湖南地区中青年人群正常体质代谢异常和代谢正常肥胖表型的流行病学及生活方式危险因素研究

目的确定中青年人群中各种体质量代谢表型的患病率,尤其是正常体质代谢异常(MONW)和代谢正常肥胖(MHO)这两种特殊表型,并调查各表型相关的人口统计学和行为学因素。方法以中南大学湘雅三医院健康管理中心44 551例中青年(30～59岁)体检人群为研究对象,根据体质量和代谢状态将人群分为四种表型:正常体质代谢正常(MHNW)、正常体质代谢异常(MONW)、代谢正常肥胖(MHO)和代谢异常肥胖(MAO)。收集一般资料,进行体格检查及生化指标检测;采用Logistic回归分析评估生活方式因素与正常体质代谢异常和代谢正常肥胖表型的相关性。结果正常体质代谢正常、正常体质代谢异常、代谢正常肥胖、代谢异常肥胖表型在中青年人群中的患病率分别为58.0%、6.4%(占正常体质人群的10.0%)、18.0%和17.6%。多元Logistic回归分析结果显示,在校正了年龄、文化程度后,男性正常体质代谢异常表型与吸烟(OR=1.12,95%CI:1.02～1.24)、饮酒(OR=1.22,95%CI:1.11～1.35)呈正相关,与健康的饮食习惯(OR=0.88,95%CI:0.80～0.98)呈负相关。而女性正常体质代谢异常表型与中高度体育锻炼(OR=0.83,95%CI:0.73～0.93)和健康饮食习惯(OR=0.80,95%CI:0.71～0.90)呈负相关。结论在中青年人群中,正常体质代谢异常表型患病率为6.4%,约占正常体质人群的10.0%,代谢正常肥胖表型患病率为18.0%,约占肥胖人群的一半。代谢表型在不同性别的中青年人群之间具有不同的临床特征。为了预防体质量正常人群出现代谢异常,应多锻炼身体,健康饮食,尤其是男性还应该戒烟、戒酒。     

代谢健康型肥胖与动脉粥样硬化的相关性研究

目的探讨在40岁以上的中国社区人群中,代谢健康型肥胖与动脉粥样硬化患病风险的相关性。方法来自上海嘉定社区共9525名不伴有心血管疾病的居民(男性3621名、女性5904名)参与了本项研究。每位参与者均完成了调查问卷、体格检查[包括肱踝脉搏波传导速度(brachial-ankle pulse wave velocity,baPWV)和血压(blood pressure,BP)的测量],以及实验室检查。根据体重指数(body mass index,BMI)和代谢水平,将参与者分为4组,分别是代谢健康型非肥胖(metabolically healthy non-obese,MHNO)、代谢不健康型非肥胖(metabolically unhealthy non-obese,MUNO)、代谢健康型肥胖(metabolically healthy obese,MHO)和代谢不健康型肥胖(metabolically unhealthy obese,MUO)。baPWV>1400 mm/s被定义为高baPWV水平,脉压差(pulse pressure,PP)高于人群上四分位数被定义为高PP水平。利用多元logistic回归分析模型探究MHO与高baPWV水平以及高PP水平之间的相关性。结果多元logistic回归分析显示,在校正性别、年龄、当前吸烟、当前饮酒及受教育程度之后,与MHNO组比较,MHO组人群与高baPWV水平(OR=1.18,95%CI 1.02~1.37)和高PP水平(OR=1.72,95%CI 1.43~2.08)有显著相关性。另外,MUNO和MUO组人群的高baPWV水平(MUNO为OR=3.02,95%CI 2.60~3.50;MUO为OR=3.26,95%CI 2.87~3.70)和高PP水平(MUNO为OR=2.56,95%CI 2.17~3.02;MUO为OR=3.49,95%CI 3.01~4.06)患病风险显著升高。结论中国社区中老年人群中,MHO与动脉粥样硬化患病风险升高有显著相关性。     

