with hypertriglyceridemia （h-TG） and low high-density lipoprotein cholesterol （1-HDL-C）, fol- lowed by those with high TC/LDL-C and TG. （25.33%）. Patients with simple borderline dyslipidemia and dyslipidemia were featured by markedly higher body mass index （BMI）, waist circumference （W）, blood pressure （BP）, fasting plas- ma glucose （FPG）, postprandial glucose at hour 2 （2 hPG）, fasting insulin （FIN）, uric acid （UA） and homeostatic mode for assessment of insulin resistance （HOMA-IR） than those in normal controls （all P〈0.05）. Significantly higher BMI, W, systolic BP, FIN, UA and HOMA-IR were noted in subjects with borderline dyslipidemia and dyslipidemia with I-GR and those with borderline dyslipidemia and dyslipidemia with DM, but not in patients with simple borderline dys- lipidemia （all P〈0.05） and dyslipidemia （all P〈0.01）. Patients with borderline dyslipidemia and dyslipidemia with DM yielded a considerable increase in HOMA-IR as compared with those who had borderline dyslipidemia and dyslipi- demia with IGR （all P〈0.05）. Conclusion There has been an increasing prevalence of IGR in subjects with border- line dyslipidemia and dyslipidemia, particularly in those witb high TC/LDL-C and TG and low HDL-C. The Patients with borderline dyslipidemia and dyslipidemia superimposed on hyperglycemia are mostly featured by increased 2 hPG, regardless of complication with IGR or DM. When compared with normal controls, patients with or without IGR yield considerably higher total and regional body fat, blood pressure, serum uric acid and the degree of insulin resis- tance as well as significant metabolic disturbances and insulin resistance following onset of hyperglycemia.