2型糖尿病并发冠心病的影响因素分析

目的应用主成分分析法(principal component analysis,PCA)分析老年2型糖尿病患者并发冠心病的主要危险因素。方法回顾性分析2010年8月—2015年8月该院住院行冠状动脉(冠脉)造影检查的60岁以上老年2型糖尿病患者503例临床资料,测定糖尿病患者尿白蛋白排泄率(urinary albuminexcretion rate,UAER)等指标,采用Gensini系统对冠脉血管病变程度进行评分。结果第1~7主成分的特征值均1,累计贡献率为64.6%;第1~4主成分分别为UAER、咀脂、血压、尿酸,贡献率分别为14.1%、11.8%、10.2%、8.7%;第5~7主成分均属血糖,累计贡献率为19.8%。结论 UAER是老年2型糖尿病患者并发冠心病最主要的危险因素,伴微量白蛋白尿的老年2型糖尿病患者冠心病患病风险增加,且严重程度增加;UAER与老年2型糖尿病患者冠心病的发生及冠脉病变严重程度呈正相关,为其独立影响因素。     

中老年人群高甘油三酯血症-腰围表型与心血管危险因素聚集关系探讨

目的:探讨40~79岁中老年人群高甘油三酯(TG)血症-腰围(HTWC)表型与心血管危险因素聚集的关系。方法 :利用2013年成都市4个社区横断面流行病学调查的1 004例40~79岁中老年人群数据,将HTWC定义为TG≥2.0 mmol/L,男性腰围≥90 cm,女性腰围≥85 cm。分为(1)TG和腰围正常组(492例)即血TG2.0 mmol/L,男性腰围90 cm,女性腰围85 cm;(2)单纯腹型肥胖组(301例)即血TG2.0 mmol/L,男性腰围≥90 cm,女性腰围≥85 cm;(3)单纯高TG组(79例)即血TG≥2.0 mmol/L,男性腰围90 cm,女性腰围85 cm;(4)HTWC组(132例)即血TG≥2.0 mmol/L,男性腰围≥90 cm,女性腰围≥85 cm,共4组。分析该人群HTWC检出率及其与心血管危险因素聚集的相关性。结果:40~79岁中老年人群HTWC表型的检出率为13.15%(男性12.69%,女性13.37%),40~79岁人群中HTWC组心血管危险因素聚集检出率为41.67%,而TG和腰围正常组心血管危险因素聚集检出率为13.21%。多因素Logistic逐步回归分析显示,经校正年龄、性别、体重指数、吸烟史、糖尿病家族史及高血压家族史后,HTWC组发生心血管危险因素聚集的检出率仍为TG和腰围正常组的4.50倍(比值比:4.50,95%可信区间:2.84~7.12,P0.05)。结论:中老年人群HTWC与心血管危险因素聚集密切相关,可作为筛查心血管危险因素聚集的指标。     

成都地区中老年人群单纯收缩期高血压流行特点及其影响因素

目的探讨成都城乡地区中老年人群单纯收缩期高血压流行状况及危险因素,为本地区中老年高血压防治工作提供理论依据。方法 2008年应用分层整群抽样方法调查成都城乡地区40~79岁中老年人5205人,经统一培训的30余名医护人员进行血压测量及资料收集。了解中老年单纯收缩期高血压的患病率,分析中老年单纯收缩期高血压的影响因素。结果成都城乡地区中老年人群单纯收缩期高血压患病率为16.64%,标化患病率为15.87%。城市居民患病率为17.18%,农村居民患病率为14.23%;城市高于农村(P0.01)。男性患病率为16.09%;女性患病率为16.99%(P=0.40)。随着年龄的增加,单纯收缩期高血压患病率呈明显的增高趋势。多元Logistic逐步回归分析发现,年龄、偏咸膳食、腹型肥胖为男性单纯收缩期高血压的危险因素。年龄、绝经、超重或肥胖、腹型肥胖、高胆固醇血症为女性单纯收缩期高血压的危险因素。文化程度高及适度的运动为女性单纯收缩期高血压的保护因素。结论成都地区中老年人单纯收缩期高血压患病率较高,与增龄关系密切。控制腰围、体质量、钠盐摄入,适度运动对中老年人单纯收缩期高血压防治工作有较为重要的意义。     

