【摘要】：近年來,隨著生活水平的提高和生活方式的改變,兒童肥胖越來越常見。與肥胖相關(guān)的糖代謝異常：糖調(diào)節(jié)受損(impaired glucose regulation, IGR)包括空腹血糖受損(impaired fasting glucose, IFG)和糖耐量減低(impaired glucose tolerance, IGT)和過去認為是成人疾病的2型糖尿病(Type2Diabetes Mellitus, T2DM)在兒童中的患病率也逐年增加。T2DM與成年期心血管疾病(cardiovascular disease, CVD)的發(fā)病密切相關(guān),而CVD已經(jīng)成為我國首位的死亡原因。IGR和T2DM發(fā)病的低齡化可使青壯年發(fā)生CVD的危險性增加,與1型糖尿病(Type1Diabetes Mellitus, T1DM)相比,T2DM相關(guān)并發(fā)癥出現(xiàn)得更早,病死率更高。因此,兒童IGR和T2DM已經(jīng)引起廣泛的關(guān)注并成為目前重要的醫(yī)學研究課題,早診斷,早治療,對減少成人期T2DM和CVD等疾病的發(fā)病有著重大的意義。目前,對兒童IGR和T2DM研究相對較少,北京市乃至全國迄今尚未有基于兒童青少年人群的、有代表性的大規(guī)模調(diào)查。本研究的目的在于：1、了解北京市學齡兒童(6-18歲在校中小學生)血糖分布特征；2、了解IGR和糖尿病特別是T2DM的現(xiàn)患率及分布特征；3、探討糖調(diào)節(jié)異常和T2DM的關(guān)聯(lián)因素,包括：人口特征(性別、年齡)、城鄉(xiāng)、糖尿病家族史、肥胖及相關(guān)代謝異常等；4、探討基于人群的糖尿病分型及特點。 本研究為現(xiàn)況調(diào)查,采用分層(城鄉(xiāng))隨機(層內(nèi)隨機)整群(抽樣單位內(nèi))的抽樣方法,對北京市七個區(qū)縣共19431名6-18歲中小學生進行血糖水,平及T2DM相關(guān)危險因素的調(diào)查。調(diào)查采用兩個階段過程,第一階段,采用空腹指尖毛細血管全血糖(fasting capillary blood glucose, FCBG)測量技術(shù)對所有研究對象進行血糖水平檢測。第一階段還進行身高、體重、腰圍、血壓、青春期發(fā)育檢測。參照1999年WHO指血糖診斷標準,對第一階段篩查出的空腹高血糖(FCBG≥5.6mmol/L)兒童476人,經(jīng)知情同意,226人(47.48%)進入第二階段的臨床診斷,進行空腹靜脈血漿葡萄糖(fasting plasma glucose, FPG)、血脂四項和胰島素的檢測。其中180人同意進行口服糖耐量試驗(oral glucose tolerance test, OGTT)。對第二階段采集靜脈血的人群,根據(jù)2012年美國糖尿病協(xié)會(American Diabetes Association, ADA)靜脈血糖標準進行糖尿病和糖尿病前期的診斷,IFG:FPG5.6mmol/L-6.9mmol/L,同時OGTT2小時血糖7.8mmol/L; IGT:OGTT2小時血糖≥7.8mmol/L-11.0mmol/L,同時FPG5.6mmol/L;糖尿�。篎PG7.0mmol/L或OGTT2小時血糖≥11.1mmol/L.糖尿病分型根據(jù)ADA建議兒童青少年T2DM篩查的高危對象標準和Dean提出的診斷標準作為臨床診斷T2DM的依據(jù)。同時參考抗體檢測,抗體陽性的兒童,診斷為T1DM可能性大。 (一)6—18歲學齡兒童血糖的分布特征： 1、男生FCBG在6-18歲各個年齡組間均高于女生。男、女生間FCBG值的差異有統(tǒng)計學意義,P0.001。男、女的血糖變化趨勢基本一致,且.呈現(xiàn)雙峰分布：男、女生在6—11歲期間,血糖水平隨年齡增長有逐漸升高的趨勢,11歲達到高峰,之后開始下降,在13歲時出現(xiàn)波谷。在14—15歲年齡段,血糖水平又出現(xiàn)上升,男生升幅大于女孩,之后又開始下降,在18歲時出現(xiàn)波谷。 2、城區(qū)、郊區(qū)兒童平均FCBG分別為4.7±0.5mmol/L和4.6±0.5mmol/L; BMI分別為19.44±4.21,18.54±3.7。城區(qū)兒童FCBG、BMI均高于郊區(qū)兒童,差異具有統(tǒng)計學意義,P均0.001。 3、體重正常、超重、肥胖兒童的FCBG分別為4.60±0.51mmol/L,4.69±0.60mmol/L和4.71±0.56mmol/L。與體重正常兒童相比,超重、肥胖兒童的FCBG明顯升高,差異有統(tǒng)計學意義,P0.001。 4、篩查出空腹高血糖(FCBG5.6mmol/L)兒童476人,占篩查人群的2.45%,男孩321例(1.65%),女孩155例(0.80%),男女比例2.1：1,性別間差異有統(tǒng)計學意義,P0.001。 5、經(jīng)多元logistic逐步回歸分析可見糖尿病家族史、性別、高TG、黑棘皮病和高血壓都是FCBG升高的危險因素。 (二)IGR和糖尿病特別是T2DM的現(xiàn)患率及分布特征、關(guān)聯(lián)因素和糖尿病分型及特點： 1、共發(fā)現(xiàn)血糖異常人群96例,其中IFG81例,IGT6例,IFG+IGT5例,T1DM6例,T2DM6例,特殊類型糖尿病2例。另外問卷調(diào)查中自我報告糖尿病2例。 2、學齡兒童IFG患病率為8.78%0,IGT患病率為0.65‰,糖尿病患病率為1.52%o,男生糖尿病患病率為0.91‰,女生糖尿病患病率為1.97‰,女生高于男生 3、學齡兒童中T2DM患病率為0.65‰,IGR患病率為8.89‰,T2DM/IGR患病率為10.41‰。 4、超重、肥胖兒童中IGR和糖尿病的檢出率為1.1%,非超重、肥胖兒童為0.4%。