中国成人多重心血管危险因素聚集的最佳腰围切割点

目的探讨中国成人多重心血管危险因素聚集的最佳腰围切割点。方法分析1994年全国糖尿病普查的15628例年龄≥25岁的中国成人资料。以腰围〈70cm组（每隔5cm分为一组）作为对照,计算其他各组发生多重心血管危险因素的优势比OR值和95％CI。采用ROC曲线分析计算不同腰围水平对多重心血管危险因素聚集识别的敏感性和特异性,以诊断指数（诊断指数=1-假阳性-假阴性）最大的腰围作为最佳切割点。结果无论男性还是女性。胰岛素抵抗、血脂异常、高血压和高血糖的百分比均随着腰围的增加而增加。男性腰围≥85cm、女性腰围≥80cm后发生代谢综合征的OR值显著增加[分别为2．08（95％CI1．80-2．39）和1．66（95％CI1．41-1．97）1。ROC分析显示以上相应腰围切割点具有最佳的敏感性和特异性。结论反映中国成人多重心血管危险因素聚集的男性最佳腰围切割点为85cm、女性为80cm。     

腰围与心率变异性相关性分析

目的探讨腰围对心率变异性（HRV）的影响。方法193例研究对象按腰围分为正常与异常两组。检测HRV、BMI、腰围、腰臀比、脂肪含量、脂肪比例、FPG、TC、TG、HDL-C、LDL-C、血尿酸等指标。结果腰围异常组除LF/HF外HRV各指标均低于正常组（P〈0.01）;协方差分析校正年龄、性别、吸烟、腰围、SBP、DBP、FPG、TC、TG、HDL-C、LDL-C、血尿酸后HRV所有指标差异均有统计学意义（P〈0.01）。结论腰围可影响HRV,腰围异常时HRV降低。     

Family history,waist circumference and risk of ischemic stroke: A prospective cohort study among Chinese adults

Background and aimsThe associations between genetic factors and waist circumference (WC) with stroke risk have been evaluated in Western studies. However, evidence of this association has rarely been reported in the Chinese population. This study aimed to evaluate the association between WC and family history of stroke (FHS) with ischemic stroke (IS) risk among Chinese adults and to further explore the potential interaction of these associations.Methods and resultsThe China Kadoorie Biobank (CKB) study recruited 35,508 participants aged 30–79 years from the Qingdao urban area during 2004–2008. A total of 33,355 participants were included in study. Cox regression analysis was used to estimate the multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the independent and interactional associations between FHS and WC and IS risk. Participants with FHS had a 29% (HR = 1.29, 95% CI: 1.12–1.50) higher IS risk than those without FHS. Participants with excessive WC (85 cm for males and 80 cm for females) had a 78% (HR = 1.78, 95% CI: 1.51–2.10) higher IS risk than those with normal WC. The combined effect of FHS and excessive WC on IS was statistically significant (HR = 2.29, 95% CI: 1.84–2.86). The present study further found statistically significant multiplicative interactions of FHS and WC with IS risk (P _interaction < 0.001).ConclusionThe present study indicated that FHS and WC were significantly associated with an increased risk of IS. The association between FHS and IS was associated with excessive WC.     

慢性心力衰竭患者肾功能恶化的危险因素分析

目的 研究慢性心力衰竭(心衰)患者肾功能恶化的危险因素及其对预后的影响.方法 采用病例对照研究方法,分析与肾功能恶化发生有统计学关联的独立危险因素,同时观察肾功能恶化对预后的影响.结果 住院心衰患者肾功能恶化发生率31%,入院肌酐水平及心功能分级与肾功能恶化的发生独立相关,OR值分别为2.248(95%CI1.088～4.647,P=0.029)和2.485(95%CI1.385～4.459.P＝0.002).发生肾功能恶化的患者住院期间病死率明显高于对照组(16.7%比2.1%,P=0.000),调整混杂因素后,肾功能恶化是死亡的独立危险因素,OR值3.824(95%CI2.452～5.137.P＜0.015).结论 肾功能恶化在住院心衰患者中发生率较高,与住院期间病死率明显相关.入院肌酐水平偏高及心功能差为发生肾功能恶化的独立危险因素.