中老年糖尿病高危人群血脂异常现状调查

目的探讨广州市中老年糖尿病高危人群血脂异常的分布情况及其危险因素。方法选取广州市5个社区年龄≥45岁且无糖尿病史居民619名,采用芬兰糖尿病风险积分(FINDRSC)表筛查糖尿病高危人群,FINDRSC≥9分者即为糖尿病高危人群并纳入研究。结果共208例糖尿病高危人群纳入研究。血脂异常患病率75.0%。单纯型血脂异常者占22.6%,混合型血脂异常者占52.4%。Logistic回归分析显示,WC(OR=1.063,95%CI:1.018~1.111)、臀围(OR=1.077,95%CI:1.022~1.134)、BMI(OR=1.154,95%CI:1.035~1.286)、FPG(OR=2.050,95%CI:1.316~3.195)、2hPG(OR=1.115,95%CI:1.012~1.228)、高血压(OR=2.220,95%CI:1.093~4.513)和FINDRSC(OR=1.320,95%CI:1.093~1.594)进入回归方程。结论广州市糖尿病高危人群血脂异常患病率较高,肥胖、高血压、高血糖和FINDRSC是血脂异常的危险因素。     

西藏与新疆地区常见代谢危险因素组合特点及其与左心室舒张功能障碍的相关性研究

目的 了解西藏与新疆地区常住居民常见代谢危险因素的不同组合,并探讨其与左心室舒张功能障碍（LVDD）的相关性。方法 采用分层多阶段随机抽样的方法于2015-2016年共抽取西藏与新疆地区≥35岁常住居民7 529名进行慢性心肺疾病调查,最终5 816名纳入分析,其中西藏地区1 958名,新疆地区3 858名。计算常见代谢危险因素不同组合的构成比和LVDD患病率,并用logistic回归模型分析主要组合的LVDD患病风险。结果 单一代谢危险因素中,西藏地区高血压占比最高,新疆地区是中心型肥胖;聚集数为2和3的组合中,中心型肥胖+高血压、中心型肥胖+高血压+高甘油三酯均为两地占比最高的组合。在西藏地区,中心型肥胖+高血压在所有组合中占比最高（34.0%）,其次为高血压（21.1%）,LVDD患病率分别为45.8%和40.2%;新疆地区中心型肥胖+高血压占构成比最高（20.1%）,其次为中心型肥胖（18.6%）,LVDD患病率分别为44.0%和27.8%。以无代谢危险因素的人群为参照,调整多种因素后的多元logistic回归分析结果显示,西藏地区LVDD患病风险最高的组合是中心型肥胖+高血压+高甘油三酯（OR=6.342,95%CI：3.359-11.973）,新疆地区为中心型肥胖+高血压（OR=2.872,95%CI：2.213-3.728）。结论 西藏与新疆地区中心型肥胖合并高血压人群LVDD的患病风险较高,应重点进行干预。     

成人肥胖测量指标与高血压患病关系

目的探讨成人肥胖测量指标与高血压患病的关系。方法利用江苏省2010年成人慢性病及其危险因素监测数据,描述新发现高血压患者在不同人群中的分布差异;运用双变量相关和非条件Logistic回归方法,分析体质量指数(BMI)、腰围、腰身比和体脂百分比等肥胖测量指标与血压及高血压患病的关系。结果江苏省成人新发现高血压患病率为35.3%,男性高于女性,患病率随年龄增长呈上升趋势(P0.05)。双变量相关分析结果表明,BMI、腰围、腰身比和体脂百分比等肥胖测量指标与收缩压和舒张压均成正相关。多因素非条件Logistic回归分析结果显示,肥胖(χ2=129.67,P0.05)、中心型肥胖(χ2=157.05,P0.05)、BMI(χ2=176.21,P0.05)、腰围(χ2=187.73,P0.05)、腰身比(χ2=221.49,P0.05)和体脂百分比(χ2=155.22,P0.05)均与高血压患病显著相关;BMI、腰围、腰身比和体脂百分比每增加1个标准差(SD),高血压患病风险分别增加59%(OR=1.59,95%CI:1.50~1.70)、60%(OR=1.61,95%CI:1.50~1.71)、68%(OR=1.68,95%CI:1.57~1.79)和149%(OR=2.49,95%CI:2.21~2.80)。BMI、腰围、腰身比和体脂百分比等肥胖测量指标对高血压患病风险的影响依次升高。结论 BMI、腰围、腰身比和体脂百分比与高血压患病相关,高血压患病风险随肥胖程度的增加而升高。     