新疆多民族地区中老年脉压与心血管危险因素的分析

目的 探讨维哈蒙汉族中老年自然人群脉压水平、心血管危险因素聚集情况及两者之间的关系。方法 采用随机整群抽样的方法对新疆博州40岁以上的蒙哈维汉四民族居民共2648人进行流行病学调查。结果 （1）男女脉压水平与年龄、收缩压、舒张压、血糖、体重指数和腹围等呈正相关，男性脉压还与血胆固醇和血甘油三酯呈正相关。（2）心血管危险因素聚集为77．24％，有随年龄增长的趋势，四民族间无叽显差异，但维族女性远高于男性，而蒙族男性高于女性。（2）脉压≤60mmHg组者中高血压、高血糖和危险因素聚集评分的异常检出率低于其他组。结论 新疆博州中老年人群心血管病的主要危险因素高血压、高脂血症、超重腹型肥胖、糖尿病和心血管危险因素聚集的流行程度均已达到较高水平，脉压〉60mmHg者心血管危险因素聚集明显增加。     

人体测量指标与血脂、血糖及血压水平的典型相关

目的：探讨人体测量指标与心血管危险因素水平的相互关系，确定与心血管危险因素相关最密切的人体测量指标。方法：在江苏省金坛县农村抽取３５～５９岁自然人群（男４９２名；女６０６名），测量身高、体重、腰围、腹围、臀围和血胆固醇、高密度脂蛋白胆固醇、血糖、收缩压、舒张压，计算出体重指数（ＢＭＩ）、腰／臀比（ＷＨＲ）、腹／臀比（ＡＨＲ）和锥削度指数（ＣＩ）后，与血脂、血糖及血压水平作典型相关分析。结果：人体测量指标与心血管危险因素指标呈典型相关（典型相关系数为０．３１～０．５０）；人体测量指标中，体重指数的贡献最大，与心血管危险因素的相关最密切；血压是心血管危险因素中与人体测量相关最密切的指标。结论：体重指数是本组人群中最简单但最有价值的人体测量指标；而血压是受肥胖影响最大的心血管危险因素指标。     

老年2型糖尿病患者并发冠心病的危险因素分析

目的 应用主成分分析法(principal component analysis,PCA)分析老年2型糖尿病患者并发冠心病的主要危险因素. 方法 回顾性分析我院住院行冠状动脉(冠脉)造影检查的60岁以上老年2型糖尿病患者503例临床资料,测定糖尿病患者尿白蛋白排泄率( urinary albuminexcretion rate,UAER)等指标,采用Gensini系统对冠脉血管病变程度进行评分. 结果 第1～7主成分的特征值均大于1,累计贡献率为64.6％;第1～4主成分分别为UAER、血脂、血压、尿酸,贡献率分别为14.1％、11.8％、10.2％、8.7％;第5～7主成分均属血糖,累计贡献率为19.8％. 结论UAER是老年2型糖尿病患者并发冠心病最主要的危险因素,伴微量白蛋白尿的老年2型糖尿病患者冠心病患病风险增加,且严重程度增加;UAER与老年2型糖尿病患者冠心病的发生及冠脉病变严重程度呈正相关,为其独立影响因素.     

2型糖尿病患者受教育水平与心血管危险因素的控制：9 921例临床分析

目的分析2型糖尿病患者的受教育水平与心血管危险因素控制的关系。方法收集糖尿病并发症筛查且心血管危险因素等指标资料齐全的2型糖尿病患者的临床资料。按患者受教育程度由低到高分为四组,比较和分析四组患者心血管危险因素控制情况。结果共入选2型糖尿病患者9921例,其中合并两种以上心血管危险因素的患者占57．3％。随着文化水平的升高,女性构成比增加,血压、心率、空腹血糖、餐后血糖、HbAlc、胰岛素抵抗指数、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、尿白蛋白／肌酐比值逐渐降低,血尿酸逐渐升高。总胆固醇、高密度脂蛋白胆固醇、血压、空腹血糖、腰围、HbAlc治疗控制达标率逐渐升高,代谢综合征患病率下降。结论受教育水平低的2型糖尿病患者心血管危险因素的控制率低。有更高的多种心血管危险因素集簇。     

