家族史及体重指数在儿童血脂紊乱筛查中的意义

目的:探讨将家族史联合肥胖用于筛查儿童血脂紊乱的意义.方法:通过整群抽样方法对北京地区6～18岁儿童青少年进行横断面流行病学调查.有效调查对象19 037例,其中男童9 495人,女童9 542人,根据年龄及性别分为学龄期男童、青春期男童、学龄期女童和青春期女童.检测受试儿童空腹末梢血总胆固醇(total cholesterol, TC)、甘油三酯(triglyceride, TG)以及身高、体重并计算体重指数.结果:在总受试儿童中,有家族史儿童占38%,肥胖儿童占4.9%,有家族史并肥胖儿童占2.5%,有家族史或肥胖儿童占40.4%.无肥胖且无家族史儿童、无肥胖但有家族史儿童、肥胖但无家族史儿童及肥胖且有家族史儿童各种血脂异常发生率分别为:高脂血症[7.9%]、9.6%、30.1%及31.5%;高胆固醇血症0.9%、1.5%、 3.3%及2.9%;高甘油三酯血症7.1%、8.6%、29.2%及31.3%;混合型高脂血症0.2%、0.5%、0.4%及2.7%.肥胖儿童发生血脂紊乱的危险性与非肥胖儿童相比各性别年龄分组OR值(95%可信区间)分别为:学龄期男童6.439 (4.178～9.925)、青春期男童6.287 (4.153～[9.518)、]学龄期女童5.063 (3.041～8.427)、青春期女童3.665 (2.536～5.296) (P均=0.000).有家族史儿童发生血脂紊乱的危险性与无家族史儿童相比各性别年龄分组OR值(95%可信区间)分别为:学龄期男童1.204[ (0.952～1.522)] (P =0.121)、青春期男童1.331 (1.047～1.692) (P=0.020)、学龄期女童1.095 (0.847～[1.416)] (P=0.490)、青春期女童1.260 (1.070～1.483)(P=0.005).在血脂紊乱儿童中,有家族史儿童占[43.8%,]肥胖儿童占15.8%,有家族史并肥胖儿童占8.2%,有家族史或肥胖儿童占51.3%.结论:家族史联合肥胖对于筛查儿童血脂紊乱有重要意义.     

重庆地区儿童肥胖症患病率及其与血压的关系

目的：了解重庆地区城市和农村儿童肥胖的发病情况及其与血压的关系。方法：对重庆地区37785名7-17岁儿童进行流行病学调查。测量指标包括：身高、体重、血压。结果：（1）城市儿童中,超重13．16％,肥胖3．73％,农村儿童中,超重5．26％,肥胖0．90％。（2）男性儿童的超重肥胖患病率13．16％,女性8．39％。（3）超重肥胖组的收缩压及舒张压高于P90和P95者明显高于正常体重组。结论：重庆地区城市儿童超重肥胖患病率高于农村儿童,男性儿童超重及肥胖患病率高于女性,超重肥胖组儿童的血压升高者明显多于正常体重组,对超重肥胖儿童应加强行为干预。     

家庭陪伴护理对糖尿病患儿家庭亲密度、适应性及血糖控制的影响分析

目的:探讨家庭陪伴护理对糖尿病患儿家庭亲密度、适应性及血糖控制的应用效果。方法:选取糖尿病患儿88例,随机分为两组,各44例。对照组行常规护理,观察组行家庭陪伴护理干预,对比两组护理前后家庭亲密度评分、适应性评分和血糖水平变化情况。结果:观察组护理后家庭亲密度评分高于对照组,差异有统计学意义(P<0.05)。观察组护理后适应性评分高于对照组,差异有统计学意义(P<0.05)。观察组Hb A1c、FBG、2 h PBG指标均低于对照组,差异有统计学意义(P<0.05)。结论:家庭陪伴护理干预运用于糖尿病患儿效果显著,可有效提高患儿家庭亲密度和适应性,控制血糖水平,值得推广。     

