老年血脂紊乱与代谢综合征及心、脑血管事件相关性研究

目的 调查老年人群的血脂紊乱状况及与代谢综合征(MS)其他组分间的相互关系,并探讨这些异常状态对心、脑血管病变的影响.方法 对1996～2005年连续在解放军总医院门诊查体的2 547例老年人群的资料进行回顾性分析,并对不同类型血脂异常与糖代谢异常、高血压和肥胖的伴存状况,及对心脑血管病变发生的影响进行比较.结果 本组老年人群中血脂紊乱的MS患病率为69.6%,其中合并单纯高胆固醇(HTC)者占23.6%(602例),单纯高甘油三酯(HTG)者占21.7%(552例),HTG伴低高密度脂蛋白胆固醇(HTG-LHDL)者占5.03%(128例),HTC伴HTG(混合组)者占19.3%(491例);血脂正常者仅占30.4%.合计有HTG者46.0%(1 171例),略多于HTC者(1 093例).单纯HTG组及混合型组2型糖尿病(T2DM)和肥胖患病率较高.本组人群中的高血压患病率高达66.2%,其中HTG者的高血压患病率最高,达70.8%,与血脂正常者比较差异显著(P＜0.01).各型血脂异常合并糖代谢异常、肥胖、高血压均增加了心、脑血管病的患病率,HTC合并高血压和糖尿病增加心了血管病变患病率,HTG合并任一项异常均增加心脑血管病变患病率.结论 本组老年人群中约2/3存在血脂紊乱,MS其他组分的患病率也较高,是心脑血管病变的高危人群.其中HTG较HTC对心脑血管病变影响更大,需在今后的防治中给予关注.     

经OGTT普查人群代谢综合征患病率及胰岛素抵抗指标的评估

目的调查北京某单位21~78岁人群(n=1022)代谢综合征(MS)的患病率及相关危险因素,比较用腰围、体重指数(BMI)评估MS和高胰岛素血症的临床意义。方法使用预定的流行病学调查表,由专业人员询问调查人群的既往史,统一行口服葡萄糖耐量(OGTT)试验评估糖代谢情况(测定空腹和餐后2h血糖、血胰岛素水平),另检测血脂、血尿酸、肝肾功能,并测量身高、体重、腰围、血压,计算BMI值,分别以腰围和BMI值来定义肥胖,分析不同定义的肥胖合并其他2项代谢异常(IDF定义)时人群的患病率及其高胰岛素血症的检出率。结果按腰围和BMI值计算肥胖患病率分别为20.6%和41.5%(P<0.01),且随年龄的增长而增加。糖代谢异常、高胰岛素血症、高血压、高甘油三酯血症、低高密度脂蛋白血症、MS(IDF定义)检出率分别为8.51%、8.10%、39.60%、30.20%、0.49%、9.00%。按腰围和BMI计算:肥胖合并其他2项代谢异常的检出率分别为9.0%、14.0%(P<0.01),其检出敏感性分别为40.9%、63.6%,特异性分别为85.1%、64.7%;肥胖合并其他2项代谢异常人群高胰岛素血症的检出率分别为6.64%、7.55%,分别占总调查人群的1.37%、3.13%,两者比较差异有显著性(P<0.01)。结论北京某单位成年人中MS及相关代谢疾病非常常见。与BMI相比,腰围对肥胖合并其他2项代谢异常的检出敏感性低、特异性高。对高胰岛素血症患者的检出将有助于识别非肥胖人群合并有2项代谢异常者。     

机关中年人群代谢综合征调查分析

目的探讨中年人群代谢异常的聚集状况,以便对危险因素进行早期干预,做好代谢综合征(MS)的预防工作。方法对年度健康查体资料进行分析,依据代谢综合征诊断标准进行分类筛选出MS组与正常组,分析组间各项指标的变化规律及特点。结果MS发病率为19.79%;MS组与正常组相比,其中24项指标中10项差异有统计学意义(P<0.05),6项差异有非常显著统计学意义(P<0.01);MS以肥胖、高血压、高血糖、血脂紊乱为特征者居多(占38.46%)。结论年龄与各项危险因素聚集状况明显相关,中年人群是一个多种危险因素聚集一体的高危人群,对危险因素进行早期干预,是预防MS发生的最佳策略。     