青少年空腹血糖受损相关危险因素分析

目的探讨青少年空腹血糖受损（IFG）的相关危险因素。方法秦皇岛地区一项3937名13-18岁青少年的横断面调查。根据空腹血糖分为空腹血糖正常组和空腹血糖受损组（IFG组）。测量身高、体重、腰围、血压、TG、TC、HDL-C、LDL-C水平。结果共检出IFG136例（3.5%）,男女IFG检出率分别为3.9%和3.1%,两性间比较无统计学差异（P=0.177）。IFG组具有2项以上心血管危险因素的危险性是空腹血糖正常组青少年的1.889倍（95%CI1.125-3.171）。IFG组45.6%存在糖尿病家族史。多元逐步回归显示年龄、腰围、胆固醇均为独立影响因素。结论青少年群体中IFG相当多见,并已开始导致心血管危险因素聚集。遗传因素、腹型肥胖及脂代谢异常是IFG的危险因素。     

成都地区中老年高血压人群糖代谢异常流行状况及其影响因素

目的 探讨成都地区中老年高血压人群糖代谢异常流行状况及影响因素.方法 于2008年采用分层整群抽样的方法,调查成都城乡地区40～79岁中老年人口4685例,进行血压、口服葡萄糖耐量试验(OGTT)等检测,已确诊糖尿病患者只测空腹血糖,开展问卷调查.比较高血压及非高血压人群糖代谢异常患病率,获取中老年高血压人群单纯性糖耐量异常及单纯性负荷后高血糖情况,分析中老年高血压人群糖代谢异常的影响因素.结果 成都地区中老年高血压人群糖代谢异常患病率(53.4%)显著高于非高血压人群(25.1%);若不行OGTT,仅依靠检测空腹血糖,将漏诊中老年高血压人群中72.9%的糖尿病前期患者和54.4%的新诊断糖尿病患者;年龄、一级亲属糖尿病史、超重或肥胖为成都地区中老年男性高血压人群发生糖代谢异常的独立危险因素,体育锻炼、文化程度高为保护因素;年龄、一级亲属糖尿病史、腹型肥胖、高TG血症为成都地区中老年女性高血压人群发生糖代谢异常的独立危险因素.结论 成都地区中老年高血压人群超过半数合并糖代谢异常,需要通过OGTT及时发现这些合并糖代谢异常的患者.适当运动,了解糖尿病相关的保健知识以采取合理的生活方式,干预超重或肥胖、腹型肥胖及高TG血症等代谢性因素,对于减少中老年高血压人群糖代谢异常的发生有着较为重要的作用.     

血清超敏C反应蛋白与心血管危险因素的关系探讨

目的在中年自然人群中探讨血清超敏C反应蛋白(hs-CRP)与心血管危险因素的关系。方法对388例"宫内发育与成人疾病"队列人群的身高、体重、血压、血糖、血脂及血清hs-CRP等进行测定。用SPSS10.0软件进行数据统计分析。结果由低至高的血清hs-CRP四等分组的心血管危险因素体重指数(BMI)、血压、空腹血糖、高密度脂蛋白胆固醇(HDL-C)组间差异有统计学意义(P0.001);总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL-C)的组间差异也有统计学意义(P0.05),四组心血管危险因素聚集检出率分别为5.7%,14.3%,28.6%,51.4%(P0.001)。结论血清hs-CRP与心血管危险因素(BMI、血压、血糖和血脂)呈正相关关系。     