脂肪肝超声诊断与血脂、血糖和肥胖的相关性分析

目的:探讨脂肪肝的超声诊断及脂肪肝与三酰甘油(TG),总胆固醇,血糖,肥胖的关系.方法:2005-08/2006-03门诊健康体检1122名脂肪肝360例和正常肝762例进行TG,总胆固醇(TC),血糖(FPG),身高,体质量测定,对结果进行分析比较.结果:脂肪肝患病率男性(46.3%)高于女性(11.2%),差异有统计学意义(P＜0.05);51～60年龄组患病率最高(53.6%),各年龄组的患病率经χ2检验,差异有统计学意义(P＜0.05);脂肪肝组TG,总胆固醇,血糖,体重指数(BMI)4项指标均高于对照组(P＜0.05),并且脂肪肝的程度越重,血脂异常率越大(P＜0.05),血糖异常率也越大(P＜0.05).结论:脂肪肝与血脂,血糖和肥胖有关. 此外,超声对脂肪肝的诊断有较高的临床实用价值.     

The concentration of serum lipids and lipoprotein in children with high and normal blood pressure and in obese and normal weight children

Summary The differences in the concentration of serum total cholesterol (TC), triglyceride (TG), β-lipoprotein (β-Lipo), and high-density lipoprotein-cholesterol (HDL-C) between the high blood pressure group and the normal pressure group, and between the obese group and the normal weight group were investigated by measuring the atove-mentioned values in 371 children aged 3–14 in Wuhan. It was found that children with high blood pressure had higher serum β-Lipo, but lower HDL-C and HDL-C β-Lipo than those with normal blood pressure. The obese group had higher β-Lipo but lower HDL-C/ β-Lipo than the normal weight group. The method stepwise regression was used to detect the factors influencing blood pressure and HDL-C in the 371 children. The results obtained show that there exist risk factors contributing to coronary heart disease in children.     

有糖尿病家族史13～15岁青少年肥胖特点分析

根据父母有无糖尿病将1619名13～15岁青少年分为糖尿病家族史阳性（FHD^＋）组和糖尿病家族史阴性（FHD^-）组。FHD^＋组的腰围（WC）、腰臀比（WHR）和腰围身高比（WhtR）,均高于FHD^-组（P〈0．01）。以WC定义的腹型肥胖检出率FHD^＋组高于FHD^-组（P〈0．01）,以体重指数（BMI）定义的超重肥胖检出率差异无统计学意义。应用logistic回归分析,校正性别和年龄,FHD^＋组单纯WC升高及BMI和WC均高者分别是FHD组的2．029（1．211—3．400）和1．364（1．043—1．784）倍（P〈0．05）。2型糖尿病患者的一级亲属13～15岁青少年已存在以腹型肥胖为特点的肥胖趋势。     

情绪障碍儿童依恋特征及其与父母依恋的关系

目的探讨情绪障碍儿童的依恋特征,为情绪障碍儿童的心理干预提供理论依据。方法采用自编一般情况调查表、青少年依恋问卷、亲密关系经历量表对70例情绪障碍患儿及其父母与140例正常儿童及其父母施测。结果（1）病例组儿童家庭亲和性、朋友亲和性因子分[分别为（12．76±3．69）分、（14．23±3．84）分]低于对照组[分别为（15．47±3．05）分、（15．82±3．06）分],而家庭消极性因子分[（12．84±3．42）分]高于对照组[（10．46±2．94）分],均差异有统计学意义（均P〈0．05）。（2）病例组母亲依恋回避与依恋焦虑维度评分[（3．60±0．70）分、（2．96±0．77）分]低于对照组[（3．84±0．63）分、（3．37±0．79）分],均差异有统计学意义（均P〈0．05）。（3）情绪障碍儿童朋友依赖性因子与父亲依恋焦虑维度呈负相关（P〈0．01）。结论情绪障碍儿童的家庭依恋特征为低亲和性、高消极性,朋友依恋特征为低亲和性。     

