应用生物电阻抗技术分析终末期肾病患者的脂肪分布情况

目的应用生物电阻抗技术对终末期肾病患者身体各部位的脂肪水平进行分析,进而探讨终末期肾病患者脂肪分布特点及其与血脂、血压的相关性,为终末期肾病患者心血管疾病的预防提供依据。方法选取2013年4月至2015年5月于该院接受治疗的终末期肾脏患者240例,测定患者体质量指数(BMI)、腰臀比(WHR),采用生物电阻抗技术分析患者的脂肪总量、去脂体质量、四肢和躯干脂肪量占体质量的百分比,分别计算总体脂肪率(BFP)和四肢脂肪率,同时测定患者的血压(舒张压、收缩压)和血脂[总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A1(ApoA1)和载脂蛋白(ApoB)]等生化指标,对测定结果相关性进行分析。结果 (1)终末期肾病男性患者脂肪总量、四肢和躯干脂肪量均显著低于女性患者,差异有统计学意义(P0.05),且随着年龄的增长,女性患者脂肪总量增加更为明显,差异有统计学意义(P0.05)。(2)在BMI、WHR和BFP正常组和升高组中,BMI与血压的相关性高于WHR和BFP,差异有统计学意义(P0.05),而WHR和BFP与血脂的相关性显著高于BMI,差异有统计学意义(P0.05),与WHR相比,BFP与TG、TC、LDL-C和ApoB相关性更高,差异有统计学意义(P0.05)。结论终末期肾病患者脂肪总量、去脂体质量、四肢和躯干脂肪量在男性和女性之间存在差异,应用生物电阻抗技术测定终末期肾病患者的体脂肪率,可以为预防心血管疾病的发生提供依据。     

不同食物摄入与心血管疾病危险因素的关系研究

目的 探讨不同食物摄入对颈动脉硬化和心血管疾病的影响。方法 使用超声射频信号血管内-中膜分析技术评估颈动脉内中膜厚度,汇总队列公式计算未来10年心血管疾病风险评分。依指南将食物摄入分为偏低组,推荐量组,偏高组。分析食物与颈动脉硬化的相关性。使用逻辑回归分析,比较三组间颈动脉硬化风险差异。分析食物摄入量与心血管疾病风险评分的关系。结果 蔬菜、水果、奶制品摄入量与颈动脉硬化呈负相关,而禽畜类与颈动脉硬化呈正相关(P＜0.05）。校正混杂因素后,蔬菜、水果类摄入量不足以及禽畜类摄入过多将增加颈动脉硬化风险（OR=1.93,2.03,3.72,P＜0.05）。粮谷类、禽畜类摄入增多及奶制品摄入不足时心血管疾病风险评分增高(p＜0.05）。结论 蔬菜、水果类摄入量不足以及粮谷类、禽畜类摄入过多增加心血管疾病的发生风险。     

Involvement of leptin in the association between percentage of body fat and cardiovascular risk factors

OBJECTIVES: Recent epidemiologic studies have shown that obesity is associated with elevated blood concentrations of prothrombotic-proinflammatory factors and markers of endothelial dysfunction such as fibrinogen, C-reactive protein (CRP), von Willebrand factor (vWF), and homocysteine. We have assessed whether these markers are associated with percentage of body fat (BF), insulin sensitivity as well as with leptin concentrations. DESIGN AND METHODS: Twenty-five men aged 49.6 +/- 12.7 yr (mean +/- SD) underwent whole-body air displacement plethysmography (Bod-Pod(R)) for estimating BF. Blood analyses for leptin and several other metabolic and cardiovascular markers were carried out. RESULTS: Obese subjects had higher levels as compared to controls of BF (37.5 +/- 5.1 vs. 26.0 +/- 6.6, p < 0.01), fibrinogen (3.30 +/- 0.43 vs. 2.67 +/- 0.11, p < 0.01), vWF (136.4 +/- 50.4% vs. 81.6 +/- 12.6%, p < 0.05), and leptin (17.6 +/- 8.7 vs. 6.2 +/- 3.3, p < 0.01), lower concentrations of HDL-cholesterol (1.09 +/- 0.20 vs. 1.51 +/- 0.10, p < 0.001) and lower QUICKI (1/[log(Ins(0)) + log(Glu(0))]) (0.31 +/- 0.03 vs. 0.34 +/- 0.02, p < 0.05). No significant changes were observed in CRP (5.7 +/- 3.4 vs. 3.8 +/- 1.6, p = 0.327) and homocysteine (9.4 +/- 4.2 vs. 8.3 +/- 0.9, p = 0.749). A positive correlation was observed between BF and fibrinogen (r = 0.67, p = 0.0003). Plasma leptin concentrations were correlated with fibrinogen (r = 0.71, p = 0.0001) and CRP (r = 0.43, p = 0.044). After adjustment for BF leptin emerged as a significant predictor of fibrinogen (beta = 0.47, p = 0.023; R(2) = 0.59, p < 0.001). QUICKI was positively correlated with HDL-cholesterol (r = 0.59, p = 0.010) and negatively with fibrinogen (r = -0.53, p = 0.025), CRP (r = -0.52, p = 0.028) and vWF (r = -0.56, p = 0.013). CONCLUSIONS: Increased BF and impaired insulin sensitivity are associated with increased concentrations of cardiovascular risk factors. Leptin seems to be involved in this elevation and emerges as a predictor of circulating fibrinogen concentrations.     

