【作者】 沈思；

【导师】 张绍艳；

【作者基本信息】 苏州大学 ， 公共卫生（专业学位）， 2015， 硕士

【摘要】 目的:糖尿病是全球的重大公共卫生问题,在世界范围内,糖尿病已是继心血管和肿瘤之后的第三大威胁人类健康的疾病。同时,糖尿病伴发的大血管、微血管并发症及周围神经病变是糖尿病主要的慢性并发症,严重危害人类的生命安全。近年来高同型半胱氨酸血症开始被人们所关注。本项研究利用2型糖尿病患者及同期对照组的病例对照研究,探讨2型糖尿病患者血清同型半胱氨酸(Hcy)水平及传统危险因素与糖尿病的关系。资料和方法:以2013年10月~2014年12月昆山市第一人民医院内分泌科收治的95例2型糖尿病患者为研究对象,及同期同院的排除心血管系统、消化系统及营养不良者的脊柱外科、关节外科、手外科和体检科的395例住院患者作为对照组,所有入选者近三个月内未服用叶酸、维生素B6、维生素B12,收集患者的人口统计学信息、生活方式、临床特征、实验室检查、疾病史等资料。采用罗氏MODULAR_DP全自动生化分析仪检测患者入院24小时内同型半胱氨酸浓度。运用多因素logistic回归模型分析同型半胱氨酸水平及传统危险因素与2型糖尿病的关系,计算OR和95%CI,并进行线性趋势检验。按照年龄、性别、心率、BMI、血脂及吸烟等分为若干亚组,分析同型半胱氨酸水平在每一亚组中与糖尿病的关联性。结果:超重者患糖尿病的危险是正常者的6.67倍(95%CI:3.81,11.68);同HDL-C水平≥1.14mmol/L者相比,HDL-C水平<1.14mmol/L者患糖尿病的OR(95%CI)是2.68倍(95%CI:1.50,4.78);LDL-C≥2.18mmol/L者患糖尿病的危险性是LDL-C<2.18mmol/L者的2.27倍(95%CI:1.09,4.73)吸烟者患糖尿病的危险是不吸烟者的5.05倍(95%CI:1.72,14.81),饮酒者患糖尿病的危险性是不饮酒者的0.28倍(95%CI:0.09,0.89),同Hcy<15μmol/L的患者相比,Hcy≥15μmol/L的患者发生糖尿病患病的OR(95%CI)是0.84(0.41,1.58)。BMI、HDL-C、LDL-C以及吸烟和饮酒与糖尿病之间存在剂量反应关系(P<0.05),而Hcy水平与糖尿病之间无明显的剂量反应关系(P>0.05)。结论:1.BMI、HDL-C、LDL-C以及吸烟显著增加了糖尿病患病的危险。2.饮酒可降低糖尿病患病的危险。3.本研究结果未发现Hcy水平与糖尿病的关系。更多还原

【Abstract】 Objective:Diabetes is a global major public health problem in the world within the scope of diabetes is the third largest after cardiovascular and tumor disease threat to human health. At the same time, the great vessels, microvascular complications of diabetes with peripheral neuropathy and is a major chronic complications of diabetes, serious harm to people’s life safety. In recent years, high homocysteine levels, begins to be the concern of the people. This study used the same period in patients with type 2 diabetes and the control group of case-control study, patients with type 2 diabetes mellitus serum homocysteine(Hcy) levels and the relationship between the traditional risk factors and diabetes.Subjects and Methods:In October 2013 to December 2014 the first people’s hospital of kunshan city at the records of 95 patients with type 2 diabetes endocrinology as the research object, and at the same time with the court ruled out of the cardiovascular system, digestive system and malnutrition of spine surgery, joint surgery, 2013, and physical examination of 395 cases of hospitalized patients as control group, all entrants in nearly three months is not taking folic acid, vitamin B6, vitamin B12, collect the patient’s demographic information, life style, clinical features, laboratory examination, history etc. Using roche MODULAR_DP automatic biochemical analyzer test patients admitted to hospital 24 hours of homocysteine concentrations.Using multiariable logistic regression model analysis of homocysteine levels and the relationship between the traditional risk factors and type 2 diabetes, calculate the OR and 95% CI, and carry on linear trend test. According to age, sex, heart rate, BMI, blood lipid and smoking is divided into several subgroups, analysis of homocysteine levels in every subgroup and the correlation of diabetesResults:Overweight people with diabetes risk was 6.67 times that of the normal(95% CI: 3.81, 11.68); With HDL- C level 1.14 OR higher tendency than L, levels of HDL- C < 1.14 tendency of diabetes OR L(95% CI) was 2.68 times(95% CI: 1.50, 4.78); LDL- C < 2.18 tendency for LDL- C L is the risk of diabetes OR greater tendency for 2.18 L of 2.27 times(95% CI: 1.09, 1.09) in smokers, the risk of diabetes was 5.05 times that of the non-smokers(95% CI: 1.72, 14.81), drinkers of diabetes risk was 0.28 times of nondrinkers(95% CI: 0.09, 0.89), with Hcy < 15 mu mol/L compared with patients, Hcy 15 mu OR mol/L outcome in patients with diabetes OR(95% CI) is 0.84(0.41, 0.41). BMI, HDL, LDL- C- C and dose-response relationship between drinking smoking and diabetes(P < 0.05), and Hcy levels and no significant dose-response relationship between diabetes(P > 0.05).Conclusion:1. The BMI, HDL- C, LDL- C and smoking significantly increased the risk of diabetes. 2. Drinking may reduce the risk of diabetes. 3. This study did not find the relationship between Hcy levels and diabetes.更多还原