成渝地区中老年人群代谢综合征流行病学特征及其相关因素

目的探讨成渝地区中老年人群代谢综合征流行病学特征及其相关危险因素。方法于2013年采用分层整群抽样的方法,调查成渝城乡地区40~79岁中老年人7807例,进行身高、体重、血压、血脂及口服葡萄糖耐量试验(OGTT)等检测。用统一设计的调查表对研究对象进行面对面的问卷调查。代谢综合征诊断标准采用中华医学会糖尿病学分会标准。结果成渝地区中老年人群代谢综合征患病率为13.8%。男性患病率为13.3%,女性患病率为14.1%,两性患病率无统计学差异。城区患病率为14.6%,农村患病率为10.6%,城市患病率高于农村。40~69岁研究人群代谢综合征患病率逐渐升高。年龄、腹型肥胖、缺乏体育锻炼是成渝地区中老年男性代谢综合征主要的危险因素;年龄、一级亲属高血压病史、腹型肥胖是成渝地区中老年女性代谢综合征主要的危险因素。结论成渝地区中老年人群代谢综合征患病率较高。控制合理的腰围,对于人群代谢综合征的预防、干预以及阻止心血管疾病的发生发展可能有重要意义。     

乌鲁木齐某社区不同睡眠时间居民的糖脂代谢指标分析

目的:调查乌鲁木齐某社区不同睡眠时间居民的糖、脂代谢指标水平。方法:利用2017年5月在乌鲁木齐某社区进行慢性代谢疾病流行病学调查所获2 049名居民的数据,选取资料完整、年龄19～80岁的居民共1 822人,测血压、腹围、身高、体重并计算体重指数。完善口服葡萄糖耐量试验采集静脉空腹及2 h血浆血糖,同时测尿酸、HbA...     

社区老年人高尿酸血症的调查研究

目的探讨社区老年人的血尿酸状况及其与高脂血症、高血压、心电图、高血糖、肥胖、肾功能异常的关系,为开展社区干预提供科学依据。方法选取本辖区60岁及以上老年人587例,免费常规体检,包括空腹血糖、血脂、肾功能、心电图、血压等项目,并对其结果和高尿酸血症组进行统计学分析。结果共检出高尿酸血症患者139例,占23.68%。高尿酸组和非高尿酸组在高血压、心电图异常、肾功能异常、高脂血症、肥胖比率比较,差异均有统计学意义(P<0.05);而高血糖比率比较,差异无统计学意义(P>0.05)。高尿酸组女性肥胖高于男性,差异有统计学意义(P<0.05)。结论老年高尿酸血症患者与血脂异常、心血管疾病、肾功能异常、高血压、肥胖有明显的相关性。高尿酸血症易引发动脉粥样硬化,增加了心脑肾血管疾病的发生率,应引起足够的重视。     

The relationship between uric acid and metabolic syndrome in normal glucose tolerance and normal fasting glucose subjects

Elevated serum uric acid (SUA) concentrations have been suggested to associate with metabolic syndrome (MetS) and its components. However, limited information is available regarding the relationship between SUA and MetS in subjects with normal glucose levels. A total of 501 subjects with normal fasting glucose and normal glucose tolerance were included in the study. Anthropometrical and biochemical parameters were examined using standard methods. The updated NECP criteria were used to define the MetS. Values of SUA above the sex-specific percentile 75 were used to define hyperuricemia. The prevalence of general and abdominal obesity, hypertension, hypertriglyceridemia, low-HDL, smokers, MetS and insulin resistance was significantly greater in the fourth SUA quartile. Multiple regression indicated that SUA was independently predicted by BMI, triglyceride and 2 h glucose in women, and BMI, triglyceride, 2 h glucose and cholesterol in men. Logistic regression analysis showed that the obesity, hypertriglyceridemia, MetS and insulin resistance were independent determinants of hyperuricemia in women. In men, hyperuricemia was associated with the obesity, hypertriglyceridemia and hypercholesterolemia. Factor analysis yielded three factors interpreted as weight/waist, blood pressure and lipid/glucose. Including SUA in the model did not affect total variance of factor analysis. Our results indicate that SUA is associated with MetS and its components even in subjects with normal glucose levels. General obesity was the major determinant of hyperuricemia in this population. The data from this study do not show the contribution of SUA as an additional component of the MetS.     

