2023年 第20卷 第1期
《工程（英文）》 >> 2023年 第20卷 第1期 doi: 10.1016/j.eng.2022.05.013
2型糖尿病患者的身体活动、久坐行为与心血管疾病患病风险的关系——MIDiab研究
a Department of Endocrinology & Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
b Shandong Key Laboratory of Endocrinology and Lipid Metabolism & Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Shandong First Medical University, Jinan 250021, China
c Department of Endocrine and Metabolic Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
d Department of Endocrinology and Metabolism, First Hospital of Jilin University, Changchun 130021, China
e Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, Fuzhou 350001, China
f Endocrinology Department, The Southwest Hospital of AMU, Chongqing 400038, China
g Department of Biostatistics, School of Public Health, Shandong University, Jinan 250012, China
h Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu 610041, China
i Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China
j Department of Endocrinology, The First People’s Hospital of Yinchuan, Yinchuan 750001, China
k Department of Endocrinology, Nanjing Integrated Traditional Chinese and Western Medicine Hospital (the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine), Nanjing 210046, China
l Department of Endocrinology and Metabolism & Institute of Endocrinology, the First Hospital of China Medical University, Shenyang 110000, China
m Department of Endocrinology, the Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, China
n Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China
o Department of Endocrinology, Yantai Yuhuangding Hospital Affiliated to Qingdao University Medical College, Yantai 264000, China
p Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
q Department of Endocrinology and Metabolic Diseases, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
r Division of Endocrinology, Department of Internal Medicine, Inner Mongolia Autonomous Region People’s Hospital, Hohhot 010017, China
s Department of Endocrinology, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010030, China
t Department of Endocrinology & Beijing Institute of Geriatrics, National Health Commission, Beijing Hospital, Beijing 100000, China
u Division of Endocrinology, Department of Internal Medicine, Xijing Hospital of Air Force Military Medical University, Xi’an 710032, China
v National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100032, China
w Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan 250021, China
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摘要
本文的研究目的是探讨中国2型糖尿病（type 2 diabetes mellitus, T2DM）患者的中等至剧烈强度身体活动（Moderate-to-vigorous-intensity physical activity, MVPA）时间和久坐（sedentary, SED）时间与心血管疾病（cardiovascular disease, CVD）风险及多种因素[即血压（blood pressure, BP）、体重指数（body mass index, BMI）、低密度脂蛋白胆固醇（low-density lipoprotein cholesterol, LDL-C）和糖化血红蛋白A1（glycated hemoglobin A1c, HbA1c）]控制状况的关系。本研究为一项基于9152名T2DM人群的横断面研究，数据来自于“Multifactorial Intervention on Type 2 Diabetes Study”，简称MIDiab研究。根据患者自我报告的MVPA时间和SED时间，将身体活动水平分为：低（< 150 min·week−1）、中（150~450 min·week−1）、高（≥ 450 min·week−1）三组；久坐行为水平也分为：低（< 4 h·d–1）、中（4~8 h·d–1）、高（≥ 8 h·d–1）三组。本研究的主要结局指标是CVD，将有自我报告CVD疾病史的患者定义为有CVD风险。采用混合效应逻辑回归模型估计与MVPA时间和SED时间相关的CVD风险和多因素控制状态的优势比（odds ratio, OR）及95%置信区间（confidence interval, CI），对中国地理区域特征进行调整。本研究人群年龄的平均±标准差为（60.87 ± 8.44）岁，其中44.5%为女性，25.1%的患者自我报告有CVD疾病史。校正潜在的混杂因素后，发现高水平的MVPA时间与CVD风险之间存在负相关关系，且独立于SED时间，然而在中等水平MVPA时间组没有观察到这种关联。与低水平身体活动组的参与者相比，高水平身体活动组的人更容易达到BMI的目标水平。进一步评估二者对CVD风险的联合作用，与参照组（即SED时间< 4 h·d–1和MVPA时间≥ 450 min·week−1）相比，低水平身体活动组（MVPA时间< 150 min·week−1）的CVD患病风险显著升高。其中，与SED时间< 4 h·d–1相关的OR值为1.270（95% CI为1.040~1.553），与SED时间≥ 8 h·d–1相关的OR值为1.499（95% CI为1.149~1.955）。在T2DM患者中，长时间的久坐行为（即≥ 8 h·d–1的SED时间）与CVD风险增加有关；高水平的身体活动（即MVPA时间≥ 450 min·week−1）与CVD患病风险降低有关，且独立于SED时间。
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参考文献
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