【作者】 刘春；

【导师】 贾崇奇；

【作者基本信息】 山东大学 ， 公共卫生（专业学位）， 2015， 硕士

【摘要】 目的：研究白细胞与2型糖尿病之间的关系,探讨白细胞分别与腰围、甘油三酯、高血压、超重的交互作用对2型糖尿病(T2DM)的影响。方法：抽取349例来自兰山区2个镇卫生院、2个社区卫生服务中心老年人的查体资料和门诊资料,采用以社区为基础的病例对照研究方法,以182例T2DM患者为病例组,以167例无T2DM者为对照组,观察身高、体重、腰围、白细胞、中性粒细胞、淋巴细胞、血糖、血尿素氮、肌酐、尿酸、总胆固醇、甘油三脂、尿蛋白、尿酸碱度、尿糖等指标。定量资料采用均数±标准差表示,计数资料采用频数(%)表示。应用单因素和多因素Logistic分析方法,分析白细胞计数及其分类与糖尿病关系。应用多元Logistic回归调整潜在的混杂因素及估计比值比(OR)。用相加模型分析白细胞分别与腰围、甘油三酯、高血压、超重的交互作用T2DM的影响。结果：经单因素logistic回归分析显示白细胞总数、淋巴细胞和中性粒细胞数每增加一个单位,患糖尿病的危险性分别增加1.25、1.50和1.30倍。将白细胞总数、淋巴细胞数、中性粒细胞数按三分位数划分后进行分析,结果显示,它们同T2DM患病危险性皆显著正相关。利用多因素logistic回归调整性别、年龄、高血压、BMI、腰围、尿素、肌酐、总胆固醇、甘油三脂、高密度脂蛋白、低密度脂蛋白、谷草转氨酶、谷丙转氨酶、尿酸碱度、尿蛋白多个潜在混杂变量后,对于白细胞总数、淋巴细胞数、中性粒细胞数每增加一个单位,患糖尿病的危险性分别增加1.18、1.27和1.23倍。将白细胞总数、淋巴细胞数、中性粒细胞数按三分位数划分后进行分析,T2DM患病危险性OR及其95%信限,白细胞分别为：1.52(0.83-2.80)、2.72(1.42-5.19)；淋巴细胞数分别为：1.10(0.61-1.98)、1.45(0.78-2.71)；中性粒细胞数分别为：1.52(0.86-2.82)、2.13(1.15-3.95)。白细胞与腰围、甘油三酯、高血压、超重之间单因素分析显示无论调整混杂因素前和后,两因素同时存在的效应皆大于各因素单独存在时效应之和,表明两因素之间在糖尿病患病中存在正相加模型交互作用。协同指数(S)分别为：1.91、3.46、1.30、3.61；交互效应超额相对危险度(RERI)分别为：2.30、9.31、1.86、3.41；归因交互效应百分比(AP)为：39.48%、66.03%、20.50%、59.67%。用多元logistic回归调整性别、年龄、高血压、腰围、血尿素氮、血肌酐、总胆固醇、甘油三脂、高密度脂蛋白、低密度脂蛋白、谷草转氨酶、谷丙转氨酶、尿蛋白、尿酸碱度后,白细胞与腰围、甘油三酯、高血压、超重对糖尿病仍具有正交互作用。调整上述各混杂因素后,S分别为：1.76、3.10、1.12、2.73；RERI分别为1.55、6.98、0.82、1.08；AP分别为：33.78%、61.74%、9.38%、39.89%。结论：白细胞总数、淋巴细胞数、中性粒细胞数无论其原始值还是其三分位数皆与T2DM的患病危险性显著相关,白细胞与T2DM患病之间的关系并不完全依赖于其它因素。腰围、甘油三酯、高血压、超重是糖尿病发生的危险因素,白细胞与这些因素在糖尿病发病中存在明显的正相加模型交互作用,使糖尿病患病危险性明显增加。更多还原

