总胆固醇与2型糖尿病关联性的前瞻性队列研究

路媛; 刘焕乐; 马韫韬; 代晓宇; 王志恒; 刘言训

doi:10.16462/j.cnki.zhjbkz.2020.04.002

总胆固醇与2型糖尿病关联性的前瞻性队列研究

doi: 10.16462/j.cnki.zhjbkz.2020.04.002

路媛^{1, 2},
刘焕乐³,
马韫韬⁴,
代晓宇^{1, 2},
王志恒^{1, 2},
刘言训^{1, 2, ,}

1.
250012 济南, 山东大学齐鲁医学院公共卫生学院生物统计系
2.
250012 济南, 山东大学健康医疗大数据研究院
3.
257000 东营, 胜利油田中心医院保健科
4.
730030 兰州, 兰州大学第二临床医学院

详细信息

通讯作者:
刘言训, E-mail:liu-yx@sdu.edu.cn

中图分类号: R587.1
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- 被引次数: 0
出版历程
- 收稿日期: 2019-06-10
- 修回日期: 2019-09-17
- 刊出日期: 2020-04-10

Association between total cholesterol and type 2 diabetes:a prospective cohort study

LU Yuan^{1, 2},
LIU Huan-le³,
MA Yun-tao⁴,
DAI Xiao-yu^{1, 2},
WANG Zhi-heng^{1, 2},
LIU Yan-xun^{1, 2
, ,}

1.
Department of Biostatistics, School of Public Health, Cheeloo College of Medcine, Shandong University, Jinan 250012, China
2.
Healthcare Big Data Institute of Shandong University, Jinan 250012, China
3.
Department of Health Care, Shengli Oilfield Central Hospital, Dongying 257000, China
4.
The Second Hospital Lanzhou University, Lanzhou 730030, China

More Information

Corresponding author: LIU Yan-xun, E-mail:liu-yx@sdu.edu.cn

摘要

摘要: 目的探讨总胆固醇与2型糖尿病(type 2 diabetes, T2DM)发病的关系。方法筛选20~90岁入队列时未患糖尿病并且体检次数≥2次者, 应用t检验或χ²检验比较有无发生T2DM两组人群基线特征, 按总胆固醇四分位数由低到高划分4组(2.10~mmol/L组、4.16~mmol/L组、4.76~mmol/L组和5.42~13.29 mmol/L组), 应用广义估计方程(generalized estimating equation, GEE)分析总胆固醇对2型糖尿病发病的影响。结果此队列共纳入12 928人, 共随访45 626人年, 平均随访时间为3.53年。随访期间, 新发T2DM患者447人, 发病密度为9.80‰, 随着总胆固醇水平增高, T2DM高发病密度呈上升趋势, 在多因素GEE分析中, 调整年龄、高密度脂蛋白、是否患高血压、是否肥胖后, 以2.10~mmol/L组为参照, 4.16~mmol/L组、4.76~mmol/L组和5.42~13.29 mmol/L组的相对危险度(relative risk, RR)值分别为1.24(95% CI:0.83~1.86)、1.75(95% CI:1.19~2.56)、3.60(95% CI:2.51~5.17)。结论总胆固醇与T2DM存在相关性, 随着总胆固醇水平的上升, 发生T2DM的危险性逐渐增大。
- 2型糖尿病 /
- 总胆固醇 /
- 纵向数据 /
- 广义估计方程
Abstract: Objective To explore the association between total cholesterol and type 2 diabetes(T2 DM). Methods Non-diabetic people who aged 20 to 90 years at the baseline and who had physical examination more than 2 times were screened. Comparisons of the baseline characteristics were conducted with Student-t test or Pearson chi-square test. Generalized estimating equation(GEE) was used to analyze the effect of total cholesterol of quantiles groups(2.10-mmol/L, 4.16-mmol/L, 4.76-mmol/L and 5.42-13.29 mmol/L) to type 2 diabetes. Results The cohort with an average age of 3.53 years per person included 12 928 subjects and 45 626 person-years. During the follow-up, 447 cases of new-onset diabetes occurred and the incidence density was 9.80‰. The high incidence of type 2 diabetes increased with the increase of total cholesterol. After adjusting the factors including age, high density lipoprotein, hypertension and obesity, based on the 2.10-mmol/L group, the relative risk(RR) of the 4.16-mmol/L, 4.76-mmol/L and 5.42-13.29 mmol/L group were 1.24(95% CI:0.83-1.86), 1.75(95% CI:1.19-2.56)and 3.60(95% CI:2.51-5.17), respectively. Conclusions Total cholesterol is associated with type 2 diabetes, and as the total cholesterol increases, the risk of developing type 2 diabetes increases.
- Type 2 diabetes /
- Total cholesterol /
- Longitudinal data /
- Generalized estimating equation