广西合浦县农村居民高血压患病率调查

目的了解广西合浦县农村居民高血压患病率及其相关危险因素,为农村开展高血压等慢性病的防控工作提供依据。方法采用分阶段整群随机抽样的方法,随机抽取合浦县6个乡镇中18个自然村屯内的所有20岁以上常住居民作为研究对象,进行面对面的问卷调查和体格检查。结果合浦县农村居民高血压患病率为16.05%,其中男性患病率为16.26%,女性患病率为15.83%,差异无统计学意义(P0.05)。男女高血压患病率均随年龄的增长而明显上升(P0.01)。不同乡镇农村居民的高血压患病率也存在明显差异(P0.01)。Logistic回归分析结果显示,该人群患高血压的危险因素为年龄(OR=1.054,95%CI=1.049~1.059)、职业因素(OR=1.702~9.491,95%CI=1.280~14.928)、超重或肥胖(OR=3.230,95%CI=2.308~4.521)、有高血压家族史(OR=3.790,95%CI=2.554~5.623)、以荤食为主的饮食习惯(OR=2.646,95%CI=1.762~3.974)、吸烟(OR=2.539,95%CI=2.183~2.952)、饮酒(OR=1.549,95%CI=1.273~1.885)。高中以上文化程度为高血压的保护因素(OR=0.669,95%CI=0.486~0.921)。结论合浦县农村居民高血压患病率属较高水平,超重或肥胖、吸烟、饮酒、荤食为主的饮食习惯等可控的高血压危险因素普遍存在,应加强农村居民高血压等慢性病健康宣传教育,倡导健康的生活方式,以降低高血压的患病率。     

北京某医院体检人群代谢综合征与高尿酸血症的相关性调查

目的探讨体检人群代谢综合征(MS)各组分与高尿酸血症的相关性。方法收集2015年在北京电力医院行健康体检的年龄大于18岁的人群资料,并采用多因素Logistic回归分析MS各组分与高尿酸血症的相关性。结果本研究共入选12 335例调查对象,其中男性7 681例,女性4 654例,平均年龄(45.5±14.2)岁。高尿酸血症的患病率为18.30%(2 257/12 335),MS人群高尿酸血症的患病率高于非MS人群(P<0.001)。MS各组分中,超重(OR=2.310,95%CI:2.054~2.598)、肥胖(OR=3.920,95%CI:3.413~4.502)、血压升高(OR=1.660,95%CI:1.505~1.831)、空腹血糖升高(OR=1.445,95%CI:1.292~1.617)、三酰甘油升高(OR=2.935,95%CI:2.660~3.237)和高密度脂蛋白胆固醇降低(OR=2.009,95%CI:1.815~2.224)与高尿酸血症的患病有显著相关性(均为P<0.05)。结论体检人群中MS各组分与高尿酸血症的发生具有一定关联。     

青岛市城阳区老年慢性非传染性疾病的流行病学调查

目的了解青岛市城阳区老年常住居民常见慢性非传染性疾病患病流行情况及其影响因素,为老年慢性病的干预治疗提供理论依据。方法采用多阶段分层随机抽样方法对青岛市城阳区8个街道的9 198名≥65岁常住居民进行问卷调查。结果流行病学调查发现,65~69岁年龄组参与度最高,比例为42.81%。老年慢性病非传染性疾病患病率前4位的依次为高血压(HT)6 546人(71.16%)、超重/肥胖(OW/OB)6 312人(68.62%)、血脂异常(DLP)5 996人(65.18%)和高血糖(HG)5 856人(63.66%)。多因素Logistic回归分析结果表明,慢性非传染性疾病患病风险与年龄(OR=4.547,95%CI=3.162~7.834)、吸烟(OR=3.252,95%CI=2.125~4.608)、高脂肪和低植物(OR=3.870,95%CI=3.440~4.202)、心理状态(OR=2.426,95%CI=2.030~2.880)和丧偶(OR=1.148,95%CI=1.041~1.504)呈正相关;与文化程度大专及以上(OR=0.513,95%CI=0.419~0.780)、自我保健认知度(OR=0.452,95%CI=0.310~0.762)、家庭经济收入(OR=0.956,95%CI=0.936~0.989)、身体活动水平(OR=0.845,95%CI=0.796~0.995)呈负相关。结论HT、OW/OB、DLP及HG是青岛市城阳区老年常住居民常见的慢性病,慢性病患病的影响因素为年龄、吸烟情况、戒烟、高脂肪和低植物、心理状态和丧偶;文化程度大专及以上、自我保健认知度、家庭经济收入、身体活动水平是其保护因素。     