【Abstract】 Objective:To study the relationship between white blood cell (WBC) and type 2 diabetes mellitus (T2DM). To investigate the effect of interaction of leukocytes with waist circumference, triglyceride, hypertension, overweight respectivly on type 2 diabetes mellitus (T2DM).Methods:The examination document and clinic data of 349 elderly people was extracted from 2 township health center and 2 community health service center in Lanshan Districts.182 cases of T2DM patients were selected as observation group,167 patients without T2DM as control group. The height, weight, waist circumference, leukocyte, neutrophil cells, lymphocytes, plasma glucose, urea, creatinine, uric acid, total cholesterol, glycerin three fat, urine protein, urine pH, urine glucose and other indicators were measured. The metric data and the count data were expressed by mean±standard deviation and frequency (%), respectively. Univariate and multiple Logistic regression were applied to analyze the relationship between Type 2 Diabetes Mellitus and white blood cell count. The potential confounding factors and estimated odds ratio (OR) were assessed by multivariate Logistic. The effect of interaction between white blood cells and these factors including waist circumference, triglyceride, hypertension, and overweight, on Type 2 Diabetes Mellitus was analyzed by the additive model.Result:The univariate logistic regression analysis revealed that the risk of diabetes increases by 1.25,1.50 and 1.30 times per unit for the total number of white blood cells, lymphocytes and the number of neutrophils, respectively. When the total number of white blood cells, lymphocytes and neutrophils were categorized by tertiles, then the results also showed significantly positive correlation with T2DM. Multiple logistic regression model was used to adjust the potential confounder including gender, age, hypertension, BMI, waist circumference, urea, creatinine, total cholesterol, glycerin three fat, high density lipoprotein, low density lipoprotein, aspartate aminotransferase, alanine aminotransferase, urine pH, urine protein. The result showed that the risk of diabetes increased by 1.18,1.27 and 1.23 times per unit for the total number of white blood cells, lymphocytes and the number of neutrophils, respectively.When the total number of white blood cells, lymphocytes and neutrophils were divided by tertiles, The results of the risk of T2DM, including OR and 95% confidence limits, are as follows:For white blood cells were:1.52 (0.83-2.80),2.72 (1.42-5.19); for lymphocyte numbers were:1.10 (0.61-1.98),1.45 (0.78-2.71); for neutrophil counts were:1.52 (0.86-2.82),2.13 (1.15-3.95), respectively. Regarding the interaction analyses, the univariate analysis of white blood cell with waist circumference, triglyceride, hypertension and overweight showed that the effect of the two factors combined was greater than that of the two factors separately, so that it indicated that there was a positive additive interaction between the two factors. The synergy index (S) were 1.91, 3.46,1.30,3.61, respectively. The relative risk (RERI) were 2.30,9.31, 1.86,3.41, respectively. And the attributable proportion due to interaction (AP) were 39.48%,,66.03%,59.67%,20.50%, respectively. The potential confounders including gender, age, blood pressure, waist circumference, blood urea, creatinine, total cholesterol, glycerin three greases, high density lipoprotein, low density lipoprotein, aspartate transaminase, glutamic pyruvic transaminase, urinary protein, urinary acid-base degree, were adjusted by multivariate logistic regression. The adjusted interaction were as follows:for waist circumference, triglyceride, hypertension, overweight, respectively, S were 1.76,3.10,1.12,2.73, RERI were 1.55,0.82,6.98,1.08, AP were 33.78%,9.38%,61.74%, 39.89%, respectively.Conclusion:White blood cell count, lymphocyte count, neutrophil count were significantly associated with the risk of T2DM, whether its original value or tertile analysis. The relationship between white blood cells and T2DM was not entirely dependent on other factors. Waist circumference, triglyceride, hypertension and overweight were risk factors of diabetes. The interaction between white blood cells and these factors above-mentioned on risk of diabetes mellitus were additive model. So it increases significantly the risk of T2DM.更多还原