成年男性肥胖与血压的关系调查

高血压是目前发病率和死亡率最高的疾病之一，在国际上其发病率约为12％～22％。而我国的高血压患者已经超过了1亿人。且随着生活水平不断提高，膳食结构的不合理搭配，社会工作频率和生活节奏加快，不合理的生活方式，有规律的体育锻炼减少等，使超重与肥胖人群逐渐扩大，导致高血压的发病率日趋增高。本文就健康人群肥胖与血压的关系作一调查，现报告如下：     

不同肥胖指标与无高血压病的成年肥胖男性血压昼夜节律改变的关系

[目的]探讨不同肥胖指标与无高血压病的成年肥胖男性血压昼夜节律改变的关系.[方法]体检无高血压成年肥胖男性（腰围≥90厘米）48例,分别测量身高、体质量、腰围和臀围,并行动态血压监测.[结果]非杓型血压检出率为54.2％.非杓型组体质量指数（BMI）、腰围（WC）、腰围身高比值（WHtR）及腰臀比（WHR）均高于杓型组（P均＜0.01）.行多元线性回归显示,WHtR为夜间收缩压下降百分率（β=-85.310,P=0.000）和夜间舒张压下降百分率（β=-109.726,P=0.000）的独立危险因素.[结论]WHtR与肥胖人群血压昼夜节律改变密切相关,WHtR可作为识别非杓型血压的简便身体测量指标.     

无高血压成年肥胖男性血压昼夜节律与糖代谢异常的关系

[目的]探讨无高血压病的成年肥胖男性血压昼夜节律与糖代谢异常的关系.[方法]选择无高血压病的成年肥胖男性48例,根据动态血压将其分为杓型组和非杓型组,比较两组间各糖代谢指标.[结果]非杓型组糖化血红蛋白（GhbA1c）、口服葡萄糖耐量试验（OGTT） 、1 h和2 h血糖均高于杓型组（P〈0.05）,两组间年龄,空腹血糖及OGTT 3 h血糖比较无统计学差异（P〉0.05）.多元线性回归显示,OGTT 1 h血糖是夜间收缩压下降百分率（β=-1.258,P=0.000）和夜间舒张压下降百分率（β=-1.392,P=0.000）的独立影响因素.[结论]在无高血压肥胖男性人群,糖负荷后血糖变化与血压昼夜节律密切相关,加强餐后血糖的控制可能有助于恢复夜间杓型血压状态.     

中青年肥胖男性的体质量指数与代谢指标的变化

【目的】探讨中青年肥胖男性人群体质量指数（BMI）与各代谢指标的变化。【方法】选取20～52岁男性75例为研究对象。根据BMI分为肥胖组、超重组、对照组三组各25例。对三组的代谢指标及人体基本参数进行检测及比较。【结果】三组比较,中青年男性肥胖组收缩压（SBP）、舒张压（DBP）、总胆固醇（TC）、三酰甘油（TG）、血尿酸（UA）、睾酮（T）、餐后2 h血糖（2 hPG）、空腹胰岛素（FINS）、餐后2 h胰岛素（2 hINS）、胰岛素抵抗指数（HOMA-IR）差异有统计学意义（分别为P ＜0．01或P ＜0．05）;HDL-C、LDL-C、FPG比较无统计学意义（P≥0．05）。多元线性回归分析最终进入回归方程的因素有 SBP、TC、T和 FINS。【结论】早期干预导致BMI增加的相关代谢因素以预防代谢综合征及相关疾病的发生发展有重要意义。     

肥胖与高血压并早期动脉粥样硬化临床分析

目的观察肥胖儿童高血压,动脉粥样硬化前期的临床特点。方法对38例患有高血压的肥胖儿童进行血脂测定,并通过B超测量外周血管(肱动脉)反应性血管内径变化。结果38例肥胖儿童中18例为临界高血压(占47.4%),10例为高血压(占2.6%),25例血脂在临界高值(占65.8%),13例为高血脂(占34.2%),反应性充血前后肱动脉内径扩张百分比平均9.21%。结论儿童高血压与体重、身高及体重指数呈正相关,同时肥胖儿童存在动脉粥样硬化前期的血管病变。     

腰围身高比值筛查学龄儿童超重肥胖的可行性研究

[目的]探讨腰围身高比值(WHtR)作为肥胖筛查指标在小学体检中应用的可行性.[方法]采用分层整群随机抽样法,选取秦皇岛市7~12岁学生1 507人(男763人,女744人)作为研究对象,测量身高、体重和腰围(WC),计算体质指数(BMI)和WHtR.[结果]WHtR与年龄无相关(男生r=-0.008,女生r=0.005,P>0.05).男生WHtR与BMI(r=0.879)和WC(r=0.892)呈正相关(P<0.01).女生WHtR与BMI(r=0.779)和WC(r=0.837)呈正相关(P<0.01).WHtR识别儿童超重肥胖的ROC曲线下面积均在 0.9以上(P<0.01),准确性高.[结论]WHtR作为相对简单的测量方法,可有效识别儿童超重肥胖,便于校医操作,应列为学生体检的常规测量项目.     