肥胖儿童非酒精性脂肪肝的肝酶检测意义及与血脂的关系

目的：探讨肝酶在儿童肥胖非酒精性脂肪肝病的检测意义及与血脂、体格测量指标的关系。方法：对79例肥胖儿童（伴有非酒精性脂肪肝58例和无非酒精性脂肪肝21例）和93例正常儿童（对照组）进行体格检查;检测血谷丙转氨酶（ALT）、谷草转氨酶（AST）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）;肥胖儿童行肝脏超声检查。结果：79例肥胖儿童体重、体质量指数（BMI）、腰围、臀围、腰臀比、AIT、TC、TG、LDL高于对照组,HDL低于对照组（P〈0．05）;非酒精性脂肪肝组ALT、AST、ALT/AST〉I的发生率、TG、体重、BMI、腰围高于无非酒精性脂肪肝组（P〈0．05或P〈0．01）;经二分类非条件Logis—tic回归分析。ALT、TG、BMI与儿童非酒精性脂肪肝相关联。结论：ALT、AST的升高是预示非酒精性脂肪肝的敏感指标;TG、肥胖程度和腹型肥胖与非酒精性脂肪肝相关;ALT、TG、BMI的升高可能是肥胖儿童惠非酒精性脂肪肝的独立危险因素。     

Prevalence of obesity in type 2 diabetes in secondary care: association with cardiovascular risk factors

Aims

To determine the prevalence of overweight and obesity among patients with type 1 and type 2 diabetes mellitus attending a secondary care diabetes clinic in the United Kingdom, and to assess the impact of overweight and obesity on glycaemic control and cardiovascular risk factors in patients with type 2 diabetes.

Methods

3637 patients with diabetes were identified from the hospital electronic diabetes register, 916 with type 1 diabetes (mean (SD) age 40.4 (15.1) years, 496 male) and 2721 with type 2 diabetes (mean (SD) age 62.5 (11.8) years, 1436 male). Data on body mass index (BMI), glycaemic control, lipid profiles, and blood pressure were extracted.

Results

Of patients with type 1 diabetes, 55.3% were overweight (BMI ⩾25 kg/m²), 16.6% were obese (BMI ⩾30 kg/m²), and 0.4% had morbid obesity (BMI ⩾40 kg/m²). In contrast, 86% of patients with type 2 diabetes were overweight or obese, 52% were obese, and 8.1% had morbid obesity. Obese patients with type 2 diabetes were younger, had poorer glycaemic control, higher blood pressures, worse lipid profiles, and were more likely to be receiving antihypertensive and lipid lowering drugs compared with patients with BMI <30 kg/m².

Conclusions

Obesity is the rule among patients attending this hospital diabetes clinic, with 86% of those with type 2 diabetes overweight or obese. Obesity is associated with significantly worse cardiovascular risk factors in this patient group, suggesting that more active interventions to control weight gain would be appropriate.     

86例单纯性肥胖儿童血脂检测结果分析及干预

目的对单纯性肥胖儿童的血脂检测结果进行总结分析,并进行干预。方法选取2014年1月~2016年1月我院确诊的86例单纯性肥胖儿童作为观察对象,随机选择同期与其性别、年龄及身高匹配的86例正常健康儿童作为对照组,比较肥胖组与对照组的身高、体重及BMI、血脂指标包括甘油三酯(triacylglycerol,TG)、总胆固醇(total cholesterol,TC)、高密度脂蛋白胆固醇(high density lipoprotein cholesferol,HDL-C)、低密度脂蛋白胆固醇(1ow density lipoprotein cholestorol,LDL-C)。结果肥胖组的体重及BMI明显高于对照组,差异具有统计学意义(P0.05)。肥胖组与对照组的身高比较,差异不显著。肥胖组的TC、TG及LDL-C检测水平明显高于对照组,但肥胖组的HDL-C明显低于对照组,差异具有统计学意义(P0.05)。结论肥胖儿童存在脂质代谢紊乱,可导致心血管疾病的危险性增加,因此,应对肥胖儿童及时采取干预措施,对于降低成年期心血管疾病的发病率和病死率,提高生命质量具有重要作用。     

The blood pressure variability, arterial elasticity and humoral factors in subjects with family history of hypertension