老年人膳食多样化与高同型半胱氨酸血症的关系

目的探讨膳食多样化对高同型半胱氨酸血症(HHcy)病人的影响,为指导老年人防治HHcy提供膳食干预依据。方法以"北京市老龄化多维纵向研究"2009年的调查人群为研究对象,进行膳食调查,并检测总同型半胱氨酸(t Hcy)。根据食物对t Hcy代谢的不同影响,将日常膳食分为富含维生素(Vit)B12/叶酸/甜菜碱饮食、Vit饮食B6、抗氧化剂饮食三类,分别计算三类膳食的膳食多样化评分(DDS),将t Hcy15μmol/L定义为HHcy,采用Logistic回归分析三类膳食DDS分值与患HHcy的关系。结果 1458人中有902人血清t Hcy升高,HHcy的患病率为61.9%。HHcy的患病风险与富含Vit B12/叶酸/甜菜碱类膳食DDS分值呈剂量-反应关系,与≤1分组相比,2分组、3分组、4分组老年人HHcy患病风险分别降低了44%(OR=0.56,95%CI:0.37~0.86,P=0.008)、51%(OR=0.49,95%CI:0.33~0.74,P=0.001)和67%(OR=0.33,95%CI:0.22~0.50,P0.001),控制各项混杂因素后,依然保持这一趋势。同时发现增加富含Vit B6膳食的摄入,是HHcy的保护因素,控制各项混杂因素后,2分组、3分组老年人患病风险比0分组分别降低了37%和53%(OR=0.63,95%CI:0.44~0.89,P=0.009;OR=0.47,95%CI:0.30~0.73,P=0.001)。未发现多样化摄入富含抗氧化剂食物与患HHcy相关。结论老年人多样化摄入富含Vit B12/叶酸/甜菜碱膳食及Vit B6膳食均可明显降低HHcy患病风险。     

社区老年人血脂异常分布及其影响因素分析

目的调查北京市万寿路地区60~95岁老年人血脂异常的患病率及影响因素。方法采用横断面设计随机整群抽取2102例常驻老年居民进行健康状况调查,将年龄划分为60~69岁、70~79岁和80~95岁3个年龄段进行血脂异常患病率分析,并采用多因素logistics回归分析性别间血脂异常的影响因素。结果 2102例老年人中,总的血脂异常、高TC、高LDL-C、低HDL-C和高TG患病率分别为38.9%、17.3%、14.0%、14.4%和17.8%。男性各年龄段的低HDL-C患病率高于女性,高TC、高LDL-C患病率均低于女性(P0.05)。此外,仅男性高TG患病率随年龄增长整体呈下降趋势(P=0.033)。多因素回归分析显示,空腹血糖(OR=1.091,95%CI:1.033~1.153,P=0.002)、血尿酸(OR=1.003,95%CI:1.002~1.004,P=0.000)和腰围(OR=1.026,95%CI:1.014~1.037,P=0.000)为共同的危险因素。结论老年人血脂异常存在性别差异,亟待开展针对性的干预措施。     

抗菌药物预防克罗恩病术后复发的Meta分析

目的 评价抗菌药物预防克罗恩病（CD）术后复发的有效性和安全性.方法 计算机检索Pubmed、Cochrane Central Register of Controlled Trials、EMbase、中国生物医学文献数据库、中国知网和万方数据库,查找所有抗菌药物预防克罗恩病术后复发的随机对照实验.按纳入、排除标准由两人独立进行文献筛选、资料提取和质量评价后,采用Rev Man 5.2软件进行Meta分析.结果 共纳入3个研究221例患者.Meta分析结果显示：（1）有效性方面：与安慰剂组比较,抗菌药物组术后3个月内镜复发率低（OR=0.40,95％ CI为0.22～0.73,P＜0.01）;术后12个月、24个月临床复发率亦低（OR =0.21,95％ CI为0.09 ～ 0.48,P＜0.01;OR=0.48,95％ CI为0.23～0.98,P＜0.05）.（2）安全性方面：与安慰剂组比较,抗菌药物组术后12个月内发生不良反应人次以及不良反应事件均较多（OR=5.13,95％ CI为2.45～10.72,P＜0.01;OR =3.51,95％ CI为2.14～5.76,P＜0.01）.结论 与安慰剂相比,抗菌药物可以显著减少CD术后的内镜复发和临床复发,但是使用抗菌药物出现的不良反应较多.     

