代谢综合征患者超敏C反应蛋白与尿微量白蛋白关系研究

目的:探讨代谢综合征(metabolic syndrome,MS)患者血清超敏C反应蛋白及尿微量白蛋白水平变化及二者之间的关系.方法:MS患者138例(MS组)和非MS患者95例(对照组),MS组根据尿白蛋白排泄率将MS患者分为正常蛋白尿组、微量白蛋白尿组和临床蛋白尿组,检测各组超敏C反应蛋白水平,并进行比较.结果:MS组血清超敏C反应蛋白及尿微量白蛋白水平较对照组明显升高;超敏c反应蛋白水平随尿白蛋白排泄率增高而增高.结论:MS患者血清超敏C反应蛋白及尿微量白蛋白水平明显升高,二者存在一定相关性.     

Association between C-reactive protein and features of the metabolic syndrome: a population-based study

OBJECTIVE: To assess the association of circulating levels of C-reactive protein, a sensitive systemic marker of inflammation, with different components of the metabolic syndrome. RESEARCH DESIGN AND METHODS: Total cholesterol (TC), HDL cholesterol, triglycerides, uric acid, BMI , and prevalence of diabetes and hypertension were assessed in 747 men and 956 women aged 18-89 years who were participating in the population-based National Health and Nutrition Survey, which was carried out in former West Germany in 1987-1988. RESULTS: There was a statistically significant positive crude correlation between C-reactive protein and TC (R = 0.19), TG (R = 0.29), BMI (R = 0.32), glucose (R = 0.11), and uric acid (R = 0.14) (all P < 0.0001). A negative correlation was found between C-reactive protein and HDL cholesterol (R = 0.13, P < 0.0001). The age-adjusted geometric means of C-reactive protein concentrations in subjects grouped according to the presence of 0-1, 2-3, and > or =4 features of the metabolic syndrome were 1.11, 1.27, and 2.16 mg/l, respectively, with a statistically highly significant trend (P < 0.0001). CONCLUSIONS: The data suggest that a variety of features of the metabolic syndrome are associated with a systemic inflammatory response.     

Association of C-reactive protein with reduced forced vital capacity in a nonsmoking U.S. population with metabolic syndrome and diabetes

OBJECTIVE—A relationship between inflammation, measured by C-reactive protein (CRP), and forced vital capacity (FVC) in diabetes or metabolic syndrome (MetS) has not been established. We investigated whether high CRP is related to reduced FVC in MetS and diabetes.RESEARCH DESIGN AND METHODS—We examined the association of MetS/diabetes and CRP (normal ≤3 mg/l, high >3 mg/l) with predicted FVC in 4,272 nonsmoking U.S. adults aged 18–79 years without lung disease in the Third National Health and Nutrition Examination Survey. Logistic regression examined odds of FVC <80% by CRP and MetS/diabetes.RESULTS—Mean FVC in individuals with MetS and high CRP (95.7%) and those with diabetes and high CRP (93.7%) was lower than in those with no MetS/diabetes and normal CRP (101.7%) (P < 0.01) and was lower in those with MetS and high CRP (95.7%) than in those with MetS and normal CRP (98.5%) (P < 0.01). The odds ratio (95% CI) of FVC <80% was highest in individuals with MetS and high CRP (odds ratio 4.26 [95% CI 2.08–8.73], P < 0.01) compared with those with no MetS/diabetes and normal CRP.CONCLUSIONS—Elevated CRP is associated with lower FVC in people with MetS.Cross-sectional (1,2) and prospective (3) studies have demonstrated impaired lung function in individuals with diabetes and metabolic syndrome (MetS). Recent studies show that reduced lung function may be a precursor of diabetes (4). People with reduced lung function have greater levels of inflammation (5), and people with diabetes or MetS (6,7), including those with elevated C-reactive protein (CRP) (8), are at increased risk of cardiovascular disease. Although the interplay among MetS, diabetes, and insulin resistance has been thoroughly investigated and extensively published, their role in systemic inflammation and lung function impairment has not been firmly established. We examined whether increased levels of CRP may help identify lung function impairment in individuals with MetS/diabetes.     

