Glucose intolerance associated with hypoxia in people living at high altitudes in the Tibetan highland.
Glucose intolerance associated with hypoxia in people living at high altitudes in the Tibetan highland.
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DOI：
10.1136/bmjopen-2015-009728
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发表时间：
2016-02-23
期刊：
影响因子：
2.9
通讯作者：
Matsubayashi K
中科院分区：
文献类型：
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作者：
Okumiya K;Sakamoto R;Ishimoto Y;Kimura Y;Fukutomi E;Ishikawa M;Suwa K;Imai H;Chen W;Kato E;Nakatsuka M;Kasahara Y;Fujisawa M;Wada T;Wang H;Dai Q;Xu H;Qiao H;Ge RL;Norboo T;Tsering N;Kosaka Y;Nose M;Yamaguchi T;Tsukihara T;Ando K;Inamura T;Takeda S;Ishine M;Otsuka K;Matsubayashi K
旨在阐明西藏高原地区缺氧环境中葡萄糖耐受不良与高海拔（2900-4800 m）之间的关系，并验证高海拔居住会增加因生活方式改变或老龄化而加速糖尿病（DM）的易感性这一假设。西藏高原地区横断面流行病学研究.我们招募了 1258 名年龄在 40-87 岁之间的参与者。农村人口包括Domkhar（海拔2900-3800米）的农民和海盐（3000-3100米）、Ryuho（4400米）和Changthang（4300-4800米）的游牧民族。市区参与者来自列城（海拔3300米）和结古（海拔3700米）。参与者被分为六个基于葡萄糖耐量的组：DM、中度高血糖 (IHG)、正常血糖 (NG)、空腹 DM、空腹 IHG 和空腹 NG。比较了农民、游牧民族和城市居民的葡萄糖不耐症患病率。结合年龄、性别、肥胖、血脂、血红蛋白、高血压和生活方式等混杂因素，采用多元Logistic回归分析居住高海拔或缺氧对糖耐受不良的影响。所有参与者中 DM（空腹 DM）/IHG（空腹 IHG）患病率分别为 8.9% (6.5%)/25.1% (12.7%)。与游牧民族 (8.2% (5.7%)/15.7% (9.7%)) 相比，城市居民 (9.5% (7.1%)/28.5% (11.7%)) 和农民 (8.5% (6.1%)/28.5% (18.3%)) 的患病率较高 (p=0.0140/0.0001)。居住在高海拔地区与空腹 IHG+空腹 DM/空腹 DM 显着相关（>4500 和 3500-4499 m 的 OR 分别为 3.59/4.36 和 2.07/1.76 与 <3500 m 相比）。调整生活方式的改变后，低氧血症和红细胞增多症与葡萄糖耐受不良密切相关。社会经济因素、低氧血症和海拔>3500米的影响在高地人葡萄糖不耐受的高患病率中发挥着重要作用。西藏高地人可能容易出现葡萄糖不耐受，红细胞增多症是缺氧适应能力差的表现，生活方式的改变和衰老会加速这种情况。
To clarify the association between glucose intolerance and high altitudes (2900–4800 m) in a hypoxic environment in Tibetan highlanders and to verify the hypothesis that high altitude dwelling increases vulnerability to diabetes mellitus (DM) accelerated by lifestyle change or ageing. Cross-sectional epidemiological study on Tibetan highlanders. We enrolled 1258 participants aged 40–87 years. The rural population comprised farmers in Domkhar (altitude 2900–3800 m) and nomads in Haiyan (3000–3100 m), Ryuho (4400 m) and Changthang (4300–4800 m). Urban area participants were from Leh (3300 m) and Jiegu (3700 m). Participants were classified into six glucose tolerance-based groups: DM, intermediate hyperglycaemia (IHG), normoglycaemia (NG), fasting DM, fasting IHG and fasting NG. Prevalence of glucose intolerance was compared in farmers, nomads and urban dwellers. Effects of dwelling at high altitude or hypoxia on glucose intolerance were analysed with the confounding factors of age, sex, obesity, lipids, haemoglobin, hypertension and lifestyle, using multiple logistic regression. The prevalence of DM (fasting DM)/IHG (fasting IHG) was 8.9% (6.5%)/25.1% (12.7%), respectively, in all participants. This prevalence was higher in urban dwellers (9.5% (7.1%)/28.5% (11.7%)) and in farmers (8.5% (6.1%)/28.5% (18.3%)) compared with nomads (8.2% (5.7%)/15.7% (9.7%)) (p=0.0140/0.0001). Dwelling at high altitude was significantly associated with fasting IHG+fasting DM/fasting DM (ORs for >4500 and 3500–4499 m were 3.59/4.36 and 2.07/1.76 vs <3500 m, respectively). After adjusting for lifestyle change, hypoxaemia and polycythaemia were closely associated with glucose intolerance. Socioeconomic factors, hypoxaemia and the effects of altitudes >3500 m play a major role in the high prevalence of glucose intolerance in highlanders. Tibetan highlanders may be vulnerable to glucose intolerance, with polycythaemia as a sign of poor hypoxic adaptation, accelerated by lifestyle change and ageing.