新疆农村地区慢性阻塞性肺疾病的危险因素调查

目的 探讨新疆农村地区COPD危险因素的特点。方法 2007年12月至2010年12月,采用统一的流行病学调查表,以整群随机抽样方法抽取新疆南部和北部农村常住人口3575人为调查对象,进行问卷调查和肺功能检测。以支气管舒张试验后FEV1/FVC＜ 70％,并排除其他心肺疾病作为COPD的诊断标准。采用logistic回归分析方法进行危险因素分析。结果 将资料完整的3489人纳入分析,新疆农村COPD总患病率为4.0％ (138/3489),诊治率仅为14.5％(20/138),维吾尔族的检出率最高(5.1％,90/1774),其次是哈萨克族(3.3％,26/784),汉族的检出率最低(2.4％,22/921),50岁以上人群的COPD检出率明显增高(＞10％,94/743)。COPD患病风险增加的因素有维吾尔族（OR=2.79,95％CI为1.71 ～4.57）、年龄＞30岁（OR =3.41,95％ CI为1.62～7.18）、家族呼吸系统疾病史（OR= 1.68,95％ CI为1.11 ～2.53）和烹饪行为（OR= 1.47,95％CI为1.02 ～2.12）。结论 新疆农村地区COPD患病风险与维吾尔族、年龄、家族呼吸系统疾病史及烹饪行为密切相关。需进一步了解不同民族间COPD患病风险与基因的关系,以及该地区COPD患病风险与生物燃料烟雾的关系。     

Transitions in metabolic health status over time and risk of heart failure: A prospective study

Aims- Evidence for the effects of metabolically healthy obese (MHO) status on heart failure (HF) is limited and ignores the dynamic change of metabolic health and obesity phenotypes. We aimed to investigate the associations of metabolic health and its transition with HF across body mass index (BMI) and waist circumference (WC) categories.Methods- This prospective cohort study was conducted with 93,288 Chinese adults who were free of cardiovascular disease, cancer or HF at baseline (2006–2007). Metabolic health was defined as having no or only one abnormality in blood pressure, glucose, high-density lipoprotein cholesterol, or triglyceride levels. Participants were cross-classified at baseline by metabolic health and obesity (defined by BMI and WC criteria). Transitions in metabolic health status from 2006 to 2007 to 2010 to 2011 were considered. The hazard ratios (HRs) and 95% confidence intervals (CIs) for HF were assessed by Cox proportional hazards regression.Results- During a mean ± standard deviation follow-up of 9.7 ± 1.5 years, 1,628 participants developed HF. Individuals with MHO (HR: 1.78, 95% CI: 1.45, 2.19 for BMI criteria; HR: 1.51, 95% CI: 1.30, 1.76 for WC criteria) had higher risk of HF than those with metabolically healthy normal weight (MHNW). Individuals with initial MHO who shifted to metabolically unhealthy phenotype during follow-up had higher risk of HF compared with stable MHNW individuals (HR 3.12; 95% CI: 2.01, 4.85 for BMI categories; HR 1.98; 95% CI: 1.42, 2.77 for WC categories). Even stable MHO individuals were at an increased risk of HF compared with stable MHNW individuals (HR: 2.17; 95% CI: 1.39, 3.39 for BMI categories; HR: 1.33; 95% CI: 0.96, 1.85 for WC categories).Conclusions- MHO phenotype is dynamic and its transition to metabolically unhealthy phenotype or even stable MHO is associated with increased risk of HF. Maintaining metabolic health may provide a clue for preventing HF.     

农村维吾尔族成人慢性牙周炎与高血压的相关性

目的 探讨农村维吾尔族成人慢性牙周炎与高血压的相关性.方法 采用分层随机抽样的方法从新疆维吾尔自治区墨玉县364个自然村按容量比例概率抽样,随机抽取1415名维吾尔族成人(≥18岁),进行问卷调查、体格测量、实验室检查及口腔检查.依据慢性牙周炎的诊断标准,将调查对象分为牙周炎组和非牙周炎组,其中牙周炎组按其严重程度进一步分为:轻度牙周炎组,中度牙周炎组和重度牙周炎组.牙周炎与高血压的关系采用Spearman相关分析.应用logistic回归模型对高血压相关影响因素进行分析.结果 慢性牙周炎患病粗率为66.0％( 934/1415),高血压患病粗率为33.8％ (478/1415),非牙周炎及轻度、中度、重度牙周炎组高血压的患病比例为18.7％(90/481),35.1％ (131/373),32.3％ (62/192),52.8％ (195/369).Speaman相关分析结果显示牙周炎与高血压呈正相关(rs =0.273,P＜0.01).校正年龄、性别、体质指数、腰围、糖代谢异常、高脂血症、慢性肾脏病后,多因素logstic回归分析显示牙周炎组高血压患病风险为非牙周炎组的1.75倍(OR= 1.75,95％CI:1.30 ～2.36,P＜0.01),轻度牙周炎组高血压患病风险为非牙周炎组的1.76倍(OR=1.76,95％ CI:1.26 ～2.48,P＜0.01),中度牙周炎组高血压患病风险为非牙周炎组的1.21倍(OR= 1.21,95％ CI:0.80～1.84,P＞0.05),重度牙周炎组高血压患病风险为非牙周炎组的2.26倍(OR =2.26,95％ CI:1.57 ～3.26,P＜0.01).结论 农村维吾尔族成人慢性牙周炎与高血压独立相关.     