超敏C反应蛋白与代谢综合征的相关性研究

目的 探讨超敏C反应蛋白(high sensitivity C-reactive protein,hsCRP)与代谢综合征(metabolic svndrome,Ms)的相关性.方法 选择2005年7月至2006年6月在浙江大学医学院附属邵逸夫医院住院体检的2453例;所有研究对象住院当天测量身高、体重、血压,于次日早晨空腹采血,用氧化物酶法检测血糖、血脂全套,采用免疫比浊法检测hsCRP,代谢综合征的诊断标准根据2004年中华医学会糖尿病学分会关于代谢综合征的建议.数据采用SPSS 13.0软件包分析,计量资料用均数±标准差((x)±s)表示,统计显著性用双侧检验,显著性水准定为α=0.05.组间差异分析应用t检验,多组间差异分析用单因素方差分析;hsCRP与代谢综合征各组分的相关性分析用斯比尔曼氏(Spearman)检验,并采用逐步回归(Stepwise)分析建立线性模型.对hsCRP发生代谢综合征的危险性用logistic分析.结果 2453例研究人群中,有代谢综合征者408例(占16.6%),代谢综合征者hsCRP水平(1.73±0.54 mg/L)与无代谢综合征者(1.46±0.58)mg/L比较,差异有统计学意义,P＜0.05;且随着代谢综合征组分的增加,hsCRP水平逐步升高(P＜0.05).相关分析显示hsCRP浓度和年龄、体重、收缩压、舒张压、空腹血糖、餐后2小时血糖、甘油三酯呈正相关,与HDL-C呈负相关.用逐步回归筛选变量,结果显示影响hsCRP水平的主要因素为体重指数、年龄、甘油三酯、高密度脂蛋白、舒张压,P＜0.05.其回归方程如下:y=0.172+0.237a+0.123b-0.111c+0.052d+0.045e.在调整年龄、性别及吸烟等影响因素后,hsCRP与代谢综合征的发生显著相关,(OR=1.126,P＜0.001).结论 代谢综合征者hsCRP水平高于无代谢综合征者;且随着代谢综合征组分的增加,hsCRP水平逐步升高.hsCRP水平的升高是发生代谢综合征的危险因素.     

C反应蛋白与胰岛素抵抗、代谢综合征的相关性研究

目的探讨血清高敏c反应蛋白（hs—CRP）水平与代谢综合征（metabolic syndrome,MS）、胰岛素抵抗的关系。方法选择408例（男207例,女201例）可疑糖尿病的门诊患者,911定其血清hs—CRP水平,同时测量体质量指数、腰围、血压、血脂、血糖及空腹胰岛素水平,计算稳态模型胰岛素抵抗指数（HOMA—IR）;根据国际糖尿病联盟的MS定义将患者分为MS组和非MS组;分析hsCRP水平与胰岛素抵抗、MS的相关性。结果MS组hs—CRP中住数18．7mg／L,明显高于非Ms组9．1mg／L（P〈0．001）;随着代谢异常个数的增加以及HOMA—IR值的增高,hs-CRP水平逐渐升高;按hs—cRP三分位分组后,随着hs—cRP的升高,血糖调节异常、高血压、血脂异常、肥胖及代谢综合征的患病率均逐渐增高（P〈0．001）;多元线性回归分析显示腰围、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、性别及年龄与血hs—CRP水平的相关系数具有统计学意义（r依次为0．32、0．17、-0．12、-0．14、0．11,P〈0．05）。结论代谢综合征、胰岛素抵抗与体内炎症反应有关,hs—CRP水平增高可以作为代谢综合征的重要标志。     

C-reactive protein,gamma-glutamyltransferase and type 2 diabetes in a Chinese population

BackgroundWe studied the association of C-reactive protein (CRP), gamma-glutamyltransferase (GGT) and type 2 diabetes in Chinese.MethodA population-based cross-sectional study.ResultsCRP and GGT levels were significantly higher in participants with diabetes than in those without (P < 0.001). Higher CRP levels were positively associated with prevalent type 2 diabetes after adjustment for age, sex, smoking, alcohol consumption, physical activity, family history of diabetes, body mass index, waist circumference, waist/hip ratio, education, systolic blood pressure, triglycerides, high density lipoprotein cholesterol, use of antihypertensive drugs, aspirin and lipid-lowering agents, with multivariable odds ratios (OR) of 1.55 (95% confidence interval (CI), 1.05–2.27, P trend = 0.005, comparing quartile 4 to quartile 1). However, after further adjustment for GGT, the association was completely attenuated (fourth quartile OR 1.23, 95% CI, 0.83–1.82, P trend = 0.127). Moreover, the association of CRP and prevalent type 2 diabetes was stronger in subjects with GGT values above the median than in those with GGT values below the median. Increasing serum GGT quartiles were positively associated with prevalent type 2 diabetes after adjustment for potential confounding variables (P for trend < 0.001).ConclusionCRP may not be an independent risk factor for type 2 diabetes, at least in Chinese people.     