High blood pressure and obesity increase the risk of abnormal glucose tolerance in young adult african americans

Higher prevalence of both hypertension and obesity in African Americans is associated with a disproportionately greater burden of cardiovascular diseases in this ethnic group. The purpose of this study was to examine whether there is an interaction between hypertension and obesity that significantly increases the expression of metabolic risk factors for cardiovascular disease. Four groups of young adult African Americans were recruited based on their weight and blood pressure (BP). The effects of weight and BP on metabolic risk factors were analyzed based on data obtained from 484 patients. Results demonstrated that high BP and obesity were independently associated with increased odds of abnormal glucose tolerance, 1.8- and 2.2-fold, respectively. The coexistence of both high BP and obesity further increased the odds of abnormal glucose tolerance 4-fold. In addition, the geometric mean of homeostasis model assessment, an estimate of insulin resistance, increased by 18% with high BP, 60% with obesity, and 90% with the presence of both high BP and obesity. Although no statistically significant interaction between high BP and obesity was detected, the relationships of both high BP and obesity with metabolic risk factors were clearly additive.     

Association between serum uric acid level and hypertension in a Chinese elderly rural population

Previous studies have examined the association between elevated serum uric acid (SUA) level and hypertension; however, the association in the Chinese elderly is still uncertain. A cross-sectional study was performed in a rural district of Beijing. A total of 2,397 participants (967 men and 1,430 women) completed the survey. The SUA levels of participants were categorized into four levels using the quartiles (P25, P50, and P75) as cutoff values. Participant was diagnosed as hyperuricemia if the SUA level was ≥417 μmol/L (male) or ≥357 μmol/L (female). Hypertension was defined as systolic blood pressure (BP) ≥140 mmHg and/or diastolic BP ≥90 mmHg and/or receiving antihypertensive drug treatment. Multiple logistic regression was used to estimate the association between SUA and hypertension. We found that higher SUA level was associated with the increased risk of hypertension in both sexes, even after adjusting for potential confounding variables. In total, the risk for having hypertension increased by 0.3% per 1 μmol/L increment in SUA level, increased by 95% for the highest vs. lowest quartile of SUA level, and increased by 111% in the hyperuricemia patients. Moreover, we found that the association was more pronounced in the male participants. There were approximately J-shaped relationships between SUA level (quartiles) and hypertension in all age groups. Higher SUA levels are positively associated with hypertension among the Chinese rural elderly. Further studies are still required to determine the relationship between SUA level and hypertension and to explore its potential biological mechanisms underlying the gender-related association in the elderly population.

Abbreviations: CVD; cardiovascular disease; BMI: body mass index; BP: blood pressure; SUA: serum uric acid; TC: total cholesterol; TG: triglycerides; HDL-C: high-density lipoprotein; LDL-C: low-density lipoprotein; FPG: fasting blood glucose; OR: odds ratio; CI: confidence interval; SD: standard deviation     

北京部分城区老年人群高血压现况调查

目的分析2002～2003年北京部分城区60～74岁老年人群高血压患病率及有关特点。方法以北京大学和首钢地区60～74岁1157例心血管病危险因素横断面调查结果为研究样本，对老年人高血压的患病率、高血压的类型、高血压患者合并其他心血管病危险因素等情况进行分析。结果（1）该地区60～74岁人群高血压患病率、治疗率和控制率分别为60．5％、60．9％和23．4％；（2）随着年龄增长，男女两性高血压患病率呈持续增加趋势（P〈0．05）；与60～64岁组相比，70～74岁组男性高血压患病率增加了30．3％，女性高血压患病率增加了32.1％；（3）老年人单纯收缩期高血压患病率为25.0％，占老年高血压患者的42.3％；（4）老年高血压患者合并至少一个其他心血管病危险因素的比例为85．9％。结论高血压是北京部分城区60～74岁老年人群常见的心血管疾病，单纯收缩期高血压为老年高血压患者的常见类型，老年高血压患者绝大多数合并有其他心血管病危险因素。     

Metabolic syndrome and cardiovascular disease in the elderly: the Progetto Veneto Anziani (Pro.V.A.) study