天津市糖尿病高危人群血脂异常患病率及相关危险因素分析

目的 探讨天津市糖尿病高危人群血脂异常患病率及相关危险因素.方法 在天津地区采用随机数字法选取1 364名无明确糖尿病病史的健康查体者作为筛查对象.采用芬兰糖尿病风险积分表(FINDRSC)筛查糖尿病高危人群,将纳入的445名糖尿病高危人群按是否合并血脂异常分为血脂异常组(n =316)和血脂正常组(n=129).比较两组间一般情况、生化指标及胰岛素抵抗和胰岛β细胞功能状态,测定纤溶酶原激活物抑制因子-1(PAI-1)及颈动脉内膜-中层厚度(IMT),并分析糖尿病高危人群血脂异常患病率及相关危险因素.结果 天津地区糖尿病高危人群血脂异常总患病率为71.01％ (316/445),高甘油三酯血症、高胆固醇血症、高低密度脂蛋白-胆固醇血症、低高密度脂蛋白-胆固醇血症的患病率分别为47.86％(213/445)、21.57％(96/445)、19.55％(87/445)、39.33％(175/445).其中单纯型血脂异常患者占28.76％(128/445),混合型血脂异常患者占42.25％(188/445).血脂异常的程度与吸烟、FINDRSC评分、腰围、体重指数、收缩压、谷草转氨酶、谷丙转氨酶、血尿酸、C反应蛋白、同型半胱氨酸(Hcy)、IMT、PAI-1及稳态模型评估-胰岛素抵抗指数(HOMA2-IR)呈正相关(r=0.145～0.786,P均＜0.05),与规律运动及稳态模型评估-胰岛β细胞功能状态(HOMA2-％β)呈负相关(r=-0.344,-0.424,P均＜0.05).二分类Logistic回归分析提示,血脂异常的发生与体重指数(OR=1.754,95％CI:1.399～2.199),腰围(OR=1.091,95％ CI:1.004 ～1.186),收缩压(OR=1.201,95％CI:1.131 ～1.276),血尿酸(OR=1.008,95％ CI:1.002 ～1.014),PAI-1(OR=1.233,95％ CI:1.150 ～1.323),HOMA2-IR(OR=4.094,95％ CI:1.352～ 12.397)及HOMA2-％β(OR=0.921,95％CI:0.888 ～0.954)独立相关(P均＜0.05).结论 血脂异常尤其混合型血脂异常在天津地区糖尿病高危人群中的患病率很高;高体重指数、高腰围、高收缩压、高尿酸、高PAI-1、高胰岛素抵抗程度及胰岛β细胞功能减低是血脂异常的独立危险因素.     

超重和肥胖与动脉僵硬度的相关性研究

目的 分析超重和肥胖与动脉僵硬度的关系.方法 选取2007至2009年江苏省社区自然人群4585名为研究对象进行回顾性研究.以体质指数(BMI)评价超重和肥胖,肱踝脉搏波传导速度(baPWV)评价动脉僵硬度.将BMI分别作为连续变量(以l kg/m2递增)和等级变量(体重正常、体重过轻、超重和肥胖)进行logistic多因素逐步回归分析,评价高动脉僵硬度风险和人群归因危险度百分比,并通过受试者工作(ROC)曲线分析BMI对高动脉僵硬度的预测价值.结果 (1)控制年龄后,男性和女性的BMI与baPWV均呈正相关(r值分别为0.213和0.186,P均＜0.01).超重、肥胖人群baPWV和高动脉僵硬度发生率均高于正常组(P均＜0.01).(2)logistic回归模型校正年龄、性别、高血压因素后,连续变量BMI致高动脉僵硬度的OR值为1.146(95％CI:1.117～1.175,P＜0.01);当BMI为等级变量时,体重过轻OR值为0.369(95％ CI:0.141～0.962,P＜0.05),超重和肥胖OR值分别为1.576(95％CI:1.333～1.863,P＜0.01)和2.087(95％CI:1.615 ～2.698,P＜0.01).超重和肥胖者高动脉僵硬度的人群归因危险度百分比分别为19.1％和11.6％.(3) BMI评估高动脉僵硬度的ROC曲线下面积为0.661(95％ CI:0.645 ～0.678,P＜0.01),BMI预测高动脉僵硬度的最佳分割值为24.25 kg/m2.结论 超重和肥胖人群的动脉僵硬度高于体重正常人群.超重和肥胖是独立于年龄、性别、高血压之外的高动脉僵硬度危险因素.     

