【作者】 安雅莉；

【导师】 李光伟；

【作者基本信息】 中国协和医科大学 ， 内科内分泌， 2009， 博士

【副题名】大庆20年随访研究

【摘要】 目的对大庆糖尿病预防研究的参加者进行20年后的随访,比较饮食干预及运动干预对糖尿病预防的长期影响,确定对糖尿病预防最有效的生活方式;分析推迟糖尿病发病时间对全因死亡、心脑血管事件死亡、心脑血管事件和脑中风发生的影响,为对IGT人群进行早期干预推迟糖尿病发病以减少大血管病变提供依据。方法对参加大庆糖尿病预防研究的576名IGT患者进行随访,调查其生存状态、死亡原因。对生存者进行体格检查(测身高、体重、血压),心电图、OGTT及各项生化检查,并做问卷调查,判定糖尿病、全因死亡、心脑血管事件死亡、心脑血管事件和脑中风等终点事件。比较饮食、运动干预对糖尿病发病的影响,并应用多因素分析探讨推迟糖尿病发病对心脑血管事件及死亡的影响。结果调整BMI及小组随机因素后,强化干预期间,饮食组、运动组与对照组比较,糖尿病发病风险下降了46%(HR 0.54;95%CI 0.34-0.88)和51%(HR 0.49;95%CI 0.27-0.87);20年随访期间,该风险分别下降了41%(0.59;0.39-0.89,P=0.0152)和47%(0.53:0.33-0.85,P=0.0117);但饮食与运动组间比较无显著差异。将总人群以BMI25 kg/m~2分为两组,在BMI＜25 kg/m~2组,运动组的HR在干预期间和随访期间分别为0.34(95%CI 0.16-0.73,P=0.0076)和0.38(95%CI0.20-0.71,P=0.0041),而饮食与对照组比较及饮食与运动组间比较均无统计学差异。在BMI≥25 kg/m~2组,饮食、运动干预对糖尿病预防在干预期及随访期均有效果,且二者比较无明显差异。调整心血管疾病风险因素后,推迟糖尿病发病5年可使全因死亡下降38%,心脑血管疾病死亡下降26%,心脑血管疾病下降18%,脑中风下降18%。结论6年的饮食干预和运动干预可预防或推迟糖尿病的发生,其作用可持续至干预后的14年,二种生活方式干预效果相同;在超重肥胖人群,预防糖尿病可采取饮食干预或运动干预;而在非超重人群,采取运动干预似乎效果更佳;推迟糖尿病分别每5年即可使全因死亡及心脑血管疾病死亡率,心脑血管疾病发生率,脑中风发生率有明显的下降。更多还原

【Abstract】 OBJECTIVES(1) To compare the long-term effect of diet and exercise on prevention of diabetes in people with impaired glucose tolerance in DaQing diabetes study,in order to find which one will be the best option.(2)To Investigate the effect of delaying onset of diabetes on all cause and CVD mortality,incidence of CVD event and stroke in this prediabetes population.METHODS 576 participants were followed-up for 20 years to assess the long-term effect of diet or exercise intervention.The causes of death,the status of survivors were investigated.Questionnaires were given to all the participants or their proxy.Height,weight,blood pressure were measured,ECG,oral glucose tolerance test and blood biochemical analysis were performed in the survivors.Long-term effect of lifestyle intervention were examed in relation to incidence of diabetes,stroke,first CVD event and mortality.RESULTS Compared with control participants,those in the diet intervention group and exercise intervention group had 46%(hazard rate ratio[HRR]0.54;95%CI 0.34-0.88) and 51%lower incidence of diabetes(0.49;0.27-0.87)respectively during the active intervention period,their HRR were 0.59(95%CI 0.39-0.89,p=0.0152) and 0.53(0.33-0.85 p=0.0117) over the 20 year period,after controlling for age,BMI and clustering by clinic.There was no significant difference between the diet and exercise group in the incidence of diabetes.In the subgroup with BMI＜25kg/m~2,those in exercise intervention groups had a 66%lower incidence of diabetes(0.34;0.16-0.73) compared with control during the active intervention period and a 62%lower incidence(0.38;0.20-0.71) over the 20 year period.But the effect of the diet intervention was not obvious.In the subgroup with BMI≥25kg/m~2,both the diet intervention and exercise intervention were effective on prevention diabetes during the active intervention period and the 20 year follow-up period.There were no differences between diet and exercise intervention in the two subgroups.After adjustment of age,sex,BMI,blood pressure,smoking at baseline,the risk of all-cause mortality was 38%lower for 5-year increase of delaying diabetes onset,and the risk of stroke,CVD event and mortality were 18%,18%,26%lower respectively for the same increase in the time of delaying of diabetes onset.All these results were statistically significant.CONCLUSIONS(1) Both the diet and exercise interventions over 6 years can prevent or delay diabetes for up to 14 years after the active intervention.But the exercise intervention seems better on diabetes prevention in the non-overweight people.(2) There were significant decrease in the risk of all-cause and CVD mortality, incidence of stroke and first CVD event when diabetes onset was delayed for 5 years.更多还原