BACKGROUND AND AIMS: The prevalence of the metabolic syndrome increases with age, although only few data are available about its prevalence in the general elderly population. This study describes the prevalence of the metabolic syndrome in an elderly population, and its association with cardiovascular diseases. METHODS: The Progetto Veneto Anziani (Pro.V.A.) is an observational study of 3,099 subjects aged 65 and older, randomly selected from the general population of Northern Italy. Cardiovascular diseases and metabolic syndrome according to Adult Treatment Panel III were evaluated in 2,910 subjects. RESULTS: The metabolic syndrome was present in 25.6% of men and 48.1% of women. Its prevalence was mainly due to high blood pressure (93%) in both sexes, and to abdominal obesity in 73% of women. The prevalence of cardiovascular diseases was significantly higher among subjects with metabolic syndrome. Together with age and former smoking habits, the metabolic syndrome was significantly associated with cardiovascular diseases. High blood pressure and low HDL were independently associated with cardiovascular diseases in men, and with high fasting plasma glucose and waist circumference in women. CONCLUSIONS: The metabolic syndrome is frequent, and significantly but not independently associated with prevalent cardiovascular diseases in the elderly. In old people, rather than the metabolic syndrome per se, some of its components are independently associated with cardiovascular diseases.     

Changes in body weight are significantly associated with changes in fasting plasma glucose and HDL cholesterol in Japanese men without abdominal obesity (waist circumference < 85 cm)

The aims are to examine whether changes in body weight (dBW) are associated with changes in cardiovascular risk factors in Japanese men without abdominal obesity (waist circumference (WC) < 85 cm) and which anthropometric index, dBW or changes in WC (dWC), is more strongly associated with changes in cardiovascular risk factors in men without abdominal obesity. It is a retrospective study in 692 Japanese men without abdominal obesity who took annual health screening tests consecutively over one year. Standardized linear regression coefficients (SRCs) of dBW and dWC were calculated for changes in systolic blood pressure (dSBP), diastolic blood pressure (dDBP), fasting plasma glucose (dFPG), triglycerides (dTG), HDL cholesterol (dHDL), and high-sensitivity C-reactive protein (dCRP). The SRCs of dBW for dFPG and dHDL were significant in all men and in men with each risk factor corresponding to the component of metabolic syndrome (MetS). The SRCs of dWC for dTG and dCRP were significant in all men but not in men with each risk factor corresponding to the MetS component. In conclusions, dBW were significantly associated with dFPG and dHDL in Japanese men without abdominal obesity. Therefore, abdominal obesity should not be considered as a necessary component of MetS in Japanese men. dBW may be more useful than dWC as a marker of changes in cardiovascular risk factors in lifestyle intervention programs.     

Nationwide survey of prevalence and risk factors of prehypertension and hypertension in Iranian adults

OBJECTIVE: The aim of this study was to estimate the prevalence and risk factors of prehypertension (Pre-HTN) and hypertension (HTN) among the adult population of Iran. METHODS: A nationwide cross-sectional survey was conducted from December 2004 to February 2005. The selection was conducted by stratified probability cluster sampling through household family members in Iran. Blood pressure (BP) and associated risk factors of 35 048 men and 34 674 women aged 25-65 years (mean 44.1 years) were measured. RESULTS: The prevalence of Pre-HTN was 59.6% in men and 44.5% in women; and 19.8% of men and 26.9% of women were hypertensive, according to Joint National Committee 7 criteria. Pre-HTN was more common among men whereas HTN was more common among women. Multivariate analysis revealed that age, overweight, obesity, abdominal obesity and high cholesterol were strongly associated with Pre-HTN in both genders. In women, low educational attainment, residence in an urban area and high blood glucose were also associated with Pre-HTN. Age, low educational attainment, overweight, obesity, abdominal obesity and high cholesterol and blood glucose were strongly associated with HTN in both genders. CONCLUSION: Pre-HTN and HTN appear to be quiet common in Iran and were associated with obesity. More men than women present with Pre-HTN, whereas more women than men present with HTN. Prevention and treatment strategies are urgently needed to address the health burden of Pre-HTN and HTN and to prevent prehypertensive people from developing HTN and cardiovascular disease.