糖负荷后胰岛细胞功能变化与老年男性糖尿病高危人群死亡风险的相关性分析

刘倩倩; 胡帆; 曾静; 马丽超; 闫双通; 李春霖; 田慧; 龚燕平

doi:10.3969/j.issn.2095-5227.2023.05.005

糖负荷后胰岛细胞功能变化与老年男性糖尿病高危人群死亡风险的相关性分析

Relationship between islet function changes of post-glucose-load and mortality in elderly men with history of hyperglycemia

摘要

摘要:
背景我国老年糖尿病人数逐年增加，糖负荷后胰岛功能的变化与老年糖尿病高危人群预后的相关性尚不明确。
目的探讨老年男性糖尿病高危人群胰岛素功能及其糖负荷后的变化与死亡风险的关系。
方法选取2005年5 - 8月在解放军总医院第二医学中心因血糖异常病史行口服葡萄糖耐量试验的年龄＞60岁的老年男性人群，分别使用1 h、2 h血糖和胰岛素乘积与空腹血糖和空腹胰岛素乘积的比值评估胰岛功能变化。回顾性随访时间截至2020年12月，记录终点事件及时间，分析影响该人群15年死亡风险的危险因素，并计算2 h胰岛功能变化量对15年死亡风险的预测效能。
结果共220例老年男性纳入研究，平均年龄(71.71 ± 7.43)岁。在15年随访中，死亡67例(78.28 ± 5.95)岁，存活153例(68.83 ± 6.06)岁。单因素Cox回归显示，年龄、舒张压、呼吸系统疾病史、三酰甘油、肌酐、谷丙转氨酶、空腹血糖、2 h血糖、2 h胰岛素、2 h胰岛功能变化量在死亡组与存活组间有统计学差异(P均＜0.05)；多因素Cox回归显示，死亡患者的年龄偏大(HR=1.185，95% CI：1.052 ~ 1.336)，舒张压偏低(HR=0.953，95% CI：0.913 ~ 0.995)，2 h胰岛功能变化量更大(HR=1.020，95% CI：1.000 ~ 1.040)。 ROC曲线分析显示2 h胰岛功能变化量预测15年死亡风险的曲线下面积(AUC)为0.682，最佳临界值为14.92。
结论老年男性糖尿病高危人群糖负荷后2 h胰岛功能变化量是15年死亡风险的独立相关因素，大于14.92的人群死亡风险显著增加。

Abstract:
Background The prevalence of diabetes in the elderly is rising in China. The relationship between the islet function changes of post-glucose-load and the prognosis of elderly patients with high risk diabetes remains unclear.
Objective To investigate the relationship between islet function changes of post-glucose-load and mortality in elderly patients with high risk diabetes.
Methods From May to August in 2005, elderly men aged over than 60 years who did the oral glucose tolerance test (OGTT) owing to an abnormal glucose history were included in the Second Medical Center, Chinese PLA General Hospital. Post-glucose-load islet function changes were assessed with the ratio of (the product of blood glucose plus insulin at 1 hour or 2 hours) to (the product of fasting blood glucose plus FINS). The retrospective follow-up time was up to December 2020, and the death and its time were recorded. Factors affecting 15-year mortality were analyzed and predictive value of the amount of change in 2-hour islet function on 15-year mortality was assessed.
Results Totally 220 elderly men were included in the study with an average age of (71.71 ± 7.43) years. During the 15-year follow-up, 67 cases (78.28 ± 5.95 years) died and 153 cases (68.83 ± 6.06 years) survived. Univariate Cox regression revealed that age, diastolic blood pressure, history of respiratory disease, triglycerides, creatinine, glutamate aminotransferase, fasting blood glucose, 2-hour blood glucose, 2-hour insulin, the amount of changes in 2-hour islet function had significant differene between the dead group and the survival group (all P<0.05). Multivariate Cox regression showed that the patients who died were older (HR=1.185, 95% CI: 1.052-1.336), with lower diastolic pressure (HR=0.953, 95% CI: 0.913-0.995) and higher amount of changes in 2-hour islet function (HR=1.020, 95% CI: 1.000-1.040). ROC curve analysis showed that the area under the curve (AUC) of the amount of change in 2-hour islet function was 0.682, and the optimal critical cut-off value was 14.92.
Conclusion The changes of islet function at 2 hours after glucose load is an independent factor associated with 15 year mortality risk in elderly men with high-risk diabetes, and the mortality risk increases significantly in people with the level greater than 14.92.

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