Metabolic syndrome and chronic kidney disease in a rural Chinese population

BackgroundMetabolic syndrome is a common risk factor for cardiovascular disease. Chronic kidney disease (CKD) is a worldwide public health problem. We investigated the association between metabolic syndrome and CKD in a rural Chinese population.MethodsThis was a cross-sectional study using data from the Handan Eye Study.Results4944 of participants aged ≥ 30 y were included in this analysis. Participants with metabolic syndrome had a higher prevalence of CKD (20.9% vs.15.8%, P < 0.001) than those without. As the number of metabolic syndrome components increased, so did the prevalence of CKD (P < 0.001). The multivariate-adjusted odds ratio (OR) of chronic kidney disease in participants with metabolic syndrome was 1.293 (95% CI 1.093–1.529) compared with those without. In multivariate logistic regression analysis, high blood pressure (OR 1.348; 95% CI 1.122–1.619) and high fasting glucose (OR 1.501; 95% CI 1.235–1.794) were independently associated with the risk for CKD. Compared with participants without any component, multivariate adjusted OR for CKD was 1.316 (95%CI 1.004–1.723), 1.397(95%CI 1.038–1.882), 1.672 (95%CI 1.183–2.363) for those with 2, 3, 4 or 5 components, respectively.ConclusionIn this rural Chinese population aged ≥ 30 y, metabolic syndrome was associated with CKD.     

Prevalence of metabolic syndrome in Han and Mongolian rural population with hypertension

The prevalence of metabolic syndrome, as defined by the International Diabetes Federation, was compared in two rural populations with hypertension in China. A total of 6326 subjects aged >or= 35 years were included: 5043 Han and 1283 Mongolian. Metabolic syndrome was identified in 33.9% (men: 16.1%; women: 47.8%) of the Han and 37.6% (men: 14.7%; women: 55.0%) of the Mongolian populations. In men, prevalence of metabolic syndrome showed no obvious ethnicity differences; however, in women, prevalence was significantly higher in the Mongolian than in the Han population. This study showed high prevalence and ethnic differences in prevalence of metabolic syndrome in these two Chinese hypertensive populations.     

C-reactive protein and features of the metabolic syndrome in a population-based sample of children and adolescents

BACKGROUND: C-Reactive protein (CRP) is a risk marker for type 2 diabetes and cardiovascular diseases. In youth, limited data are available on the distribution of high-sensitivity CRP as well as on its association with components of the metabolic syndrome. METHODS: In 1999, we conducted a school-based survey of a representative sample of youths 9, 13, and 16 years of age in the province of Quebec, Canada. Standardized clinical measurements and fasting plasma lipid, glucose, insulin, and CRP concentrations were available for 2224 individuals. RESULTS: The distribution of CRP was positively skewed. The median and 95th percentile values by age and sex ranged from < 0.2 to 0.56 mg/L and from 2.72 to 6.28 mg/L, respectively. A total of 7.7% of 9-year-olds, 5.5% of 13-year-olds, and 12.8% of 16-year-olds had CRP concentrations > 3.0 mg/L, the threshold defining the adult high-risk category. We observed a strong relationship between CRP concentrations and both body mass index (BMI) and fasting insulin values. The association between CRP and insulin concentration was markedly attenuated after adjustment for BMI, whereas that between CRP and BMI remained unchanged after adjustment for insulin: a 1 SD increase in BMI was associated with a 52% increase in CRP concentration. An increased CRP concentration was independently associated with a worsening of the lipid profile, whereas the association between increased CRP values and high systolic blood pressure was no longer statistically significant after adjustment for BMI. CONCLUSIONS: The metabolic correlates of excess weight, including a state of low-grade systemic inflammation, are detectable early in life. Their health impact in adults remains to be fully examined.     