通心络联合降压治疗改善老年男性高血压患者动脉硬化相关指标的研究

目的:探讨通心络联合常规降压治疗对老年男性高血压患者的抗动脉硬化作用。方法:将65～80岁男性高血压患者81例,随机分为常规降压治疗组(41例,单用坎地沙坦治疗)及通心络联合治疗组(40例,通心络联合坎地沙坦治疗)。两组在治疗前后分别检测胰岛素、总睾酮、HDL、血浆同型半胱氨酸(Hcy)水平、颈动脉内中膜厚度(CIMT)等指标。43例血压正常者作为对照组,但不进行治疗。结果:除血压异常外,老年男性高血压患者还有内分泌紊乱、血浆Hcy水平较高和HDL水平较低等的重要特征。与常规降压治疗组比较,通心络联合治疗组能有效地降低收缩压(P<0.05),血浆Hcy水平(P<0.01),有效地升高血浆HDL水平(P<0.05)。两种治疗均不能改善CIMT。结论:通心络联合常规降压治疗能明显改善动脉硬化相关的心脑血管疾病风险因素,有利于老年男性高血压患者的抗动脉硬化治疗。     

瘦素抵抗与老年男性肥胖高血压的关系

背景：目前已经了解血清瘦素与肥胖的关系密切，血清瘦素和胰岛素与伴有肥胖的高血压关系如何?目的：研究老年男性肥胖高血压患者血清瘦素和胰岛素水平的变化，探讨瘦素抵抗与老年男性肥胖高血压的关系。设计：以诊断为依据，设立对照的回顾性研究。单位：华中科技大学同济医学院附属协和医院神经内科、核医学科。对象：62例老年男性患者均来自2001—10／2002—06华中科技大学同济医学院附属协和医院的住院和门诊患者，年龄60—82岁。高血压的诊断采用1999年世界卫生组织建议的血压判定标准：收缩压≥140mmHg(1mmHg=0．133kPa)和(或)舒张压390mmHg即诊断为高血压。方法：用放射免疫法测定41例高血压和21例正常血压的老年男性患者血清瘦素和胰岛素的含量。主要观察指标：老年男性肥胖患者和非肥胖者血压、体质量指数、血清瘦素和胰岛素水平。结果：高血压肥胖者较正常血压肥胖者血清瘦素和胰岛素含量分别升高1．8μg／L和2．7mIU／L，差异均有显著性意义(t=2．212，2．395，P&;lt;0．01)。高血压肥胖者较非肥胖者血清瘦素和胰岛素水平分别升高2．7μg／L和4．7mIU／L，差异均有显著性意义(t=3．348，5．113，P均&;lt;0．001)。高血压70岁以上者较高血压60-70岁者血清瘦素水平升高1．7μg／L，差异均有显著性意义(t=2．767，P&;lt;0．05)。结论：老年肥胖高血压患者存在瘦素抵抗和胰岛素抵抗．瘦素与伴肥胖的高血压有密切关系。     

126例成年男性肥胖相关指数与超敏C反应蛋白关系的探讨

目的 通过检测健康人群和肥胖人群的超敏C反应蛋白(hs-CRP)水平比较,探讨成年男性肥胖相关指数中体质量指数(BMI)和腹型肥胖指数腰围(WC)或腰臀比(WHR)与hs-CRP的关系.方法 成年男性体检人群物理检测BMI、WC、血压,采用全自动生化分析仪和化学发光仪检测受试者血hs-CRP、血糖、血脂、胰岛素等相关生化指标,比较BMI和WHR与hs-CRP的关系.结果 BMI≥25组和 BMI＜25组的临床和实验室指标显示,两组间hs-CRP、SBP、TG、FBG、HOMA-IR差异有统计学意义(P＜0.01,WHR≥0.90和WHR＜0.90两组间比较,与BMI组基本相同;回归分析显示,BMI和WHR与hs-CRP(r值分别为0.382、0.314),有良好的正相关性.结论 hs-CRP同成年男性肥胖相关指数BMI和WHR一样与代谢综合征(MS)关系密切,炎性反应可能在MS的发病机制中起重要作用.     

Cost-Effectiveness of Bariatric Surgery for Severely Obese Adults With Diabetes

OBJECTIVE

To analyze the cost-effectiveness of bariatric surgery in severely obese (BMI ≥35 kg/m²) adults who have diabetes, using a validated diabetes cost-effectiveness model.

RESEARCH DESIGN AND METHODS

We expanded the Centers for Disease Control and Prevention–RTI Diabetes Cost-Effectiveness Model to incorporate bariatric surgery. In this simulation model, bariatric surgery may lead to diabetes remission and reductions in other risk factors, which then lead to fewer diabetes complications and increased quality of life (QoL). Surgery is also associated with perioperative mortality and subsequent complications, and patients in remission may relapse to diabetes. We separately estimate the costs, quality-adjusted life-years (QALYs), and cost-effectiveness of gastric bypass surgery relative to usual diabetes care and of gastric banding surgery relative to usual diabetes care. We examine the cost-effectiveness of each type of surgery for severely obese individuals who are newly diagnosed with diabetes and for severely obese individuals with established diabetes.

