不同指标识别高血压患者血糖异常适宜切点值研究

作者：张前  北京大学人民医院心脏中心

摘要：目的 探索高血压患者不同指标识别血糖异常的适宜切点值。方法:对2013年入组的102例受试者5年后再召回进行横断面研究。测定患者口服葡萄糖耐量试验（OGTT）,空腹、OGTT中２h血糖 和HbA1c（糖化血红蛋白）水平。利用Pearson相关分析对体质量指数（BMI）、腰臀比（WHR）、腰围身高比（WHtR）、体脂率、周次均运动时间与血糖指标，包括空腹血糖（FPG）、OGTT中2 h血糖（2hPG）、糖化血红蛋白（HbA1c）进行分析。 采用受试者工作特征（ROC）曲线评价五项指标在高血压患者对血糖异常的诊断切点。决策曲线分析法（Decision Curve Analysis，DCA）评价五项指标对识别血糖异常的效用度。结果：研究共入选患者103（男53、女50）例，平均年龄63.79岁，体质量指数（body mass index，BMI）、腰臀比（waist to hip ratio，WHR）、腰围身高比（waist to height ratio，WHtR）、体脂率（Body fat rate）均与血糖指标呈正相关（r=0.140～0.748，P＜0.05），而周次均运动时间（Number of sports per week）与血糖指标呈负相关（r=-0.162～-0.920，P＜0.05）。ROC曲线分析显示识别血糖异常的切点值：五项指标分别为：体质量指数（BMI）：25.30，腰臀比（WHR）：0.89、腰围身高比（WHtR）：0.52、体脂率：35.35%，周次运动时间：0.05小时/次/周。结论：BMI、WHR、WHtR、体脂率及周次均运动时间均对识别高血压患者的血糖异常有良好的效能。

Different indicators identify the appropriate cut-point value of abnormal blood glucose in patients with hypertension

Abstract : Objective: Exploring the appropriate cut-point value for identifying abnormal blood glucose in different indicators of hypertensive patients.Method:A total of 102 subjects enrolled in 2013 were recalled for cross-sectional studies after 5 years. The levels of HbA1c, fasting blood flucase and oral glucaose tolerance test (OGTT) ２-hour blood glucase were determined.A correlation analysis was made of body mass index (BMI), waist to hip ratio， (WHR), waist-to-height ratio (WHtR), Body fat rate, Number of sports per week blood and glucose level (fasting plasma glucose, 2-hour postprandial blood glucose and hemoglobin A1c) using Pearson correlation. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic cut-off point of five indicators in patients with hypertension.Decision Curve Analysis (DCA) evaluates the utility of five indicators for identifying abnormalities in blood glucose.Result The study enrolled 103 patients (male 53 and female 50) with an average age of 63.79 years, body mass index (BMI), waist to hip ratio (WHR), waist to height ratio ( WHtR), body fat rate (Body fat rate) were positively correlated with blood glucose index (r = 0.140 ~ 0.748, P < 0.05), while the number of sports per week was negatively correlated with blood glucose index (r = -0.162 to -0.920, P < 0.05). ROC curve analysis showed cut-point values for identifying abnormal blood glucose: five indicators were: body mass index (BMI): 25.30, waist-to-hip ratio (WHR): 0.89, waist-to-height ratio (WHtR): 0.52, body fat percentage: 35.35 %, weekly exercise time: 0.05 hours / time / week. Conclusion  BMI, WHR, WHtR, body fat percentage and weekly exercise time have good efficacy in identifying abnormal blood glucose in patients with hypertension.

关键词：高血压； 血糖异常； 体质量指数；腰围身高比；腰臀比；体脂率；周次均运动时间

Key words：Hypertension; abnormal blood glucose; body mass- index; waist height ratio; waist-hip ratio; Number of sports per week;

《中国心血管病报告2018》显示：在危险因素控制方面，23%的国人有高血压，患病率呈上升趋势，但治疗控制率明显提高，为37.5%；全国糖尿病患病率约一成，但预防心血管病的措施不足如何识别高血压患者的血糖异常成为了目前预防心血管疾病发病的重中之重。2013年到2014年间孙宁玲教授及严晓伟教授等人在北京９家三级甲等医院采用标准化的HbA1c检测方法，将既往无糖代谢异常病史的高血压患者的空腹血糖、OGTT与 HbA1c进行比较，对HbA1c诊断糖代谢异常的切点进行了探索。

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