Comparison between C-reactive protein and adipocyte fatty acid-binding protein as a component of metabolic syndrome in middle-aged women

Objectives

We compared the diagnostic accuracy of CRP and adipocyte fatty acid-binding protein (A-FABP) for the metabolic syndrome (MS).

Design and methods

We examined 310 middle-aged Caucasian women.

Results

CRP and AFABP values were significantly associated with the MS probability in the logistic regression model. Operating characteristic curves comparison showed similar areas under the curve.

Conclusions

Measurement of A-FABP is equivalent to CRP in the diagnostic utility of the MS.     

Defining metabolic syndrome and factors associated with metabolic syndrome in a poly-pharmaceutical population

Objectives: Metabolic Syndrome (METs) definitions vary and diagnosis takes into account consumption of medications commonly prescribed for conditions defining METs. This paper evaluates the potential differences in population characteristics using two different methods of defining METs, with and without the adjustment of the effects of pharmacotherapy on biochemical and blood pressure (BP) measurements

Methods: This was a cross-sectional study utilizing the Malaysian Elders Longitudinal Research (MELoR) cohort comprising urban community-dwellers aged ≥55 years. Participants were interviewed using a structured questionnaire during home visits where medications were reviewed. Health impacts assessed included heart disease, stroke, body mass index (BMI), peptic ulcers, arthritis, and number of medications and comorbidities. Risk factors and health impacts associated with METs were determined by Poisson multivariate regression models using a binary and count dependent variables.

Results: A total of 891 participants with a mean (SD) age of 68.6 (7.3) years were included. The prevalence of METs vary from 52.7% to 35.1% depending upon the definition used. The risk factors associated with METs were increasing age, ethnicity, lower education levels, BMI, stroke and medication use. Male gender was considered a risk factor following modification for medication usage using a count model. The drug-modified model removed marginal candidates prescribed medications used for specific conditions which defined METs who did not meet the criteria once their BP or biochemical parameters were modified for the effects of medication-use.

Conclusion: The IDF definition for METs that makes allowance for treatment for each specific condition can lead to an overestimation in the prevalence of METs in population studies. Not including those medicated with normal results conversely underestimates the prevalence of METs. We have therefore proposed adjustments to BP and lipid measurements based on pooled mean effects from published systematic reviews to mitigate bias in future research on prevalence of METs.     

Association between plasma alkaline phosphatase and C-reactive protein in Hong Kong Chinese

BACKGROUND: Alkaline phosphatase (ALP) is a biomarker for hepatobiliary and skeletal diseases. It is also raised in sepsis. In atherosclerotic plaques, ALP is expressed. Similar to C-reactive protein (CRP), it may be another marker of systemic inflammation. Therefore, we investigated their association in a Hong Kong Chinese population. METHODS: Plasma ALP and CRP were measured in 205 subjects (110 men, 95 women; age 55.2+/-11.6 years) in the Hong Kong Cardiovascular Risk Factor Prevalence Study-2 cohort. RESULTS: The blood levels of ALP and CRP were significantly correlated (r=0.30, p<0.001), which was due to a significant correlation in women (r=0.43, p<0.001). In a multivariate model, CRP level was related to ALP (beta=0.18, p=0.008). After adjusting for confounding factors and other liver enzymes, the relationship between ALP and CRP remained significant in women (beta=0.28, p=0.019), but in men, ALP was not an independent determinant of CRP levels. CONCLUSIONS: ALP may be another marker of systemic inflammation, especially in women. Whether it provides clinical information additional to CRP requires further study.     

社区男性代谢综合征对下尿路症状影响的研究

目的探讨社区中老年男性下尿路症状与代谢综合征的相关性。方法随机选择50岁以上北京多个社区男性人群作为研究对象。下尿路症状的评估包括国际前列腺症状评分（IPSS）、生活质量（QOL）评分、腹部超声测量前列腺体积、最大尿流率测定。代谢综合征的调查包括高血压、糖尿病诊治病史的确认,以及体重指数（BMI）的算定。结果本研究共调查社区中老年男性人群1656人,符合本研究要求的共计1639人。平均年龄（64．4±9．6）岁。具有高血压、糖尿病或肥胖（BMI〉25kg／m^2）一项的人群分别为519人（31．67％）、199人（12．14％）和462人（28．19％）。同时具有上述三项诊断的代谢综合征组人群为40人（2．44％）,不具备任何一项诊断的非代谢综合征组人群为762人（46．49％）。研究结果显示代谢综合征组人群的IPSS评分以及QOL评分显著高于非代谢综合征组人群（P〈0．05）。代谢综合征单一危险因素高血压、糖尿病或肥胖主要影响70～79岁高龄男性人群的下尿路症状。结论本研究提示代谢综合征明显影响社区中老年男性人群的下尿路症状和生活质量。     