体质量指数与心血管的危险因素个体聚集性的关系

目的探讨体质量指数与心血管危险因素个体聚集性的关系。方法分析1560名(35～70岁)渔区自然人群中高血压、高血清胆固醇(高TC)、高血糖、高密度脂蛋白胆固醇过低(低HDL-C)与体质量指数(BM I)水平的关系。结果人群中高血压、高TC、高血糖及低HDL-C的患病率均随BM I上升而明显升高。4种高危因素中,具有至少1种和同时具有2种或以上的个体在人群中,所占百分比随BM I上升而显著升高。且后者的上升速度大于前者。结论超重和肥胖常伴多种心血管病的危险因素聚集。BM I对于心血管病一级预防具有重要价值。     

Bioelectrical impedance vector analysis in haemodialysis patients: relation between oedema and mortality

In this work, bioelectrical impedance vector analysis (BIVA) method is used in a sample of haemodialysis patients in stable (without oedema) and critical (hyperhydrated and malnutrition) states, in order to establish the relation between hyperhydration (oedema) and mortality. The measurements obtained were single frequency (50 kHz), tetrapolar (hand-foot) complex impedance measurements (vector components are: resistance R and reactance Xc). The impedance components were standardized by the height H of the subjects, (R/H and Xc/H) to obtain de impedance vector Z/H, that is represented in the RXc plot (abscise R/H, ordinate Xc/H). Measurements were performed on a sample of 74 patients (30 men and 44 women, 18-70 year, body mass index (BMI), 19-30 kg m(-2)) at the Saturnino Lora University Hospital in Santiago de Cuba. The 46 stable patients comprised 28 men and 18 women; the 28 critical patients 16 men and 12 women. The reference population consisted of 1196 healthy adult subjects living in Santiago de Cuba (689 men and 507 women, 18-70 year, BMI 19-30 kg m(-2)). We used the RXc plot with the BIVA method to characterize the reference population using the 50%, 75% and 95% tolerance ellipses. Student's t-test and Hotelling's T2-test were used to analyse the separation of groups obtained by means of clinical diagnosis and those obtained by BIVA. We obtained a significant difference (P < 0.05) in R/H, Xc/H and phase angle (PA) in men as in women between the location of Z/H vectors in the RXc graph and the separation made by the doctors between stable and critical patients. Critical (hyperhydrated) patients were located below the inferior pole of the 75% tolerance ellipse, whereas stable patients were within the tolerance ellipses. Some cases classified as stable by the clinic were classified as hyperhydrated by BIVA with 100% sensitivity and 48% specificity. In conclusion, the BIVA method could be used to classify patients by hydration state and to predict survival. Advantages of the method are its simplicity, objectivity and that it does not require the definition of patient dry weight.     

中老年高级知识分子人体质量指数与心血管疾病危险因素的关系

目的:研究中老年高级知识分子人体质量指数(bodymassindex,BMI)与心血管疾病危险因素之间的关系。方法:按照北京阜外医院心血管流行病研究室统一设计的规格,对焦作煤业集团公司45岁以上的具有高级职称的知识分子进行调查。项目包括年龄、性别、身高、体质量、收缩压、舒张压、BMI以及血清中总胆固醇、三酰甘油、空腹血糖、高密度脂蛋白胆固醇(highdensitylipoproteincholesterol,HDL-C)等指标,并对所有调查对象做心电图、肝、胆、脾、肾B超及全面检查。结果:本组人群超重率55.6%,肥胖率19.8%,男性超重率63.5%,肥胖率23.1%,女性超重率41.4%,肥胖率14.0%,男女超重率比较(χ2=36.77,P<0.01);肥胖率比较(χ2=10.12,P<0.05),男女超重肥胖率比较,差异有显著性意义。不同BMI人群的心血管病危险因素水平具有明显的差异,BMI<24的人群心血管病危险因素水平及心血管病发病率明显低于超重及肥胖组人群(41.7<χ2<210.8,P<0.01)。结论:中老年高级知识分子人群超重和肥胖率较高,BMI与心血管疾病危险因素之间有密切关系。     

