基于新分型方法的糖尿病亚型与心血管疾病发生风险的回顾性队列研究

doi:10.12183/j.scjpm.2026.0405

摘要/Abstract

摘要： 目的探讨基于新分型方法的糖尿病亚型与心血管疾病发生风险的关系,以推动精准分型管理和心血管疾病一级预防策略优化。方法回顾性队列研究,纳入2015—2022年843例初诊T2DM患者,收集基线临床资料,采用K-means聚类分为4种亚型,随访至2025年7月判定心血管结局,比较各亚型心血管事件发生风险。结果 828例T2DM患者中,SIDD 146例（17.63%）,SIRD 168例（20.29%）,MOD 173例（20.89%）,MARD 341例（41.18%）。不同亚型年龄、BMI等指标差异显著（P<0.05）。共86例（10.39%）发生心血管疾病,SIDD亚型15例（10.27%）,SIRD亚型30例（17.86%）,MOD亚型18例（10.40%）,MARD亚型23例（6.74%）,不同亚型心血管疾病发生有差异（Log-rank χ²值=17.132,P=0.001）。多因素Cox分析显示,T2DM亚型（SIDD亚型HR=3.484、SIRD亚型HR=4.999、MOD亚型HR=6.287）、年龄、eGFR、LDL-C是影响因素。Fine-Gray竞争风险模型和cause-specific Cox模型均显示SIRD分型是独立危险因素（HR=2.710、2.855,P<0.001）,SIDD、MOD分型作用无统计学意义（P>0.05）。结论新分型方法可评估T2DM患者心血管疾病风险,SIRD亚型是高危人群,应重点干预。

关键词: 2型糖尿病, 糖尿病亚型, 心血管疾病, 主要不良心血管事件, 回顾性队列研究, 聚类分析

Abstract: Objective To investigate the association between diabetes subtypes, classified using a novel typing method, and the risk of cardiovascular disease, in order to promote precision subtype management and optimize primary prevention strategies for cardiovascular diseases. Methods A retrospective cohort study was conducted on 843 patients newly diagnosed with type 2 diabetes mellitus (T2DM) between 2015 and 2022. Baseline clinical data were collected, and patients were categorized into four subtypes using K-means clustering. They were followed up until July 2025 to determine cardiovascular outcomes, and the risk of cardiovascular events among the subtypes was compared. Results Among the 828 T2DM patients, 146 (17.63%) were classified as Severe Insulin-Deficient Diabetes (SIDD), 168 (20.29%) as Severe Insulin-Resistant Diabetes (SIRD), 173 (20.89%) as Mild Obesity-Related Diabetes (MOD), and 341 (41.18%) as Mild Age-Related Diabetes (MARD). Significant differences in age, BMI, and other indicators were observed among the different subtypes (P<0.05). A total of 86 patients (10.39%) developed cardiovascular diseases. The incidence was 15 cases (10.27%) in the SIDD subtype, 30 (17.86%) in the SIRD subtype, 18 (10.40%) in the MOD subtype, and 23 (6.74%) in the MARD subtype. There was a statistically significant difference in the incidence of cardiovascular diseases among the subtypes (Log-rank χ²=17.132, P=0.001). Multivariate Cox analysis revealed that T2DM subtypes (SIDD: HR=3.484, SIRD: HR=4.999, MOD: HR=6.287), age, eGFR, and LDL-C were influencing factors. Both the Fine-Gray competing risk model and the cause-specific Cox model indicated that the SIRD subtype was an independent risk factor (HR=2.710 and 2.855, respectively; P<0.001), while the effects of the SIDD and MOD subtypes were not statistically significant (P>0.05). Conclusion The novel classification method can effectively assess the risk of cardiovascular disease in patients with T2DM. The SIRD subtype represents a high-risk population that should be prioritized for intervention.

Key words: Type 2 diabetes mellitus, Diabetes subtypes, Cardiovascular disease, Major adverse cardiovascular events, Retrospective cohort study, Cluster analysis

中图分类号:

R181.2

汤冰倩, 王平, 袁媛. 基于新分型方法的糖尿病亚型与心血管疾病发生风险的回顾性队列研究[J]. 华南预防医学, 2026, 52(4): 405-410.

Tang Bingqian, Wang Ping, Yuan Yuan. Novel diabetes subtypes and risk of incident cardiovascular disease: A retrospective cohort study[J]. South China Journal of Preventive Medicine, 2026, 52(4): 405-410.

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