Abstract：

Objective To investigate the risk factors of worsening renal function (WRF) in patients with chronic heart failure ( CHF) and WRF influence on prognosis. Methods A case-control study were undertaken to analyze independent risk factor statistically related to incidence of WRF, and to assess the influence of WRF on prognosis. Results The independent predictors of WRF were creatinine level at admission (OR 2.248,95% CI 1.088-4.647, P = 0.029) and NYHA class on admission ( OR 2.485, 95% CI 1.3854. 459, P = 0.002). The mortality of patient with WRF was obviously higher than that of control group during hospitalization( OR 3. 824,95% CI 2. 452-5. 637 ,P ＜0.015). Conclusions WRF is a common complication among patients hospitalized for CHF, and is obviously associated with mortality during hospitalization. Higher creatinine level and weak heart function are independent risk factors for incidence of WRF of patients with CHF.     

不同体重指数及腰围2型糖尿病患者甲状腺功能的变化探讨

目的 探讨不同体重指数（BMI）及腰围（WC）2型糖尿病（T2DM）患者促甲状腺激素（TSH）和甲状腺激素（TH）水平的变化及肥胖对TSH、TH的影响。方法 收集住院T2DM患者275例,根据BMI不同将其分为正常组（18.5kg/m²≤BMI＜24kg/m²,88例）、超重组（24kg/m²≤BMI＜28kg/m²,90例）和肥胖组（BMI≥28kg/m²,97例）,比较3组患者的血脂水平及甲状腺功能。再根据性别和WC不同将其分为M1组（男性WC<85cm）、M2组（男性WC≥85cm）、F1组（女性WC<80cm）、F2组（女性WC≥80cm）,比较各组间上述指标。相关性分析采用Spearman相关分析,影响因素分析采用多元线性逐步回归分析。结果 与正常组比较,超重组及肥胖组患者的TSH水平明显增加（P<0.05）。F2组TSH水平明显高于F1组和M2组,游离甲状腺素（FT₄）水平低于M2组（P<0.05）。相关性分析结果显示,T2DM患者BMI与TSH呈正相关(r=0.25,P<0.05),TC与游离三碘甲腺原氨酸（FT₃）呈负相关(r=-0.39,P<0.05),BMI、WC与FT₄(r=-0.31,r=-0.29,P<0.05)呈负相关。多元线性逐步回归分析结果显示,BMI是TSH的独立相关因素,WC是FT₄的独立相关因素（P<0.05）。结论 肥胖T2DM患者TSH水平升高,FT₄下降,女性较男性腹型肥胖者变化更加明显。     

Prevalence of cardiovascular risk factors in middle-aged Lithuanian women in different body mass index and waist circumference groups

Background and aimsThe aim of this study was to evaluate the prevalence of cardiovascular risk factors in middle-aged Lithuanian women in different body mass index and waist circumference groups.Methods and resultsData selected from the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program between 2009 and 2016. This community-based cross-sectional study comprised 53,961 women aged 50–64 years old. We compared the prevalence of arterial hypertension, dyslipidaemia, diabetes mellitus, smoking, and metabolic syndrome in different body mass index (BMI) and waist circumference (WC) groups. The most prevalent cardiometabolic risk factor was dyslipidaemia (91.71%, n = 49,488). The prevalence of arterial hypertension, dyslipidaemia, diabetes mellitus, and metabolic syndrome was greater in those with higher-than-normal BMI and WC. Smoking was the most prevalent in women with low BMI and normal WC (24.00% and 13.17% respectively).ConclusionThe analysis showed that all risk factors, except smoking, were significantly more prevalent in women with higher-than-normal BMI and with increased WC or abdominal obesity. The prevalence of dyslipidaemia was surprisingly high in all BMI and WC groups. Obesity measured by WC was more strongly associated with an adverse metabolic profile.     

