Iranian Journal of Endocrinology and Metabolism

fa شناسایی اختلال تحمل گلوکز ایزوله با استفاده از داده‌‌های بالینی رایج؛ مطالعه‌ی قند و لیپید تهران Identifying Isolated Impaired Glucose Tolerance Using Common Clinical Data Tehran Lipid & Glucose Study پژوهشی Original <span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ansi-font-size: 10.0pt mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US">مقدمه<span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ansi-font-size: 10.0pt mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US">: تعیین ویژگی‌های بالینی افراد دچار اختلال تحمل گلوگز ایزوله (<span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US">Isolated IGT<span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ansi-font-size: 10.0pt mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US">) که به صورت گلوکز ناشتای سرم (<span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US">FPG<span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ansi-font-size: 10.0pt mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US">) کمتر از 100 میلی‌گرم بر دسی‌لیتر و گلوکز 2 ساعته‌ی سرم (<span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US">2h-PG<span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ansi-font-size: 10.0pt mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US">) بین 140 و 200 میلی‌گرم بر دسی‌لیتر تعریف می‌شود. مواد و روش‌ها: در این مطالعه‌ی مقطعی، داده‌‌ها و یافته‌های آزمون تحمل گلوکز خوراکی (<span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US">OGTT<span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ansi-font-size: 10.0pt mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US">) مربوط به 8212 شرکت‌کننده‌ی مطالعه‌ی قند و لیپید تهران (4742 زن و 4370 مرد) با سن مساوی یا بیشتر 20 سال که مبتلا به دیابت بودند ارزیابی شد. مدل‌های رگرسیون لوجیستیک برای پیش‌بینی ابتلا به <span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US">IGT<span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ansi-font-size: 10.0pt mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US"> ایزوله در میان 7012 فرد دارای <span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US">FPG<span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ansi-font-size: 10.0pt mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US"> کمتر از 100 میلی‌گرم بر دسی‌لیتر ساخته شد. یافته‌ها: شیوع کلی <span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US">IGT<span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ansi-font-size: 10.0pt mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US">، 6/13% (تعداد 1120 نفر) بود که از این میان 6/59% (668 نفر) دچار <span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US">IGT<span dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ansi-font-size: 10.0pt mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US"> ایزوله بودند. در مدل بالینی، نسبت‌های شانس تطبیق داده شده برای ابتلا به<span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US"> IGT<span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ansi-font-size: 10.0pt mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US"> ایزوله، برای سن بالای 40 (6/2)، فشار خون بالا (9/1)، اضافه وزن (7/1)، یا چاقی (2/2)، سابقه‌‌ی خانوادگی دیابت (3/1) و جنس مؤنث (2/1) از نظر آماری معنی‌داری بودند. اضافه کردن پروفایل‌های لیپید به مدل بالینی، سطح زیر منحنی <span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US">(AUC)<span dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ansi-font-size: 10.0pt mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US"> را فقط اندکی افزایش داد (5/72% در مقابل 4/71% و 001/0<span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US">P=<span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ansi-font-size: 10.0pt mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US">). مدل بالینی دیگری شامل دور کمر، قدرت پیش‌بینی کنندگی مشابهی با مدل بالینی شامل جنسیت مؤنث داشت. (سطح زیر نمودار 7/71% در مقابل 4/71% و 15/0<span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US">P=<span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ansi-font-size: 10.0pt mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US">). نتیجه‌گیری: این آنالیز نشان داد که در بزرگسالان تهرانی با <span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US">FPG<span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ansi-font-size: 10.0pt mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US"> کمتر از 100 میلی‌گرم بر دسی‌لیتر، جنس مؤنث، سن بالا، سابقه‌ی خانوادگی دیابت، اضافه وزن یا چاقی و فشار خون بالا، به طور معنی‌داری با احتمال بالاتر وجود <span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US">IGT<span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ansi-font-size: 10.0pt mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-ansi-language: EN-US mso-fareast-language: EN-US"> ایزوله ارتباط دارند؛ بنابراین انجام آزمون تحمل گلوکز خوراکی در افراد دارای ویژگی‌های ذکر شده توصیه می‌شود. AbstractIntroduction:To determine the clinical traits of subjects with isolated impaired glucose tolerance (isolated-IGT) defined as fasting plasma glucose (FPG)<100 mg/dl and 2-hour plasma glucose (2h-PG) between 140 mg/dl and 200 mg/dl. Materials and Methods: In this cross-sectional study, we evaluated the data and results of oral glucose tolerance test (OGTT) from 8212 participants of the <city w:st="on"><place w:st="on">Tehran</place></city> Lipid and Glucose Study (4742 women and 3470 men) aged≥20 years, without diabetes. Logistic regression models for having isolated-IGT were developed among 7012 subjects with FPG<100 mg/dl to predict isolated-IGT. Results: The overall prevalence of IGT was 13.6% (n=1120) of these subjects, 59.6% (n=668) were isolated-IGT. In the clinical model, the adjusted odds ratios (OR) for having isolated-IGT were statistically significant for age≥40 years (2.6), hypertension (1.9), overweight (1.7) or obesity (2.2), family history of diabetes (1.3), and female gender (1.2). Adding the lipid profiles to the clinical model increased the area under the receiver-operating characteristics curve (AUC) only slightly (72.5% vs. 71.4%, P=0.001). The other clinical model including waist circumference had similar predictive power compared to the clinical model including female gender (AUC: 71.7 vs. 71.4, P=0.15). Conclusion: This analysis showed that in Tehranian adults with FPG<100 mg/dl, female gender, older age, family history of diabetes, overweight and obesity, and hypertension were significantly associated with a higher likelihood of isolated-IGT OGTT should hence be recommended in subjects with the above mentioned characteristics. : اختلال تحمل گلوکز ایزوله، تشخیص، غربالگری، آزمون تحمل گلوکز خوراکی (OGTT)، شیوع Isolated-impaired glucose tolerance, Diagnosis, Screening, Oral glucose tolerance test (OGTT), Prevalence 423 433 http://ijem.sbmu.ac.ir/browse.php?a_code=A-10-4-24&slc_lang=fa&sid=1 F. Hosseinpanah فرهاد حسین پناه fhospanah@erc.ac.ir 400031947532846004496 400031947532846004496 Yes M. Rambod مهدی رامبد 400031947532846004497 400031947532846004497 No A. Moteavalizadeh ardakani عماد متولی زاده اردکانی 400031947532846004498 400031947532846004498 No F. azizi فریدون عزیزی 400031947532846004499 400031947532846004499 No