Microalbuminuria and the metabolic syndrome and its components in the Chinese population

BACKGROUND: Microalbuminuria and the metabolic syndrome (MetS) have both been linked to chronic kidney disease and cardiovascular disease. This study investigated the association between urinary albumin-to-creatinine ratio (ACR) and MetS and its components. MATERIALS AND METHODS: A total of 2311 subjects aged 40 years and over were recruited in 2004 in a metropolitan city in Taiwan. The biochemical indices, such as fasting glucose levels, urinary albumin, urinary creatinine and anthropometric indices, were measured. We defined microalbuminuria as a urinary ACR ranging from 30 to 300 mg g(-1) creatinine. MetS was defined using the American Heart Association and the National Heart, Lung and Blood Institute (AHA/NHLBI) and the International Diabetes Federation (IDF) definitions. The relationship between MetS and microalbuminuria was examined using multiple logistical regression analysis. RESULTS: Subjects with microalbuminuria had higher age, body mass index (BMI), waist circumference, blood pressure, fasting plasma glucose, triglycerides, total cholesterol (TCHOL)/high-density lipoprotein cholesterol (HDL-C) ratio, prevalence of diabetes mellitus and hypertension and lower HDL-C than subjects with normoalbuminuria. After adjusting for age and BMI, microalbuminuria was associated with the individual components of MetS, except in central obesity in women and elevated fasting glucose in men. After adjusting for age, BMI, smoking and alcohol consumption status, multiple logistical regressions revealed that microalbuminuria is strongly associated with MetS in both genders and according to both definitions. The odds ratio of having MetS using the AHA/NHLBI and IDF definition was 1.76 (1.16-2.67) and 1.73 (1.06-2.83) in men and 2.19 (1.38-3.50) and 2.09 (1.24-3.51) in women, respectively. CONCLUSIONS: Microalbuminuria was strongly associated with MetS and its components. There is an increased likelihood of having MetS if subjects have microalbuminuria.     

初诊2型糖尿病合并代谢综合征患者血清高分子量脂联素水平与胰岛素抵抗、C反应蛋白的相关性

目的观察初诊2型糖尿病(T2DM)合并代谢综合征(MS)患者血清高分子量脂联素(HMW-APN)水平及其与胰岛素抵抗(IR)、C反应蛋白(CRP)的相关性。方法选取研究对象168例,分为健康人对照组80例及初诊T2DM患者88例;初诊T2DM患者再根据是否合并MS分为单纯T2DM组45例和T2DM合并MS组43例。研究对象均行75 g口服葡萄糖耐量试验及胰岛素释放试验,并检测血清HMW-APN、CRP、血脂等相关生化指标。结果与健康人对照组比较,T2DM合并MS组及T2DM组血清HMW-APN水平降低(P0.01),以T2DM合并MS组最低。T2DM合并MS组及T2DM组血清CRP升高(P0.01),以T2DM合并MS组最高。简单相关分析显示,血清HMW-APN水平与体质指数(BMI)、腰围(WC)、腰臂比(WHR)、收缩压(SBP)、空腹血糖(FPG)、餐后2小时血糖(2h PG)、糖化血红蛋白Alc(Hb A1c)、三酰甘油(TG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)及CRP呈负相关(P均0.01),与高密度脂蛋白胆固醇(HDL-C)水平、胰岛β细胞功能指数(HOMA-β)呈正相关(P均0.01)。多元逐步回归分析显示,WC、2h PG及CRP是血清HMW-APN水平的独立影响因素(P均0.01)。Logistic回归分析显示,HMW-APN是T2DM发生MS的保护因素,BMI、FPG、SBP、TG是其危险因素(P0.01或P0.05)。结论血清HMW-APN水平在初诊T2DM合并MS患者中降低,其与IR及CRP密切相关,在初诊T2DM合并MS的发生、发展中起保护作用。