Influences of body mass index and waist circumference on physical function in older persons with heart failure

BACKGROUND:

In older persons with heart failure (HF), body composition may influence physical function and treatment effectiveness. There is a lack of research concerning the associations between waist circumference (WC) or body mass index (BMI) and physical function in this population.

OBJECTIVE:

To determine whether BMI and WC are associated with physical function in older men and women with HF.

METHODS:

Seventy-one men and 36 women 65 years of age and older living with HF completed two surveys spaced three months apart. Height, weight, WC, time since diagnosis, edema, comorbidities and physical function were self-reported at baseline and follow-up. Physical function was determined using the physical component score of the Short Form-12 and the physical limitation domain (PLD) of the Kansas City Cardiomyopathy Questionnaire. Multivariate linear regression and analysis of covariance were used to evaluate the relationships between WC and BMI, as well as cross-classifications of WC and BMI with physical function, after adjusting for confounders and interactions.

RESULTS:

The cross-sectional and short-term follow-up analyses did not detect an association between WC or BMI and physical function, with the exception of changes in the PLD, which were significantly different across WC categories. Persons with a moderate WC experienced the greatest improvement in function. The physical component and PLD scores were lower than those reported by Canadians 75 years of age and older and stable HF patients, respectively. Women reported lower physical function scores than men.

CONCLUSION:

Findings from the present study indicate that older persons with HF, especially women, have poor physical functioning regardless of their WC or BMI.     

腰围身高比值与2型糖尿病心血管病危险因素的关系

目的探讨腰围身高比值（WHtR）用于2型糖尿病（T2DM）评估腹型肥胖及其与心血管病危险因素的关系。方法新诊断T2DM患者4ll例，测血压、血糖、血脂、身高、体重、腰围（WC）、臀围，计算BMI、WHtR及腰臀比（WHR），分析WHtR、BMI、WC及WHR与身高的关系，各肥胖指数与血压、血脂的关系。结果（1）WHtR与血压、TG及HDL-C的相关程度均大于与BMI、WC、wHR的相关程度。WHtR与高血压、高TG及低HDL-C均显著相关。结论WHtR升高与血压、血脂关系密切，可作为评估腹型肥胖及预测T2DM心血管疾病危险因素指标之一。     

体质指数与腰围指标联合应用对心血管病危险的预测作用

目的 分析和评价在体质指数(BMI)分层基础上,增加腰围指标对心血管病危险因素的检出作用以及对心血管病发病危险的预测作用.方法 以1992年建立的中国多省市前瞻性队列35～64岁共30 378人数据为依据,在基线BMI分为正常、超重和肥胖的基础上,分析和评价加入腰围指标对心血管病代谢因素的检出作用以及心血管病发病危险的预测作用.诊断标准分别参照<中国成人超重和肥胖症预防控制指南>中的BMI切点和<中国成人血脂异常防治指南>中的腹部肥胖切点.结果 (1)联合应用BMI和腰围指标诊断肥胖时,呈现交叉重叠情况.以BMI为标准,队列人群肥胖率是10%,其中76.4%的人同时伴有腹部肥胖;以腰围为标准诊断人群腹部肥胖率为17.5%,其中有43.4%的人同时符合BMI的肥胖标准.(2)在BMI分层中加入腰围指标,男女两性有腹部肥胖者其心血管病危险因素患病率均高于无腹部肥胖组.在调整了年龄、性别、吸烟和体力活动等因素后,其特点仍存在,并有统计学的显著性.(3)以BMI和腰围均正常组为对照,多因素分析显示:超重和肥胖组中有腹部肥胖者的缺血性心血管病发病危险分别增加了38%(RR=1.383,95%CI 1.083～1.765)和57%(RR=1.570,95%CI 1.226～2.010).结论 在BMI分层中加入腰围指标可增加心血管病代谢危险因素以及心血管病发病危险的预测作用.     

