CAJ | 학술논문

目的探讨糖尿病前期人群强化生活方式干预对心脑血管事件及死亡的长期影响.方法 1986年入选大庆市519例糖耐量正常(NGT)者和577例糖耐量减低(IGT)者.IGT者被随机分到对照组和饮食、运动或饮食加运动干预组进行6年生活方式干预.通过问卷和系统病历查阅,跟踪调查随后23年间首次心血管事件(心肌梗死、卒中)和死亡状况.结果 IGT未干预组心血管事件发生率和死亡率最高(44.44％及20.00％),NGT组最低(29.59％及7.52％),IGT干预组居二者之间(37.84％及12.53％).多因素分析调整基线年龄、性别、BMI、血压、吸烟和既往心血管事件的影响后,IGT未干预组的心血管病死亡率和心血管事件发生率为NGT组的1.89和1.38倍(HR=1.89,95％CI1.11～3.22;HR =1.38,95％CI1.01～1.90).而IGT干预组的心血管病死亡率和心血管事件发生率与正常对照组相比差异均无统计学意义(HR=1.39,95％CI0.89 ～2.18及HR=1.25,95％CI0.98～1.59).结论 IGT者心血管事件和死亡风险均显著高于NGT人群.数年生活方式干预可以减少长期心脑血管事件发生率和心血管病死亡率.
목적 탐토당뇨병전기인군강화생활방식간예대심뇌혈관사건급사망적장기영향.방법 1986년입선대경시519례당내량정상(NGT)자화577례당내량감저(IGT)자.IGT자피수궤분도대조조화음식、운동혹음식가운동간예조진행6년생활방식간예.통과문권화계통병력사열,근종조사수후23년간수차심혈관사건(심기경사、졸중)화사망상황.결과 IGT미간예조심혈관사건발생솔화사망솔최고(44.44％급20.00％),NGT조최저(29.59％급7.52％),IGT간예조거이자지간(37.84％급12.53％).다인소분석조정기선년령、성별、BMI、혈압、흡연화기왕심혈관사건적영향후,IGT미간예조적심혈관병사망솔화심혈관사건발생솔위NGT조적1.89화1.38배(HR=1.89,95％CI1.11～3.22;HR =1.38,95％CI1.01～1.90).이IGT간예조적심혈관병사망솔화심혈관사건발생솔여정상대조조상비차이균무통계학의의(HR=1.39,95％CI0.89 ～2.18급HR=1.25,95％CI0.98～1.59).결론 IGT자심혈관사건화사망풍험균현저고우NGT인군.수년생활방식간예가이감소장기심뇌혈관사건발생솔화심혈관병사망솔.
Objective To investigate if a six-year intensive lifestyle intervention in people with prediabetes lead to reduction of cardiovascular events and cardiovascular disease (CVD) mortality in subsequent 23 years.Methods Five hundreds and nineteen subjects with normal glucose tolerance (NGT) and 577 subjects with impaired glucose tolerance (IGT) in Da Qing city were recruited in the study in 1986.The IGT subjects randomly assigned to either the no-intervention group or one of three lifestyle intervention groups (diet,exercise,or diet plus exercise) to receive a 6-year lifestyle intervention.In 2009,the participants were followed up to assess the primary outcomes of cardiovascular events and CVD mortality by a questionnaire and medical records.Results Subjects in IGT no-intervention group had the highest incidences of cardiovascular events (44.44％) and CVD mortality (20.00％),while those in NGT group had the lowest incidences of cardiovascular events (29.59％) and CVD mortality (7.52％) after 23-year follow-up.The incidences of cardiovascular events and CVD mortality in IGT intervention subjects were 37.84％ and 12.53％,respectively.The multivariable analyses showed that,after controlling of age,gender,BMI smoking,blood pressure and cardiovascular event at baseline,the CVD mortality and incidence of cardiovascular events in IGT no-intervention group was 1.89 (HR =1.89,95 ％ CI 1.11-3.22,P =0.02) and 1.38(HR =1.38,95％ CI 1.01-1.90,P =0.04) times of those in NGT group.However,the CVD mortality and incidence of cardiovascular events were not different in the IGT intervention group compared with those in the NGT group (HR =1.39,95 ％ CI 0.89-2.18,P =0.15 and HR =1.25,95％ CI 0.98-1.59,P =0.07,respectively).Conclusions Subjects with IGT were at high risk for cardiovascular events and mortality.A six-year lifestyle intervention in this population can reduce both the incidence of cardiovascular event and CVD mortality.