Prevalence of metabolic syndrome and its association with obesity indices in a Chinese population

Background: To investigate the prevalence of metabolic syndrome in an urbanizing community in Qingpu, a suburb of Shanghai, and to determine which obesity indices, including body mass index, waist circumference (WC), and waist:hip (WHpR), and waist:height (WHtR) ratios, are most closely associated with metabolic syndrome. Methods: We conducted a cross‐sectional health survey of 1634 individuals (age 15–87 years) in the Jinhulu community located in Qingpu. The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP ATP III) criteria were used to define metabolic syndrome, with central obesity defined according to Asia–Pacific (APC) region criteria. Results: The age‐standardized prevalence of metabolic syndrome was 3.6% in men and 7.2% in women. Using the criterion of central obesity in the APC, the age‐standardized prevalence of metabolic syndrome increased to 8.3% in men and 10.9% in women. Regardless of age, WHtR consistently showed a higher odd ratios (OR) after adjustment for confounding factors of 2.17 (95% confidence interval [CI] 1.12–4.20; P = 0.022) in subjects<52 years of age and 1.92 (95% CI 1.18–3.11; P = 0.008) in those ≥52 years of age. In men, the WHtR was the only significant predictor (OR 2.42; 95% CI 1.15–5.08; P = 0.02) of metabolic syndrome after adjustment, whereas in women WHtR (OR 1.87; 95% CI 1.37–2.85; P =0.0088) was slightly inferior to WHpR and WC. Conclusion: Metabolic syndrome is prevalent in an urbanizing rural area in Qingpu. Of the anthropometric parameters commonly used to identify metabolic syndrome, WHtR may be the best.     

Impact of metabolically healthy obesity on carotid intima-media thickness - The Brazilian Longitudinal Study of Adult Health

Background and aimsObesity increases the risk of metabolic abnormalities, which contributes to elevated cardiovascular risk. However, the independent role of obesity in the development of cardiovascular disease is still debatable. There are individuals with an obesity phenotype without metabolic abnormalities: “metabolically healthy obesity” (MHO). This study evaluates the association between MHO and carotid intima-media thickness (CIMT), an early marker of subclinical atherosclerosis.Methods and resultsThis is a cross-sectional analysis of the baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We used a strict definition to classify MHO: body mass index ≥30 kg/m² and meeting none of the four metabolic syndrome criteria. Data from 10,335 participants were analyzed. The obesity prevalence in our population was 21.2% (n = 2191). The prevalence of MHO was 5.6% (n = 124). When individuals were stratified according to metabolic health, we found the metabolically healthy individuals were younger, more likely to be women and never smokers. The mean CIMT of the sample was 0.81 mm (±0.20). The mean CIMT of the metabolically healthy subsample was 0.70 mm (±0.13) in individuals without obesity and 0.76 mm (±0.13) in individuals with obesity (p < 0.001). The mean CIMT of the metabolically unhealthy subsample was 0.81 mm (±0.20) in individuals without obesity and 0.88 mm (±0.20) in individuals with obesity (p < 0.001). These findings remained essentially unchanged after multivariate adjustment for confounding factors.ConclusionThe concept of MHO, even with the strict definition, seems inadequate, as even in this population, obesity is associated with higher CIMT levels.     