终末期肾病患者发生缺血性心脏病的危险因素分析

目的探讨终末期肾病患者发生缺血性心脏病的危险因素。方法选取终末期肾病患者102例,根据缺血性心脏病确认标准分为缺血性心脏病组52例,无缺血性心脏病组50例。记录两组患者年龄、性别、原发病、透析龄,同时记录血生化指标血尿酸、血红蛋白、血浆白蛋白、总蛋白、胆固醇、甘油三酯、低密度脂蛋白、血钙、血磷、全段甲状旁腺素（iPTH）、25-（OH）D、尿素氮和肌酐水平。结果缺血性心脏病组血浆总蛋白、白蛋白（28．13±1．07比35．44±1．08）、血红蛋白（80．63±3．24比96．54±4．51）、血肌酐、25-（OH）D（9．31±0．64比15．22±1．09）水平均低于无缺血性心脏病组（P〈0．05或P〈0．01）;而年龄、血胆固醇、尿酸（484．27±26．34比365．22±20．76）水平则明显高于无缺血性心脏病组（P〈0．01）。二分类Logistic回归分析显示,血浆白蛋白、胆固醇、血红蛋白、血尿酸、25-（OH）D可能是终末期肾病患者发生缺血性心脏病的危险因素。结论缺血性心脏病是终末期肾病患者常见的并发症之一,血脂异常、营养不良、贫血、高血尿酸、低血25-（OH）D是终末期。肾病患者发生缺血性心脏病的重要危险因素。     

PCI对老年冠心病合并肾功能不全患者心、肾功能的影响

目的:研究经皮冠状动脉介入术(PCI)对老年冠心病(CHD)合并肾功能不全(RI)患者心、肾功能的影响。方法:选择本院2016年1月~2018年1月间收治的61例老年CHD+RI患者为研究组,同期本院的61例老年肾功能正常的CHD患者为冠心病对照组,两组均接受PCI治疗。对比两组PCI术中指标及治疗前后、肾功能。结果:术前:与冠心病对照组比较,研究组单支病变、AHA/ACC A型病变比例显著降低,多支病变、AHA/ACC B型、C型病变比例显著升高,P均=0.001;手术时间[(84.37±9.87)min比(112.03±10.28)min]、置入支架数量[(1.38±0.26)个比(2.16±0.31)个]和造影剂用量[(139.62±20.05)ml比(185.47±20.18)ml]均显著升高,P均=0.001;与术前比较,术后研究组LVEF [(54.05±5.85)%比(56.17±5.91)%]显著升高,但仍显著低于冠心病对照组[(56.17±5.91)%比(58.43±6.12)%],P均<0.05;研究组LVESd [(33.61±4.78)mm比(31.59±4.59)mm]显著缩小,但仍显著大于冠心病对照组[(31.59±4.59)mm比(29.64±4.28)mm],LVEDd [(52.16±1.97)mm比(50.24±1.98)mm]显著缩小,但仍显著大于冠心病对照组[(50.24±1.98)mm比(49.23±2.09)mm]P<0.05或<0.01。无论术前术后,与冠心病对照组比较,研究组Scr、BUN、CysC水平均显著升高,GFR均显著降低,P均=0.001;CIN发生率(0比9.84%)、3个月内总的心血管不良事件发生率(6.56%比22.95%)均显著升高,P均<0.05。结论:PCI治疗对老年冠心病合并肾功能不全患者能够显著改善心功能,但其预后仍逊于老年冠心病肾功能正常的患者。     

Waist height ratio and waist circumference in relation to hypertension,Framingham risk score in hospitalized elderly Egyptians

Background

Hypertension is a public health problem and obesity is becoming an epidemic, increasing the risk of hypertension. Both are risk factors for cardiovascular diseases (CVD).