Normotensive subjects with family history of hypertension (FHT) have been reported to have increased left ventricular mass index and reduced ventricular compliance. Of interest is whether blood pressure variability (BPV), which has been associated with target organ damage, is then part of this complex inherited syndrome? The objectives of this study are to determine whether there are any significant differences in BPV, arterial compliance and humoral factors in subjects with FHT as compared to controls. Thirty-five subjects with self reported FHT and 35 matched controls underwent 24 hour BP monitoring (BR-102, Schiller Inc. Germany). Arterial compliance was measured using systolic pulse wave tonometry (HDI/Pulsewave Cardiovascular Profiling Instrument, Hypertension Diagnostic Inc. USA). None of the subjects were hypertensive or diabetic. Out of these numbers, 25 subjects with FHT and 26 controls had measurements of plasma catecholamines, plasma renin and serum aldosterone. Catecholamines were assayed with high performance liquid chromatography, while both renin and aldosterone measurements were by radioimmunoassay. Subjects with FHT have higher night time BPV. There was no significant difference in arterial compliances between both groups. There were increased level of norepinephrine (NE) in subjects with FHT but epinephrine (E), renin and aldosterone levels were similar in both groups. There were no correlations between NE and BPV but E was negatively associated with daytime and mean arterial systolic BPV. In conclusion subjects with FHT demonstrated a higher night time BPV and NE level as compared to controls.     

体质指数对超重与肥胖青少年血压的影响

目的 探讨体质指数对超重与肥胖青少年高血压的影响.方法 测量郴州市6所学校部分12～15岁青少年体重、身高、血压.结果 2566名在校学生血压偏高率为20.7%,其中血压偏高在非超重组、超重组和肥胖组检出率分别为19.15%、34.55%和39.29%,非超重组、超重组和肥胖组儿童血压偏高检出率组间差异有统计学意义(P＜0.05).结论 青少年血压偏高检出率随体质指数增加而明显增高.     

Hyperinsulinemia and abdominal obesity are more prevalent in non-diabetic subjects with family history of type 2 diabetes

BACKGROUND: This study was undertaken in order to identify the relationships between family history of type 2 diabetes and cardiovascular risk factors in non-diabetic Mexican individuals. METHODS: The design was a cross-sectional, population-based study stratified by age and sex. Participants consisted of 189 non-diabetic volunteers 30-64 years of age, both males and non-pregnant females randomly selected from a middle income neighborhood in Durango, Mexico and distributed into two groups, with and without family history of type 2 diabetes mellitus. Hypertensive subjects were excluded. Body mass index (BMI) and waist-to-hip ratio (WHR) were assessed. Hematocrit, both fasting and 2-h post 75-g glucose load insulin, and glucose levels, lipid profile, serum albumin, and proteinuria were measured. RESULTS: Ninety-four (49.7%) individuals with family history of type 2 diabetes, and 95 (50.3%) in the control group were included. The prevalence of obesity was greater among women with family history of diabetes, 39 (73.6%) vs. 27 (50.0%) of the control group, p = 0.02. Adiposity tended to be centrally distributed in 86 subjects, of whom 22 (25. 6%) males and 54 (62.8%) females were in the group with family history of diabetes and four (4.6%) males and six (7.0%) females in the control group, p <0.000. Multivariate logistic regression analysis showed a strong relationship between family history of type 2 diabetes with both abdominal obesity (odds ratio [OR] 4.2, CI 95% 1.9-10.1, p <0.05) and fasting hyperinsulinemia (OR 3.1, CI 95% 1. 4-11.2, p <0.05). CONCLUSION: In the absence of additional risk factors such as diabetes and hypertension, there is a strong relationship between family history of diabetes with hyperinsulinemia and abdominal obesity in middle-aged Mexican individuals.     