抗核仁蛋白B23抗体在系统性硬化病患者中的临床意义探讨

目的 探讨抗核仁蛋白 B23抗体在系统性硬化病(SSc)患者中的临床意义.方法 采用酶联免疫吸附试验(ELISA)法检测SSc患者血清中抗核仁蛋白B23抗体,非参数检验比较抗核仁蛋白B23抗体阳性组和阴性组之间临床表现和免疫指标的差异,使用Logistic回归分析抗核仁蛋白B23抗体与患者临床表现、免疫指标的相关性.结果 纳入156例SSc患者,其中抗核仁蛋白B23抗体36例阳性,占23.1%.非参数检验表明,抗核仁蛋白B23抗体阳性组的用力肺活量(FVC)、肺一氧化碳弥散功能(DLco)明显低于B23抗体阴性组;肺动脉高压发生率更高,抗着丝点抗体、抗U1RNP抗体和抗核仁纤维蛋白抗体阳性率更高.多因素Logistic回归分析表明,抗核仁蛋白B23抗体阳性是SSc患者发生肺动脉高压的独立危险因素(OR=123.92,95%CI 26.67～575.66,P＜0.01),是严重胃肠道受累的保护性因素(OR=0.08,95%CI 0.01～0.70,P＜0.05).Logistic回归分析表明,抗核仁蛋白B23抗体与抗核仁纤维蛋白抗体(OR=11.50,95%CI 3.85～34.37,P＜0.O1)、抗U1RNP抗体相关(OR=3.43,95%CI 1.01～11.63,P＜0.05),与不同程度肺动脉高压均显著相关.结论 抗核仁蛋白B23抗体阳性患者应该严密监测其肺动脉压力.

Abstract：

Objective To explore the clinical significance of anti-nuclear protein B23 antibody in systemic sclerosis. Methods Enzyme-linked immunosorbent assay was employed to detect the serum antinuclear B23 autoantibody. Mann-Whitney U test was used to compare the clinical and autoantibody profiles between SSc patients with B23 antibody and those without B23 antibody. Logistic regression analysis was employed to analyze the correlation between B23 antibody and clinical manifestations and autoantibody profiles. Results Mann-Whitney U test showed that, forced vital capacity (FVC) diffusion capacity of CO (DLco) in B23 positive SSc was significantly lower than that in B23 negative counterparts, pulmonary artery hypertension was more prevalent in B23 positive SSc patients. While anti-fibrillarin, anti-U1RNP, and antic entromere antibodies were more prevalent in B23 positive SSc. Multivariate logistic regression showed that anti-B23 antibody positivity was an independent risk factor for pulmonary artery hypertension in SSc (OR=123.92, 95％CI 26.67～575.66, P＜0.01), and a protective factor for severe gastrointestinal involvement (OR=0.08, 95％CI 0.01 ～0.70, P＜O.05). Logistic analysis showed that anti-B23 antibody was correlated with antifibrillarin (OR=11.50, 95％CI3.85～34.37, P＜0.01) and anti-U1RNP antibodies (OR=3.43, 95％CI 1.01～11.63, P＜0.05), and correlated with different degree of pulmonary artery hypertension. Conclusion The pulmonary artery pressure should be monitored closely in those SSc patients with a positive B23 antibody.     

Prevalence and clinical profile of metabolic obesity and phenotypic obesity in Asian Indians

Background

We estimated the prevalence of metabolically obese nonobese (MONO), metabolically obese obese (MOO), and metabolically healthy obese (MHO) individuals and correlated this with the prevalence of coronary artery disease (CAD) compared to metabolically healthy nonobese (MHNO) in urban South Indians.

Method

Study subjects (n = 2350) were recruited from the Chennai Urban Rural Epidemiology Study. Generalized obesity was defined as a body mass index (BMI) ≥25 kg/m², based on the World Health Organization Asia Pacific guidelines. Metabolic syndrome (MS) was diagnosed based on the South Asian Modified-National Cholesterol Education Programme criteria. Coronary artery disease was defined by known myocardial infarction or Q waves on resting electrocardiogram.

Results

Metabolically obese nonobese was defined as nonobese subjects (BMI < 25 kg/m²) with MS, MOO as obesity (BMI ≥ 25 kg/m²) with MS, MHO as obese subjects (BMI ≥ 25 kg/m²) with no MS, and MHNO as no obesity or MS. Metabolically obese nonobese was identified in 355 (15.1%), MOO in 348 (14.8%), MHO in 312 (13.3%), and MHNO in 1335 (56.8%) subjects. The prevalence of CAD among the MONO, MOO, MHO, and MHNO was 5.5%, 4.2%, 1.4%, and 2.6%. However, when age standardization was done, there was no statistically significant increase in the risk of CAD among MONO [odds ratio (OR) = 1.300, 95% confidence interval (CI) 0.706–2.394, p = .339], MOO (OR = 1.651, 95% CI 0.852–3.199, p = .137), and MHO (OR = 0.524, 95% CI 0.250–2.130, p = .564) groups compared to MHNO, perhaps due to small numbers.

Conclusion

Metabolic obesity may have different clinical implications than phenotypic obesity.