颈动脉粥样硬化与心血管主要危险因素的相关性研究

目的探讨颈动脉粥样硬化发生与心血管主要危险因素之间的相关性。方法对219例年龄≥50岁的体检者行颈动脉超声检查,根据颈动脉内-中膜厚度(IMT)不同分为3组,正常组93例,单纯增厚组54例及斑块组72例。将IMT及斑块指标与心血管危险因素进行单因素检验和多因素分析。结果单因素分析示单纯增厚组及斑块组在年龄、男性比例、吸烟者比例、收缩压、尿酸、甘油三酯水平方面均明显高于正常组(P﹤0.05),斑块组的男性比例明显高于单纯增厚组(P﹤0.05);多因素分析显示,年龄、男性比例、收缩压、尿酸、甘油三酯水平与颈动脉IMT呈明显相关性,受累血管段数与年龄、吸烟者比例、血压、尿酸、胆固醇、甘油三酯水平、低密度脂蛋白均无明显相关性。斑块指数仅与收缩压(r=0.194,P=0.004)和尿酸(r=0.156,P=0.025)显著相关。结论年龄、男性比例、高血压病、高甘油三酯及高尿酸血症不仅是心血管疾病的危险因素,同样也作用于颈动脉粥样硬化的发生、发展。超声检查颈动脉无放射性、无痛苦,可以直接反应颈动脉IMT的情况,具有重要临床应用价值。     

新疆地区部分2型糖尿病患者体脂分布与心血管危险因素的研究

目的探讨新疆地区部分2型糖尿病(T2DM)患者体脂分布特点与心血管危险因素之间的关系。方法用Inbody720人体成分分析仪对155例T2DM患者行腹部内脏脂肪面积(VA)、体脂百分比(PBF)测量,同时测量空腹三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、收缩压(SBP)、舒张压(DBP)、糖化血红蛋白(HbA1c)、体质量(W)、身高(H)、腰围(WC)、臀围(HC),计算体质量指数(BMI)、腰臀比(WHR)。对体脂参数与代谢危险因素行Pearson相关分析及多元逐步回归分析。结果无论男女,腹部内脏型肥胖(VFO)的BMI水平高于腹部皮下型肥胖(SFO),男性VFO的TG水平高于SFO。女性患者PBF、TC及LDL-C显著高于男性患者。少数民族男性患者VA、PBF显著高于汉族男性。在校正年龄、病程、BMI后,女性患者WHR与DBP呈正相关,PBF与LDL-C呈正相关。男性患者的BMI与SBP、VA与DBP、VA与PBF和HDL-C有关联;女性患者的BMI与SBP、WHR与DBP有关联。结论 T2DM患者体脂分布均以腹型肥胖为主,尤其是以VFO为特点,其心血管危险因素不仅与体脂水平增加有关,更与VFO有关,且存在性别、族别差异。     

非乙醇性脂肪肝病患者身体成分及其危险因素分析

目的探讨非乙醇性脂肪肝病(NAFLD)患者与正常人群身体成分的差异及NAFLD的危险因素。方法选择40~69岁NAFLD患者172例,179名体检健康者(对照组);分别测量两组的身体成分和血生化指标。结果 NAFLD组细胞内液百分比、细胞外液百分比(ECW%)、蛋白质百分比、无机盐百分比、细胞外液与细胞内液比及高密度脂蛋白胆固醇均低于对照组(P0.05),而体脂肪百分比、体质量指数、腰围、臀围、腰臀比(WHR)及内脏脂肪面积、空腹血糖、总胆固醇、三酰甘油(TG)、极低密度脂蛋白胆固醇、低密度脂蛋白胆固醇均高于对照组,差异有统计学意义(P0.05)。Logistic回归分析显示,WHR、ECW%、TG与NAFLD具有相关性。结论 NAFLD患者的人体成分与健康人相比存在差异,代谢紊乱明显;NAFLD的发生可能与腹型肥胖、细胞外液百分比减少及高三酰甘油血症存在一定的关系。     

Predicting cardiovascular risk using measures of regional and total body fat

Excessive body fat is associated with increased risk for coronary heart disease (CHD). Various anthropometric methods are currently used to quantify regional and total body fat. The objectives of this study were to provide more insight into differences in cutoff points between methods for measuring total body fat and those for measuring regional body fat, independently and in combination, and to determine how well anthropometric and bioelectrical impedance methods of estimating body composition predict cardiovascular risk in a sample of unfit National Guard soldiers. Unfit healthy men (n = 123) and women (n = 32) between 21 and 55 years old from the Army National Guard were assessed for total and regional body fat. After having their degree of total and regional body fat assessed, the participants were categorized by level of body fat and 10-year CHD risk. Comparisons and predictions were made between degree of total as well as regional body fat and 10-year CHD risk estimated from Framingham Heart Study equations. A significant positive relationship was observed between waist circumference and 10-year CHD risk in men. When controlling for age, waist circumference was predictive of 10-year CHD risk, contributing to 6.4% of the variance, whereas waist-to-hip ratio did not contribute to the model significantly. The results of this study show that waist circumference is the best measure for identifying unfit male individuals at risk for CHD.