2026 年第 8 期 第 21 卷

社会隔离与孤独对糖尿病前期人群血管疾病发病的影响

Effects of social isolation and loneliness on the onset of vascular diseases in prediabetic populations

作者：王一帆温海初贾立昕杜杰

英文作者：Wang Yifan Wen Haichu Jia Lixin Du Jie

单位：北京市心肺血管疾病研究所首都医科大学附属北京安贞医院心血管重塑相关疾病教育部重点实验室心血管重大疾病防治协同创新中心，北京100029

英文单位：The Key Laboratory of Cardiovascular Remodeling-related Diseases Ministry of Education Collaborative Innovation Center for Prevention and Treatment of Major Cardiovascular Diseases Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：糖尿病前期；社会隔离；孤独；血管疾病；危险因素

英文关键词：Prediabetes;Socialisolation;Loneliness;Vasculardiseases;Riskfactors

• 摘要：

• 目的 探讨客观社会隔离与孤独对糖尿病前期人群新发冠心病（冠状动脉粥样硬化性心脏病）及慢性肾脏病（CKD）的影响，并分析潜在的中介作用路径。方法 基于英国生物样本库开展前瞻性队列研究，纳入31 263例基线无冠心病及CKD的糖尿病前期个体。通过自我报告调查问卷评估基线社会隔离与孤独状态，采用Cox比例风险回归模型分析其与新发冠心病及CKD的关联，随后进行模型中介路径分析判断和计算中介效应量及中介比例。结果 中位随访15.3年，校正人口学、社会经济学、行为生活方式及生化指标后，孤独（风险比=1.23，95%置信区间：1.05～1.44）与社会隔离（风险比=1.16，95%置信区间：1.05～1.29）均是新发CKD的独立危险因素（均P<0.05），二者与新发冠心病风险的关联差异均无统计学意义（均P>0.05）。中介路径分析显示，在孤独与CKD的关联中，体重指数的中介比例为18.40%，睡眠状况、吸烟及饮酒的中介比例分别为5.50%、3.90%和1.78%。在社会隔离与CKD的关联中，吸烟、饮酒及睡眠状况的中介比例分别为5.35%、4.64%和1.26%，糖化血红蛋白及抑郁状态的中介比例分别为3.48%和2.09%，均表现出显著的中介效应（均P＜0.05）。结论 在糖尿病前期人群中，社会隔离与孤独均为新发CKD的独立危险因素，但并非冠心病的独立预测指标。行为生活方式和部分代谢因素在风险传递中发挥重要中介作用。

• Objective To explore the effects of objective  social isolation and loneliness on new-onset coronary atherosclerotic heart disease and chronic kidney disease (CKD) among prediabetic individuals, and analyze potential mediating pathways. Methods A prospective cohort study was conducted based on the UK Biobank, enrolling 31 263 prediabetic participants free of coronary atherosclerotic heart disease and CKD at baseline. Baseline social isolation and loneliness were assessed via self-reported questionnaires. Cox proportional hazards regression models were used to analyze their associations with incident coronary atherosclerotic heart disease and CKD, followed by mediating pathway analysis to identify and calculate mediating effect sizes and mediating proportions. Results The median follow-up duration was 15.3 years. After adjusting for demographic, socioeconomic, behavioral lifestyle and biochemical indicators, loneliness (hazard ratio=1.23, 95% confidence interval: 1.05-1.44) and social isolation (hazard ratio=1.16, 95% confidence interval: 1.05-1.29) were independent risk factors for new-onset CKD (both P<0.05), while neither showed statistically significant associations with the risk of incident coronary atherosclerotic heart disease (both P>0.05). Mediating pathway analysis demonstrated that in the association between loneliness and CKD, the mediating proportion of body mass index was 18.40%, and the mediating proportions of sleep status, smoking and alcohol drinking were 5.50%, 3.90% and 1.78%, respectively. In the association between social isolation and CKD, the mediating proportions of smoking, alcohol drinking and sleep status were 5.35%, 4.64% and 1.26%, and the mediating proportions of glycated hemoglobin and depression were 3.48% and 2.09%, all with significant mediating effects (all P＜0.05). Conclusions Both social isolation and loneliness are independent risk factors for incident CKD rather than independent predictors of coronary atherosclerotic heart disease in prediabetic populations. Behavioral lifestyle factors and partial metabolic factors exert critical mediating effects in risk transmission.