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北京中日友好医院杨文英博士成功发文国际顶级杂志《新英格兰医学杂志》

中日友好医院, 杨文英, 国际顶级杂志, 新英格兰医学杂志
Prevalence of Diabetes among Men and Women in China



ABSTRACT

Background Because of the rapid change in lifestyle in China, there is concern that diabetes may become epidemic. We conducted a national study from June 2007 through May 2008 to estimate the prevalence of diabetes among Chinese adults.

Methods A nationally representative sample of 46,239 adults, 20 years of age or older, from 14 provinces and municipalities participated in the study. After an overnight fast, participants underwent an oral glucose-tolerance test, and fasting and 2-hour glucose levels were measured to identify undiagnosed diabetes and prediabetes (i.e., impaired fasting glucose or impaired glucose tolerance). Previously diagnosed diabetes was determined on the basis of self-report.

Results The age-standardized prevalences of total diabetes (which included both previously diagnosed diabetes and previously undiagnosed diabetes) and prediabetes were 9.7% (10.6% among men and 8.8% among women) and 15.5% (16.1% among men and 14.9% among women), respectively, accounting for 92.4 million adults with diabetes (50.2 million men and 42.2 million women) and 148.2 million adults with prediabetes (76.1 million men and 72.1 million women). The prevalence of diabetes increased with increasing age (3.2%, 11.5%, and 20.4% among persons who were 20 to 39, 40 to 59, and 60 years of age, respectively) and with increasing weight (4.5%, 7.6%, 12.8%, and 18.5% among persons with a body-mass index [the weight in kilograms divided by the square of the height in meters] of <18.5, 18.5 to 24.9, 25.0 to 29.9, and 30.0, respectively). The prevalence of diabetes was higher among urban residents than among rural residents (11.4% vs. 8.2%). The prevalence of isolated impaired glucose tolerance was higher than that of isolated impaired fasting glucose (11.0% vs. 3.2% among men and 10.9% vs. 2.2% among women).

Conclusions These results indicate that diabetes has become a major public health problem in China and that strategies aimed at the prevention and treatment of diabetes are needed.

一项新近开展的研究表明,目前将近1/10的中国成年人都患有糖尿病,尽管其中60%以上尚未确诊。该研究估计,中国的糖尿病负担将位居世界各国之首。



3月24日,《新英格兰医学杂志》(New England Journal of Medicine)刊载了一项研究报告。该研究小组由北京中日友好医院的杨文英博士领导,共有20名研究者参与,他们对2007年6月~2008年5月城镇和农村地区年龄在20岁以上的46,239名中国籍男性和女性的数据进行了分析。



研究者还发现,在受试人群中,糖尿病前期的患病率高达15.5% (男性16.1%,女性14.9%)。较之农村居民,糖尿病在城镇居民中更为常见(11.4%对8.2%),不过,农村居民更容易出现已经患病但之前并未诊断的情况(N. Engl. J. Med. 2010;12;1090-101)。



研究者估计中国患有糖尿病的成年人口高达0.924亿之多,还有1.428亿糖尿病前期患者。研究者总结道,这些数据表明,糖尿病已经成为“中国的一大公共卫生问题”,必需对此制定更加完善的防治策略。



研究者通过问卷调查来确定哪些人之前已确诊患有糖尿病,同时也在受试者整夜禁食后开展了口服葡萄糖耐量试验,结果发现,糖尿病的总患病率为9.7% (男性10.6%,女性8.8%)。在所有这些病例中,60.7%之前都未确诊其患有糖尿病。作为杨博士的同事也是该研究的作者之一,中日友好医院的肖建中博士说,虽然中国的卫生部门已充分意识到全国的糖尿病患病率持续呈现上升趋势已经有一段时间了(这种趋势很可能与城镇化及其带来的饮食和锻炼模式的改变有关),但这次新的研究数据可能还是会让一部分人惊讶。肖博士在采访中说:“他们可能不相信目前的情况已经如此糟糕。”肖博士称,该研究由中国政府资助,是中国到目前为止开展的最为全面的一项糖尿病调查。所有作者都声明无相关利益冲突。



研究者还引用了早期开展的一些研究的结果:1980~1994年中国的糖尿病患病率增加了3倍之多,当时所估计的糖尿病患病率为2.5% (Chin. Med. J. 1981;20:678-81 and Diabetes Care 1997;20:1664-9)。截至2001年,全国的糖尿病患病率已经达到5.5% (Diabetologia 2003;46:1190-8)。



但研究者认为,早期开展的研究很可能低估了糖尿病的患病率,因为并不是所有的受试者都接受了2h口服葡萄糖耐量试验。研究者写道:“经研究证实,单纯糖负荷后2h高血糖在亚洲糖尿病患者中较为常见。”



因此,杨博士及其同事只将那些完成了2h葡萄糖耐量试验的患者纳入了分析。肖博士说:“2001年开展的那项研究就只测定了空腹血糖。”该研究发现,单纯糖耐量异常的患病率远远高于单纯空腹血糖异常的患病率(男性11.0%对3.2%,女性10.9%对2.2%)。



肖博士说,未确诊糖尿病的患病率很高,在农村地区高达70%的糖尿病病例之前都没有确诊,这一研究结果尤其令人担忧。肖博士表示,他希望这项研究能够说服中国的卫生部门考虑对年龄在40岁以上的居民每年开展一次空腹血糖检查。肖博士说:“实施这一计划只需花费很少的资金。”



该研究的局限性包括女性和城镇居民的样本量偏大,不过研究者称,在计算统计权重时已对这些因素进行了校正。此外,该研究没有评价受试者的膳食摄入情况以及与工作相关的体力活动。研究者还指出,该研究采用的是世界卫生组织的诊断标准来定义糖尿病。但研究者承认:“对于血糖类别与微血管和大血管疾病之间的关系,尚未在中国人口中予以广泛调查。”



Source Information

From China–Japan Friendship Hospital, Beijing (W.Y., J.X.); Chinese People's Liberation Army General Hospital, Beijing (J. Lu); Sun Yat-sen University Third Hospital, Guangzhou (J.W.); Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai (W.J.); Peking University People's Hospital, Beijing (L.J.); First Affiliated Hospital, Chinese Medical University, Liaoling (Z.S.); Shanxi Province People's Hospital, Taiyuan, Shaanxi (J. Liu); West China Hospital, Sichuan University, Chengdu, Sichuan (H.T.); Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi (Q.J.); Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu (D.Z.); Xinjiang Uygur Autonomous Region's Hospital, Urmqi, Xinjiang (J.G.); Fujian Provincial Hospital, Fuzhou, Fujiang (L.L.); Qilu Hospital, Qilu Hospital of Shandong University, Jinan, Shandong (L.C.); Peking University First Hospital, Beijing (X.G.); Henan Province People's Hospital, Zhengzhou, Henan (Z. Zhao); Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang (Q.L.); Xiangya Second Hospital, Changsha, Hunan (Z. Zhou); and Peking Union Medical College, Beijing (G.S.) — all in China; and Tulane University School of Public Health and Tropical Medicine, New Orleans (J.H.).

Address reprint requests to Dr. Yang at the Department of Endocrinology, China–Japan Friendship Hospital, Beijing 100029, China, or at ywy_1010@yahoo.com.cn.

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