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表 1 各总胆固醇组段的T2DM发病人数及密度

Table 1. Type 2 diabetes incidence number and density in each total cholesterol group

总胆固醇(mmol/L)	随访人年	发病人数(人)	发病密度(‰)
2.10~	10 675.33	73	6.84
4.16~	11 246.09	98	8.71
4.76~	11 503.74	125	10.87
5.42~13.29	12 200.48	151	12.38

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表 2 T2DM发病者和未发病者进入队列时的信息

Table 2. Baseline information for diabetic and non- diabetic population

变量	发病者(n=447)	未发病者(n=12 481)	t/χ²值	P值
总胆固醇(mmol/L)	5.13±1.02	4.83±0.95	-6.18	< 0.001
甘油三酯(mmol/L)	1.77±1.36	1.37±1.04	-6.21	< 0.001
高密度脂蛋白(mmol/L)	1.24±0.32	1.31±0.32	4.33	< 0.001
低密度脂蛋白(mmol/L)	2.96±0.79	2.79±0.75	-4.67	< 0.001
体质指数(kg/m²)	25.33±3.80	24.08±3.44	-6.38	< 0.001
收缩压(mmHg)	131.40±20.66	124.10±17.12	-6.94	< 0.001
舒张压(mmHg)	81.69±14.02	77.66±12.46	-5.68	< 0.001
年龄(岁)	42.81±11.81	39.83±10.64	-5.26	< 0.001
男性n(%)	310(69.35)	7 534(60.36)	14.61	< 0.001

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表 3 T2DM的单因素GEE分析结果

Table 3. Simple GEE analysis of type 2 diabetes

变量	β值	S_x	Z值	RR(95% CI)值	P值
总胆固醇(mmol/L)
2.10~	Ref	Ref	Ref	Ref	Ref
4.16~	0.31	0.20	1.55	1.37(0.92~2.03)	0.121
4.76~	0.68	0.19	3.58	1.98(1.36~2.87)	< 0.001
5.42~13.29	1.46	0.18	8.27	4.29(3.04~6.05)	< 0.001
甘油三酯(mmol/L)	0.26	0.02	12.53	1.29(1.24~1.34)	< 0.001
高密度脂蛋白(mmol/L)	-0.99	0.19	-5.14	0.37(0.25~0.54)	< 0.001
低密度脂蛋白(mmol/L)	0.45	0.06	7.13	1.57(1.39~1.78)	< 0.001
年龄(岁)	0.02	0.00	5.29	1.02(1.01~1.03)	< 0.001
随访时间(年)	0.40	0.03	14.41	1.49(1.41~1.57)	< 0.001
高血压	1.23	0.10	11.79	3.42(2.79~4.20)	< 0.001
肥胖	1.11	0.11	10.19	3.04(2.46~3.77)	< 0.001
男性	0.44	0.12	3.83	1.55(1.23~1.94)	< 0.001

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表 4 T2DM发病的多因素GEE分析结果

Table 4. Multiple GEE analysis of type 2 diabetes

变量	β值	S_x	Z值	RR(95% CI)值	P值
总胆固醇(mmol/L)
2.10~	Ref	Ref	Ref	Ref	Ref
4.16~	0.22	0.21	1.05	1.24(0.83~1.86)	0.293
4.76~	0.56	0.20	2.84	1.75(1.19~2.56)	0.005
5.42~13.29	1.28	0.18	6.96	3.60(2.51~5.17)	< 0.001
高密度脂蛋白(mmol/L)	-1.11	0.22	-5.05	0.33(0.22~0.51)	< 0.001
年龄(岁)	0.01	0.01	1.74	1.01(1.00~1.02)	0.082
随访时间(年)	0.42	0.03	14.58	1.52(1.44~1.61)	< 0.001
高血压	0.91	0.12	7.72	2.48(1.97~3.13)	< 0.001
肥胖	0.58	0.12	4.81	1.79(1.41~2.27)	< 0.001

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