2型糖尿病患者糖化血红蛋白和血脂检测及临床意义

目的检测2型糖尿病患者的糖化血红蛋白(HbAlc)、空腹血糖(FPG)、血脂水平并观察它们之间的关系及其临床意义。方法选择100例2型糖尿病患者进行HbAlc、FPG、TC、TG、LDL-C、HDL-C检测。糖化血红蛋白检测采用层析法;FPG检测采用葡萄糖氧化酶法;TC检测采用酶法(CHOD-PAP法);TG检测采用酶法(GHO-PAP法);低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)采用直接酶法。结果空腹血糖增高,糖化血红蛋白水平随之增高,二者呈显著正相关(P<0.01);甘油三酯(TG)、总胆固醇(TC)和低密度脂蛋白(LDL)随血糖和糖化血红蛋白值的上升而数值增大,呈正相关(P<0.05);高密度脂蛋白(HDL)随血糖和糖化血红蛋白值的上升反而逐渐减小,呈负相关(P<0.05)。结论糖尿病患者的血脂和糖化血红蛋白增高程度与血糖的增高有关;联合检测HbAlc和血脂对糖尿病早期预防诊断及治疗有重要意义和价值。     

糖尿病家族史对妊娠糖尿病孕妇血糖、血脂及妊娠结局的影响

目的：探究糖尿病家族史对妊娠糖尿病（GDM）孕妇血糖、血脂以及妊娠结局的影响。方法：通过1∶4匹配回顾性分析2019年1—12月在浙江大学医学院附属妇产科医院产科分娩的GDM孕妇1265例,其中有糖尿病家族史组253例,无糖尿病家族史组1012例。两组间血脂、血糖水平及妊娠结局（大于胎龄儿、小于胎龄儿、巨大儿、剖宫产、子痫前期、早产、产后出血、胎儿窘迫）差异采用?t?检验和χ²检验,糖尿病家族史与妊娠结局相关性分析采用二元Logistic回归分析。结果：有糖尿病家族史组孕晚期高密度脂蛋白水平低于无糖尿病家族史组（P<0.05）,空腹血糖、口服葡萄糖耐量试验（OGTT）1?h血糖、OGTT?2?h血糖及糖化血红蛋白水平较无糖尿病家族史组更高（均P<0.01）。糖尿病家族史是GDM孕妇子痫前期的独立危险因素（OR=3.27,95%CI：1.39~7.68）。结论：有糖尿病家族史的GDM孕妇高密度脂蛋白水平更低、血糖水平更高。糖尿病家族史是GDM孕妇发生子痫前期的独立危险因素。     

儿童血压和心率近日节律的特征

目的研究儿童血压和心率近日节律的特征。方法连续48小时检测儿童的血压和心率，通过余弦法分析其近日节律特点。结果儿童的收缩压、舒张压和心率呈现明显的近日节律：男性儿童和女性儿童收缩压、舒张压和心率的近日节律特征，如中值、振幅男女不同而位相没有明显差别：儿童收缩压、舒张压和心率的中值和振幅与年龄呈正相关，而心率则呈负相关。结论儿童的心血管系统功能呈现近日节律，并与年龄相关。     

腹腔镜辅助下胃转流术对胃癌合并2型糖尿病患者血糖、血脂、血压的影响

目的:探讨腹腔镜辅助下胃转流术(Laparoscopic Roux-en-Y gastric bypass,LRYGB)对胃癌合并2型糖尿病(T2DM)患者血糖、血脂、血压的影响。方法:62例胃癌合并T2DM患者分为观察组(n=31)与对照组(n=31),观察组行LRYGB治疗,对照组行腹腔镜下BillrothⅡ术治疗,对比两组患者手术前后血糖、血脂、血压控制情况。结果:术后6个月与术前1 d比较,两组患者空腹血糖(FPG)、餐后2h血糖(2h PG)、糖化血红蛋白(Hb Alc)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)均显著降低,差异有统计学意义(P<0.05);术后6个月观察组上述指标均显著低于对照组,高密度脂蛋白(HDL)显著高于对照组(P<0.05);观察组术后6个月清晨、睡前及平均血压均显著低于治疗前1 d(P<0.05),对照组无明显变化(P>0.05),且术后6个月观察组清晨、睡前及平均血压均显著低于对照组(P<0.05)。结论:LRYGB用于胃癌合并2型糖尿病患者的治疗,能够有效控制血糖,同时改善血脂代谢,降低血压,疗效确切,值得推广。