超重、肥胖兒童IGR和糖尿病的發(fā)生率與體重正常兒童有顯著性差異,P0.001。 5、經(jīng)多元logistic逐步回歸分析,家族史、高TC、黑棘皮病、高血壓、腹型肥胖、高TG和性別是影響IGR和糖尿病的危險因素。 6、在新診斷的14例糖尿病中T1DM6例,T2DM6例(均為女性),特殊類型糖尿病2例。T2DM和T1DM的比例為1：1。 通過以上研究我們可以得到以下結(jié)論： 1、北京地區(qū)6-18歲學齡兒童的空腹血糖水甲與性別、年齡和肥胖有關(guān),存在城鄉(xiāng)差異。 2、學齡兒童IFG患病率為8.78‰,IGT患病率為0.65‰,T2DM患病率為0.65‰,IGR患病率為8.89%0,T2DM/IGR患病率為10.41‰,流行率較高。 3、家族史、高TC、黑棘皮病、高血壓、腹型肥胖、高TG和性別是影響IGR和T2DM的主要危險因素。 4、T2DM在兒童糖尿病中所占的比例增高,達到50%,應(yīng)該引起重視。 綜上所述,隨著肥胖兒童的日益增多,兒童糖代謝異常逐漸增多,其與成年期糖尿病和CVD等疾病的發(fā)生密切相關(guān),已經(jīng)成為一個日益受到關(guān)注的公共健康問題。了解兒童糖代謝異常的流行特征及相關(guān)危險因素,對于預防和治療兒童糖代謝異常均有重要的意義。目前,國際及國內(nèi)以人群為基礎(chǔ)的針對兒童糖代謝水半的大規(guī)模的研究非常少見,本研究反映了正常兒童血糖水平的變化趨勢,獲得了兒童青少年糖調(diào)節(jié)異常和糖尿病的流行特征,初步探討了相關(guān)的危險因素,為今后兒童血糖相關(guān)課題的研究提供了參考。
[Abstract]:In recent years, with the improvement of living standards and lifestyle changes, obesity is becoming more and more common in children. Impaired glucose metabolism associated with obesity: impaired glucose regulation (impaired glucose regulation, IGR) including impaired fasting blood glucose (impaired fasting glucose, IFG) and impaired glucose tolerance (impaired glucose tolerance, IGT) and the past thought to be The prevalence of Type2Diabetes Mellitus (T2DM) in adult disease (T2DM) is also closely related to the incidence of.T2DM in children year by year and the incidence of cardiovascular disease (CVD) in adulthood, and CVD has become the first cause of death in China, and the low age of.IGR and T2DM hair disease can increase the risk of CVD in young and young adults. Compared with type 1 diabetes (Type1Diabetes Mellitus, T1DM), T2DM related complications are earlier and more fatality. Therefore, children's IGR and T2DM have attracted wide attention and become important medical research topics. Early diagnosis and early treatment are of great significance for reducing the incidence of T2DM and CVD diseases in adult stage. There are relatively few studies on child IGR and T2DM. There is not yet a representative large scale survey based on children and adolescents in Beijing and even the whole country. The purpose of this study is: 1, to understand the blood sugar distribution characteristics of school aged children in Beijing (6-18 years old school students); 2, to understand the prevalence and distribution characteristics of IGR and diabetes, especially T2DM 3, to explore the related factors of abnormal glucose regulation and T2DM, including demographic characteristics (sex, age), urban and rural, family history of diabetes, obesity and related metabolic abnormalities, and 4, to explore the classification and characteristics of diabetes based on population.