RESULTS

In all analyses, bariatric surgery increased QALYs and increased costs. Bypass surgery had cost-effectiveness ratios of $7,000/QALY and $12,000/QALY for severely obese patients with newly diagnosed and established diabetes, respectively. Banding surgery had cost-effectiveness ratios of $11,000/QALY and $13,000/QALY for the respective groups. In sensitivity analyses, the cost-effectiveness ratios were most affected by assumptions about the direct gain in QoL from BMI loss following surgery.

CONCLUSIONS

Our analysis indicates that gastric bypass and gastric banding are cost-effective methods of reducing mortality and diabetes complications in severely obese adults with diabetes.In recent years, bariatric surgery has emerged as a popular treatment to reduce body weight and improve obesity-related complications, particularly in the diabetic population. Several studies have shown that surgery can lead to significant weight loss, with excess body weight reduced by >50% (1,2). Although weight loss declines over time, the Swedish Obese Subjects (SOS) Study found significant weight loss even 10 years after surgery (3,4). In addition to sustained weight loss, bariatric surgery may provide additional benefits to people with diabetes. Among severely obese patients with diabetes, bariatric surgery often leads to diabetes remission, with remission rates that are as high as 80% in the short run (1) and that remain significant in the long run (3,4).Although the evidence suggests that bariatric surgery is a successful long-term treatment of obesity for people with diabetes, it is an expensive procedure. The average cost of surgery exceeds $13,000 (5), with additional costs possible in the months following surgery (6). This raises the question of whether bariatric surgery is cost-effective for severely obese people with diabetes.Several studies have estimated the cost-effectiveness of bariatric surgery and found that surgery is either cost-effective (7–10) or that it leads to cost savings over time (6,11–13). The existing studies tend to be relatively simple, and only two (10,13) focus on people with diabetes. The studies generally do not model the microvascular complications associated with diabetes, the effect of surgery on blood pressure and cholesterol levels, or the resulting outcomes.This study used the Centers for Disease Control and Prevention (CDC)-RTI Diabetes Cost-Effectiveness Model to analyze the cost-effectiveness of bariatric surgery in severely obese adults with diabetes. We separately estimated the cost-effectiveness of gastric bypass surgery relative to usual diabetes care and the cost-effectiveness of gastric banding surgery relative to usual diabetes care. Gastric bypass and gastric banding are the two forms of bariatric surgery most commonly studied (1). We examined the cost-effectiveness of each type of surgery for severely obese people who are newly diagnosed with diabetes (no more than 5 years after diagnosis) and for people with established diabetes (at least 10 years after diagnosis).     

Primary Care Physician Attitudes and Practice Patterns in the Management of Obese Adults: Results from a National Survey

Abstract

Purpose: Obesity remains a serious public health problem. The purpose of this study was to identify the current attitudes and practices of primary care physicians (PCPs) with respect to obesity. Methods: A survey was systematically developed and administered electronically to PCPs, who received a small honorarium for their time. Results were analyzed to identify specific attitudes and practices and their associations with each other and with demographic and other variables. Results: Physicians expressed little confidence in their ability to manage obesity. In general, however, they believed that obesity could be successfully managed. Lifestyle changes were perceived to be the most effective available method for patients to lose weight, and respondents were more likely to recommend this approach over pharmacotherapy or bariatric surgery. Respondents perceive the greatest barrier to managing obese patients to be a lack of patient motivation. Physicians were significantly more likely to initiate discussions with obese patients about their weight if they believed they had positive attitudes about and knowledge of weight management, and adequate resources to manage the problem. Conclusions: Physicians report a lack of confidence in managing obesity. Lack of patient motivation is perceived to be the greatest barrier. Physicians with greater knowledge, more positive attitudes toward obesity management, and access to more resources are more likely to provide weight management in primary care settings.     

Screening of an Elderly Population in Primary Care for Primary Hyperparathyroidism

In order to assess the diagnostic outcome of a screening for primary hyperparathyroidism (PHPT) in an elderly population, we determined ionized calcium in serum from 368 individuals participating in a health control at Mölnlycke Primary Care Centre (200 women, 168 men; age range 75–95 years); four-fifths of the individuals living in their homes, the remainder in homes for aged or nursing homes.

Intact parathyroid hormone was determined in the samples with oinized calcium concentration > mean ± 3SD of the truncated population sample, and these individuals were also recalled for another blood sample. Moderate hypercelcaemia, probably due to PHPT, was found in eight individuals (2% of the complete sample, 3% of the women), five having neuropsychiatric or neuromuscular symptoms consistent with PHPT.

Surgical intervention is probably indicated in only a small proportion of elderly patients. We conclude that optimal benefits in relation to costs of screening for PHPT in old people will depend on the availability of a safe and simple pharmacological treatment that could determine any causal relationship between hypercalcaemia and symptoms.