腰围甘油三酯指数与胸痛患者心血管危险因素聚集的关系

目的 研究腰围甘油三酯（WT）指数与胸痛患者心血管危险因素聚集的关系。 方法 回顾性分析在我院就诊的胸痛患者。比较心血管危险因素聚集组和非聚集组基线资料的差异。分析腰WT指数与心血管危险因素聚集的相关性。 结果 共有309例患者入选,其中女性115例。心血管危险因素聚集的检出率为73.8%。心血管危险因素聚集组的体重、腰围、体重指数、低密度脂蛋白胆固醇、甘油三酯、空腹血糖和腰WT指数均高于非聚集组（P<0.05）;高密度脂蛋白胆固醇低于非聚集组（P<0.05）。WT指数与心血管危险因素数量呈正相关（r=0.414,P<0.001）。多因素Logistic回归表明,WT指数是心血管危险因素聚集的独立预测因素（OR=1.012,95%CI：1.008~1.018）。WT指数在全部研究人群、男性人群及女性人群, ROC曲线下面积分别为0.750（95%CI：0.689~0.811）、0.709（95%CI：0.631~0.788）和0.852（95%CI：0.771~0.933）;其预测心血管危险因素聚集的最佳切点分别为138.7、110.6和134.4。 结论 WT指数是心血管危险因素聚集的独立预测因素,而且可以对心血管危险因素聚集做出定量的评价。     

冠心病患者肾动脉狭窄及危险因素分析

目的:对冠心病患者动脉粥样硬化性肾动脉狭窄的发病率和危险因素进行探讨。方法:569例冠状动脉造影诊断为冠心病的患者同时进行选择性双侧肾动脉造影。结果:肾动脉狭窄的发生率为16·5%(94/569)。肾动脉狭窄的患病率随着年龄的增加而上升(χ2=19·170,P<0·001)。肾动脉狭窄的发病率随着冠状动脉病变程度的加重而增加(χ2=22·115,P<0·001)。多因素Logistic回归分析中,年龄、高血压和冠心病多支病变为肾动脉狭窄的独立危险因素。结论:对冠心病患者,尤其是多支病变、高血压、高龄的冠心病患者应常规行选择性肾动脉造影。     

慢性心力衰竭合并肾功能不全相关危险因素分析

目的分析慢性心力衰竭(CHF)患者合并肾功能不全的临床特点,探讨CHF患者伴发肾功能不全的危险因素。方法收集就诊于本院心内科的CHF患者385例,其中男性211例,女性174例,平均年龄69.62±8.59岁。采用回顾性对照研究的方法,按照肾小球滤过率估计值(eGFR)将CHF患者分为肾功能不全组[eGFR60 mL/(min·1.73 m~2)]和非肾功能不全组[eGFR≥60 mL/(min·1.73 m2)]。分析比较两组患者的一般资料、心脏基础疾病、伴随疾病、对比剂应用史、心脏超声参数、肾功能指标、血脂、N末端B型利钠肽前体(NT-proBNP)、D-二聚体、血红蛋白、尿微量白蛋白等实验室检查结果。多因素Logistic回归分析CHF患者合并肾功能不全的危险因素。结果385例CHF患者中合并肾功能不全的发生率约为42.1%。单因素分析结果显示,年龄、NYHA心功能分级、高血压病、贫血、糖尿病、心房颤动在肾功能不全组和非肾功能不全组之间的差异有统计学意义(P0.05);肾功能不全组血清肌酐、尿素氮、尿酸、胱抑素C和NT-proBNP水平较非肾功能不全组升高;左心室射血分数和血红蛋白水平较非肾功能不全组降低,差异有统计学意义(P0.05)。多因素Logistic回归分析显示,年龄(OR 1.543,95%CI1.067~2.231)、NYHA心功能分级(OR 1.840,95%CI 1.054~3.212)、高血压病史(OR 1.967,95%CI 1.175~3.292)以及胱抑素C(OR 1.989,95%CI 1.027~3.851)与肾功能不全的发生独立相关。结论 CHF患者合并肾功能不全的发生率较高,高龄、NYHA心功能Ⅳ级、高血压病史以及血清高胱抑素C水平是CHF患者合并肾功能不全的独立危险因素。     