In this study, a survey was conducted with a stratified (urban and rural) random (stratified random) cluster sampling method. A total of 19431 6-18 - year - old students in seven districts and counties in Beijing were investigated for blood glucose, level and risk factors related to T2DM. Two stages were used, and the first stage was the use of fasting fingertip capillary blood glucose (FAS Ting capillary blood glucose, FCBG) measurement of blood glucose level for all the subjects. The first stage also carried out the height, weight, waist circumference, blood pressure, puberty development test. According to the 1999 WHO index of blood glucose diagnosis, 476 children with high blood sugar (FCBG > 5.6mmol/L) were screened for the first stage, and 226 people (4 7.48%) into the second stage of clinical diagnosis, fasting plasma glucose (FPG), blood lipid four and insulin test. 180 of them agreed to take oral glucose tolerance test (oral glucose tolerance test, OGTT). For the second stage of collecting venous blood, according to the 2012 American Diabetes Association (Americ) An Diabetes Association, ADA) the standard of venous blood glucose for the diagnosis of diabetes and prediabetes, IFG:FPG5.6mmol/L-6.9mmol/L, and OGTT2 hour blood glucose 7.8mmol/L, IGT:OGTT2 hourly blood glucose more than 7.8mmol/L-11.0mmol/L, and FPG5.6mmol/L; diabetes: FPG7.0mmol/L or OGTT2 hours diabetes classification based on diabetes mellitus It is suggested that the standard of high risk subjects for T2DM screening in children and adolescents and the diagnostic criteria proposed by Dean are the basis for clinical diagnosis of T2DM. At the same time, reference to antibody test and antibody positive children, the possibility of diagnosis of T1DM is great.
(1) distribution characteristics of blood glucose in children aged 6 to 18 years of age:
1, male FCBG was higher than girls in all age groups of 6-18 years. The difference of FCBG value between male and female was statistically significant. The trend of blood sugar change in P0.001. male and female was basically the same, and the distribution of blood sugar in Shuangfeng was the same, and the trend of blood sugar level increased gradually during the age of 6 to 11, the peak of blood sugar level increased with age, and then reached the peak at the age of 11, then began to decline, 1 At the age of 14-15, blood glucose levels rose again, boys increased more than girls, and then began to decline again. At the age of 18, there was a trough.
