摘要目的:探讨上海崇明地区中老年人群血红蛋白与糖尿病的相关性。方法:采取随机整群抽样法以上海崇明区城桥镇7 534名常驻居民为研究对象，完成规范的问卷调查、体格检查和相关实验室检查，血红蛋白浓度采用氰化高铁血红蛋白分光光度法测定。根据1999年世界卫生组织诊断标准以及病史将调查人群分为正常糖代谢组、新诊断糖尿病组和已知糖尿病组，根据世界卫生组织贫血诊断标准将调查人群分为贫血组和非贫血组。采用二元logistic回归模型评估不同血红蛋白水平四分位数间2型糖尿病的发生风险。血红蛋白与临床及实验室等代谢指标间的相关系数采用Spearman相关分析进行评价。结果:基线总人群中，正常糖代谢组（ n=5 579）贫血患病率[275（4.9%）]高于新诊断糖尿病组（ n=1 203）和已知糖尿病组（ n=752）[23（1.9%）及22（2.9%）]，已知糖尿病组贫血患病率高于新诊断糖尿病组，差异有统计学意义（ P<0.01）。腰围（ r=0.257）、臀围（ r=0.155）、体质指数（ r=0.141）、空腹血糖（ r=0.232）、糖负荷后2 h血糖（ r=0.140）、糖化血红蛋白（ r=0.028）、胰岛素（ r=0.036）、稳态模型评估胰岛素抵抗指数（ r=0.102）、低密度脂蛋白胆固醇（ r=0.056）、总胆固醇（ r=0.054）、甘油三酯（ r=0.202）均与血红蛋白呈正相关（ P均<0.05）。将基线正常糖代谢人群根据血红蛋白进行四分位，3年后随访，血红蛋白第4四分位数组的糖尿病新发率、空腹血糖、糖负荷后2 h血糖均高于第1四分位数组（ P<0.01）。在校正其他风险因素后，血红蛋白第4四分位数组其2型糖尿病发生风险较第1四分位数组显著增加，优势比为1.415，95%可信区间为1.087~1.841， P<0.01。 结论:血红蛋白与糖尿病发生率存在明显正相关，高血红蛋白水平是2型糖尿病的独立危险因素和潜在的预测指标。

abstractsObjective:To investigate the relationship of hemoglobin level with type 2 diabetes in middle-aged and elderly population in Shanghai Chongming District.Methods:A populational-based array research with multiple stage stratified cluster and random sampling was performed to study 7 534 residents from a community in Shanghai Chongming District. The standardized questionnaires, physical examinations and related laboratory tests were undertaken. The hemoglobin concentration was determined by cyanmethemoglobin spectrophotometry. The participants were divided into non-diabetic group, newly diagnosed diabetic group and previously diagnosed diabetic group according to the 1999 WHO diagnostic criteria and medical history; the participants were also divided into non-anemia group and anemia group according to the 1999 WHO anemia diagnostic criteria. Binary logistic regression models were used to estimate the odds ratios (ORs) and confidence intervals (CIs) for diabetes mellitus for every quartile of hemoglobin compared to the lowest quartile. Spearman correlation analysis was used to estimate the association of all related metabolic parameters with hemoglobin.Results:The prevalence of anemia in the non-diabetic group [275 (4.9%)] was higher than that in the newly diagnosed diabetic group and the previously diagnosed diabetic group [23 (1.9%) and 22 (2.9%)] ( P<0.01). The prevalence of anemia in the previously diagnosed diabetic group was higher than that in the newly diagnosed diabetic group ( P<0.01). Hemoglobin levels were positively correlated with waist（ r=0.257）, hip（ r=0.155）, BMI（ r=0.141）, FPG（ r=0.232）, 2 h PG（ r=0.140）, HbA 1C（ r=0.028）, insulin（ r=0.036）, HOMA-IR（ r=0.102）, LDL-C（ r=0.056）, TC（ r=0.054） and TG（ r=0.202）( P<0.05). Non-diabetic people at baseline were quartile according to hemoglobin level. At follow-up, the incidence of diabetes, fasting blood glucose and 2 h plasma glucose after glucose loading were higher in the highest hemoglobin quartile population than the lowest quartile population. After adjusting for other influencing factors, binary logistic regression analysis showed that the highest quartile hemoglobin was associated with increased risk of T2DM, with a fully adjusted odds ratio ( OR) of 1.415 (95% confidence interval ( CI), 1.087 to 1.841, P<0.01). Conclusions:There is a significant positive correlation between hemoglobin and the incidence of diabetes. Increased level of hemoglobin level is an independent risk factor and potential predictor for incidence of type 2 diabetes in middle-aged elderly population in this study.