摘要目的:探讨代谢综合征（MS）组分中糖耐量减低（IGT）对2型糖尿病（T2DM）发病风险的预测作用。方法:为回顾性队列研究。以2012年6月至2019年9月在解放军火箭军特色医学中心参加体检的1 989名年龄≥40岁且既往无T2DM的某部机关干部作为调查对象，对一般人口学信息、体格检查及实验室指标进行分析，并随访观察其T2DM发生情况作为研究结局。根据是否发生T2DM，将研究对象分为T2DM组和非T2DM组。采用Cox比例风险模型评估是否患有MS和（或）IGT人群发生T2DM的风险，并计算人口归因分数（PAF）以表达T2DM的发病归因于MS和IGT的比例。结果:平均随访时间为5.1年。随访期间，共有291例（14.63%）确诊T2DM。与非T2DM组（1 698例）比较，T2DM组患者年龄较大，糖尿病家族史、吸烟史比例更高，并且腰围、体重指数、收缩压、甘油三酯、空腹血糖及口服葡萄糖耐量试验糖负荷后2 h血糖水平更高（均 P<0.01）。在调整年龄、性别、吸烟、饮酒、运动、糖尿病族家族史等混杂因素后，与非MS人群相比，基线时患有MS的人群T2DM的发病风险（HR=2.84，95%CI 1.20~6.69）及PAF（PAF=18.70%，95%CI 11.82%~25.60%）均显著升高。IGT人群的T2DM发生风险（HR=3.17，95%CI 1.88~5.34）和PAF（PAF=21.63%，95%CI 10.07%~35.53%）均高于糖耐量正常者。具有IGT的非MS人群（PAF=11.50%，95%CI 10.71%~19.83%）比糖耐量正常的MS人群（PAF=0.69%，95%CI -5.75%~11.47%）与T2DM发生关联更强。代谢异常组分中含有IGT的MS患者其T2DM发生风险（HR=4.39，95%CI 2.40~8.04）及PAF最高（PAF=21.87%，95%CI 10.63%~37.34%）。 结论:本研究MS且代谢异常组分中含有IGT的人群其T2DM发病风险高。

abstractsObjective:To investigate the predictive role of impaired glucose tolerance (IGT) on the risk of type 2 diabetes mellitus (T2DM) in patients with metabolic syndrome (MS).Methods:This study was a retrospective cohort study. A total of 1 989 participants who underwent medical examination in PLA Rocket Force Characteristic Medical Center from June 2012 to September 2019 were enrolled. The participants were equal or more than 40 years old and without previous T2DM. The general information, physical examination data, and laboratory indexes were analyzed, and the occurrence of T2DM was followed up as the research outcome. According to occurrence of T2DM, the subjects were divided into T2DM group and non-T2DM group. Multivariate Cox regression analysis was used to assess the risk of T2DM in people with MS and (or) IGT, and the population attribution score (PAF) was calculated to express the proportion of T2DM attributed to MS and IGT.Results:The average follow-up time of the study was 5.1 years. During the follow-up period, a total of 291 people (14.6%) were diagnosed with T2DM. Compared with those without T2DM, individuals with T2DM were older and had higher waist circumference, body mass index, systolic blood pressure, triglycerides, fasting blood glucose, and oral glucose tolerance test 2-hours plasma glucose ( P<0.01). Participants with a family history of diabetes and a history of smoking were more likely to develop T2DM ( P<0.05). After adjusting for baseline age, gender, smoking, drinking, exercise, and family history of diabetes, participants with MC at baseline had a higher risk of developing T2DM (HR=2.84, 95%CI 1.20-6.69) and PAF (PAF=18.70%, 95%CI 11.82%-25.60%) than participants with non-MC. The risk of T2DM with IGT (HR=3.17, 95%CI 1.88-5.34) and PAF (PAF=21.63%, 95%CI 10.07%-35.53%) were higher than those with non-IGT. Participants with non-MC and IGT (PAF=11.50%, 95%CI 10.71%-19.83%) was more related to the incidence of T2DM than participants with MC and normal glucose tolerance (PAF=0.69%, 95%CI -5.75%-11.47%). Patients with MC who have IGT among the metabolic components have the highest risk of T2DM (HR=4.39, 95%CI 2.40-8.04) and the highest PAF (PAF=21.87%, 95%CI 10.63%-37.34%). Conclusions:In this certain department of physical examination center, individuals with both MC and IGT have the high risk of T2DM.