2, the average FCBG of children in urban areas was 4.7 + 0.5mmol/L and 4.6 + 0.5mmol/L, respectively, and BMI was 19.44 + 4.21,18.54 + 3.7. urban children FCBG, and BMI was higher than those in suburban children. The difference was statistically significant, P 0.001. was all 0.001..
3, normal weight, overweight, obese children FCBG were 4.60 + 0.51mmol/L, 4.69 + 0.60mmol/L and 4.71 + 0.56mmol/L. compared with normal weight children, overweight, obese children's FCBG significantly increased, the difference was statistically significant, P0.001.
4, 476 children were screened for fasting hyperglycemia (FCBG5.6mmol/L), accounting for 2.45% of the screening population, 321 in boys (1.65%), 155 in girls (0.80%), and the proportion of men and women was 2.1:1, and the gender difference was statistically significant, P0.001.
5. Multiple logistic stepwise regression analysis showed that family history of diabetes mellitus, sex, high TG, acanthosis nigricans and hypertension were risk factors for increased FCBG.
(two) the prevalence and distribution characteristics of IGR and diabetes, especially T2DM, the related factors and types and characteristics of diabetes:
1, 96 cases of abnormal blood glucose were found, including IFG81, IGT6, IFG+IGT5, T1DM6, T2DM6, and 2 cases of special type diabetes. In addition, 2 cases of diabetes were reported in the questionnaire survey.
2, the prevalence rate of IFG in school-age children was 8.78%0, the prevalence rate of IGT was 0.65 per thousand, the prevalence rate of diabetes was 1.52%o, the prevalence rate of male diabetes was 0.91 per thousand, the prevalence rate of girls was 1.97 per thousand, and the female students were higher than the boys.
3, the prevalence of T2DM among school-age children was 0.65 per thousand, the prevalence rate of IGR was 8.89 per thousand, and the prevalence of T2DM/IGR was 10.41 per thousand.
4, overweight, obese children IGR and diabetes detection rate is 1.1%, non overweight, obese children are 0.4%. overweight, obese children IGR and diabetes incidence and weight normal children have significant differences, P0.001.
5. Multiple logistic stepwise regression analysis showed that family history, high TC, acanthosis nigricans, hypertension, abdominal obesity, high TG and sex were risk factors for IGR and diabetes.
6. Of the 14 newly diagnosed diabetes mellitus cases, 6 were T1DM6, 6 were T2DM6 (all female), and 2 were of special type. The ratio of T2DM to T1DM was 1:1.
Through the above research, we can draw the following conclusions:
1, fasting glycemic beetle in 6-18 years old school children in Beijing is related to gender, age and obesity, and there is a difference between urban and rural areas.
2, the prevalence rate of IFG in school-age children was 8.78 per thousand, the prevalence rate of IGT was 0.65 per thousand, the prevalence rate of T2DM was 0.65 per thousand, the prevalence rate of IGR was 8.89%0, the prevalence rate of T2DM/IGR was 10.41 per thousand, and the prevalence rate was high.
3, family history, high TC, acanthosis nigricans, hypertension, abdominal obesity, high TG and gender are the major risk factors for IGR and T2DM.
4, the proportion of T2DM in children's diabetes increased to 50%, which should be paid attention to.
To sum up, with the increasing number of obese children, the abnormal metabolism of sugar metabolism in children is increasing gradually. It is closely related to the occurrence of diabetes and CVD and other diseases in adult. It has become an increasingly concerned public health problem. To understand the epidemic characteristics and related risk factors of abnormal glucose metabolism in children and to prevent and treat children's sugar generation. Xie Yichang has important significance. At present, a large scale of international and domestic research on children's glucose metabolism water half is rare. This study reflects the change trend of blood glucose level in normal children, obtains the characteristics of abnormal glucose regulation and diabetes in children and adolescents, and discusses the related risk factors preliminarily. It provides a reference for future research on children's blood glucose related subjects.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：博士
【學位授予年份】：2012
【分類號】：R725.8

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