糖负荷后1h血糖值与绝经后女性代谢综合征相关研究

Correlation of one-hour postload plasma glucose levels with metabolic syndrome in postmenopausal women

摘要:

目的 探讨绝经前后非糖尿病人群代谢综合征（MS）及动脉粥样硬化因素与糖负荷后1h血糖（1h-PG）的关系，及1h-PG在绝经后MS人群的可能切点值。方法 以2013年8月～10月在中山大学孙逸仙纪念医院进行健康体检年龄30～70岁女性为研究对象，收集身高、体质量、腰围、血压、血脂及葡萄糖耐量试验（OGTT）0，1，2h相对应的血糖、胰岛素水平。根据OGTT结果剔除糖尿病患者，按照不同绝经阶段分为两组：绝经前组143例，绝经后组145例，根据国际糖尿病联盟（IDF）MS定义标准，分析1h-PG与MS的相关性及在绝经后女性MS的切点值。结果 （1） 绝经后组年龄、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、收缩压、舒张压均高于绝经前组，差异均有统计学意义（P＜0.05）。（2）各组受检者行OGTT测试后，相比于绝经前组，绝经后组各时点葡萄糖、胰岛素及恒稳态模型评价-胰岛素抵抗（HOMA-IR）水平均显著增高，差异均有统计学意义（P＜0.05）。（3）绝经前组中，检出MS患者22例（13.39%），绝经后组中，检出MS患者47例（32.40%），两组MS发生率比较，差异有统计学意义（χ2＝11.46，P＝0.01）。（4）MS相关影响因素的logistic回归分析结果显示，1h-PG与MS显著相关（OR＝1.849，95%CI＝1.557?2.195，P＜0.001）。（5）当1h-PG以8.70mmol/L为临界值时，1h-PG对绝经后组MS预测的敏感度为87.50%，特异度为81.44%，Youden指数为0.689，受试者工作特征（ROC）曲线下面积（AUC）为0.907。结论 绝经前后非糖尿病人群MS与1h-PG均密切相关，推测1h-PG预测绝经后女性MS的可能切点值为8.70mmol/L，可以作为预测绝经后女性MS的一个可选指标，对早期临床干预或治疗有指导意义。

Abstract:

Objective To investigate the relationship of one-hour postload plasma glucose (1h-PG) levels with atherosclerotic risk factors and metabolic syndrome (MS) between pre-menopause and post-menopause in a group of nondiabetic population, and to determine the possible cut point of 1h-PG for MS in postmenopausal women. Methods A cross-sectional study was performed in our hospital during August to October 2013, and the women (aged from 30 to 70 years) who were in hospital for routine check-up at the Medical Examination Center were enrolled. All subjects underwent laboratory examinations of oral glucose tolerance test (OGTT), lipid, and anthropometric measurements (height, body mass and waistline). Diabetes were excluded according to the results of OGTT. According to their menstrual status, the subjects were divided into 2 groups: premenopausal group (n＝143) and postmenopausal group (n=145). MS was defined according to the International Diabetes Federation (IDF) criteria. The relationship of 1h-PG and MS of women in different stage of menopause was analyzed, and the cut point of 1h-PG for MS in postmenopausal women was determined. Results (1) Triglycerides, total cholesterol, low density lipoprotein cholesterol, systolic and diastolic blood pressure were significantly higher in postmenopausal group than in premenopausal group (P＜0.05). (2) Subjects in postmenopausal group had higher plasma glucose and insulin levels in each time point of OGTT accordingly when compared with premenopausal group (P＜0.05). Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) was also significantly higher in the former group (P＜0.05). (3) The incidence of MS was 13.39% (22/143) in premenopausal group and 32.40% (47/145) in postmenopausal group, with significant difference between the 2 groups (Chi-square＝11.46, P＝0.01). (4) The logistic regression analysis for MS showed that MS was significantly associated with 1h-PG (OR＝1.849, 95% CI＝1.557?2.195, P＜0.001). (5) When the cut-off value of 1h-PG was defined at 8.70mmol/L, the sensitivity of 1h-PG for predicting MS was 87.50%, the specificity was 81.44%, the area under the receiver operating characteristic curve (ROC) was 0.907, and Youden index was 0.689 in post-menopausal group. Conclusion MS is closely related to 1h-PG in both pre-menopausal and post-menopausal nondiabetic women. When the cut point of 1h-PG is 8.70mmol/L, it is a selectable marker to predict MS in postmenopausal woman, and represents useful in clinical practice for early intervention or treatment.