腰围、腰高比、内脏脂肪指数对大连地区40岁以上新诊断糖尿病前期女性患者的预测价值

目的探讨WC、腰高比(WHtR)、内脏脂肪指数(VAI)对大连地区40岁以上新诊断糖尿病前期女性患者的预测价值。方法依托REACTION研究,选取2725名受试者,随访3年后最终纳入2044名受试者。分析WC、WHtR及VAI预测糖尿病前期发生的价值及合适的切点。结果2044名受试者3年后共有317例(15.51%)出现糖尿病前期。二元Logistic回归分析结果显示,WC、WHtR及VAI均是糖尿病前期患病的危险因素(OR 1.023、2.013、1.259,95%CI 1.004~1.042、1.580~2.564、1.124~1.410,P<0.05或P<0.01)。分别以WC、WHtR、VAI为检验变量,绘制预测糖尿病前期的受试者工作特征曲线,结果显示,WC、WHtR及VAI预测糖尿病前期的曲线下面积分别为0.598,0.602及0.625,合适切点分别为82.5 cm、0.55及1.45。经Z检验证实,VAI的预测效果优于WC及WHtR(Z=3.352、2.930,P<0.05)。结论WC、WHtR、VAI是糖尿病前期患病的危险因素;WC、WHtR及VAI预测糖尿病前期患病切点分别为82.5 cm、0.55及1.45;VAI预测糖尿病前期患病的效果优于WC、WHtR。     

体重指数和腰围与代谢综合征发生风险的比较研究

目的 比较体重指数、腰围与代谢综合征发生风险的相关性.方法 554例人选者(男316例,女238例),按照体重指数和腰围被分为周围肥胖组192例、腹部肥胖组135例和混合肥胖组237例,7年后进行随访.结果 共随访到520例.周围肥胖组代谢综合征累积发生率26.3%(49/186),腹部肥胖组代谢综合征累积发生率41.7%(50/120),混合肥胖组代谢综合征累积发生率43.0%(92/214).腹部肥胖组和混和肥胖组代谢综合征累积发生率显著高于周围肥胖组(X2分别为7.825和12.082,均P＜0.01),且基线时舒张压、甘油三酯、空腹血糖、空腹胰岛素及稳态模型评估法胰岛素抵抗指数(HOMA-IR)也显著高于前者(均P＜0.05).以有或无代谢综合征分组后基线资料比较,代谢综合征组无论男女,腰围和腰臀比均高于非代谢综合征组(P＜0.01和P＜0.05),体重指数在两组无统计学差异,并且代谢综合征组空腹血糖、空腹胰岛素和HOMA-IR显著高于非代谢综合征组(均P＜0.05).Logistic回归显示,与代谢综合征发生风险相关的因素主要为腰围(P=0.021)、腰臀比(P=0.009)、HOMA-IR(P=0.004).结论 腹部脂肪堆积及胰岛素抵抗是代谢综合征发生的两个重要因素,腰围比体重指数与代谢综合征的发生风险关系更密切.     

Comparison of anthropometric indices (body mass index,waist circumference,waist to hip ratio and waist to height ratio) in predicting risk of type II diabetes in the population of Yazd,Iran

Background and objectives

The purpose of this study was to determine the best anthropometric index and calculate the cut-off point for each anthropometric index in predicting the risk of type II diabetes in the population of Yazd city in Iran.

蒙古族农牧民代谢综合征诊断的腰围切点观察

目的研究我国蒙古族农牧民代谢综合征（MS）诊断的腰围（WC）适宜切点。方法以内蒙古自治区通辽市科左后旗朝鲁吐苏木和奈曼旗固日班花苏木32个自然村2589名年龄大于20岁的蒙古族农牧民为研究对象,以国际糖尿病联盟（IDF）MS全球共识诊断标准为基础,分析蒙古族男女不同WC水平与MS其他组分聚集的关联,检出至少两个组分存在时灵敏度和特异度均较高的WC界限,作为诊断蒙古族农牧民MS的WC切点,并以此计算不同年龄组MS的检出率。结果随WC增大,MS组分聚集的OR值显著增高。当男性WC≥84cm、女性WC≥81cm时,ROC曲线下面积最大。结论IDF标准在蒙古族农牧民男性中WC切点偏高,宜降至男性≥85cm、女性≥80cm。