评估代谢综合征的临床意义

随着社会经济的发展和人民生活水平的提高,与人类主要饮食成分有关的多代谢异常及其相关的血管损伤性疾病患病率及死亡率均有所增加这种情况在发展中国家尤为明显。我国正是代谢病高发的发展中国家,相关的心、脑血管病变发生和死亡的危险均在增加,所以及早控制代谢异常对减少心、脑血管病变发病率、降低死亡率意义重大。1代谢综合征(metabolic syndrome,MS)的流行趋势及控制现状流行病学资料显示,无论是在发达国家还是发展中国家,目前公认的代谢综合征四组病症的人群累及率均很高,尤其老年人群达90%以上[1]老年人MS检出率高于中青年,如老…     

老年2型糖尿病合并代谢综合征患者的治疗方式和控制达标状况调查

目的 了解老年2型糖尿病(T2DM)合并代谢综合征(MS)患者的临床特点、用药情况及代谢异常组分的控制达标状况.方法 回顾性分析2001～2005年住院的老年T2DM患者共349例,其中合并MS者194例,观察194例患者的临床特点、用药情况以及各代谢异常组分控制达标水平.结果 老年T2DM合并MS者的比例为55.6%,体重指数(BMI)、餐后血糖、血压和甘油三酯(TG)均高于T2DM不合并MS组,HDL-C低于不合并MS组(P＜0.05).老年T2DM合并MS的患者中,91.2%应用药物控制血糖,以双胍类、磺脲类、胰岛素为主,所占比例分别为59.3%、48.4%和36.1%;77.3%服用降压药物,以钙拮抗剂和血管紧张素转换酶抑制剂(ACEI)为主,分别为47.3%和46.2%;56.3%服用降脂药物,所占比例他汀类为34.8%,贝特类为71.4%.194例患者中,血糖各项均达标者占18.6%,血压整体达标者占40.9%,血脂四项全部达标者占29.3%.结论 老年T2DM合并MS的比例很高,虽然积极用药控制,但是各代谢异常组分的控制达标率并不理想.对于血糖而言,在联合口服药物治疗效果不佳时,应使用胰岛素治疗.     

年龄与代谢综合征的关系及防治对策

目的 了解中老年人群年龄与多种代谢异常的聚集状况,为心脑血管疾病的一级预防提供依据.方法 对744例中老年人按不同年龄分为5组,分析代谢综合征各项指标的变化规律及特点.结果 年龄与肥胖呈明显负相关(P＜0.001),与高血糖、高血压及冠心病、脑卒中呈明显正相关(P＜0.05,或P＜ 0.001);40～60岁组代谢综合征的患病率基本一致(约为30%),70岁以后明显增加,到80岁时可高达51%( P＜0.05,或P＜0.01).代谢综合征与冠心病和脑卒中的患病率均明显相关(P＜0.05),随着临床指标个数的增加,冠心病的患病率增加了6.8%,脑卒中的患病率增加了7.44%.结论 中年人群超重或肥胖的患病率明显高于老年组,应引起足够重视;随着年龄增长,代谢异常数目增多,尤其是≥3项指标的人数明显增加;代谢综合征作为心血管危险因素直接导致冠心病、脑卒中患病率增加.因此,针对中老年人群代谢综合征的特点,制定相应的干预措施十分重要.     

磁共振波谱技术在代谢综合征研究中的应用

高热卡饮食和久坐的生活方式，使得肥胖、2型糖尿病、高血脂及高血压等慢性代谢性疾病的患病率显著增加，临床上把这些代谢异常称之为代谢综合征（metabolic syndrome，MS）。MS的发病机制很复杂，胰岛素抵抗（insulin resistance，IR）在其发生发展中起着重要的作用，而糖类及脂质代谢异常是该疾病的核心所在。作为一个症候群，MS会累及人体的多个重要器官，主要包括心脏、肝脏、胰腺、肾脏、骨骼肌等，由于代谢异常，     

颈动脉粥样硬化的发生率及其危险因素

 目的探讨颈动脉粥样硬化的发生率及其与危险因素的关系.方法以340例年龄在29～90岁的患者为研究对象,采用彩色多普勒超声仪检测颅外段颈动脉,并与多项相关的因素进行对比分析.结果颈动脉粥样硬化的检出率为58.2%,颈动脉粥样硬化组高血压病、缺血性脑血管病、糖尿病的发生率高于非硬化组,年龄、收缩压、载脂蛋白B、血浆黏度、红细胞聚集指数亦高于非硬化组,颈动脉粥样硬化与吸烟、总胆固醇、低密度脂蛋白胆固醇、C-反应蛋白水平无显著相关.结论颈动脉粥样硬化的患病率较高,年龄、高血压是主要的危险因素.     

腰围、体重指数和高胰岛素血症在代谢综合征评估中的意义

目的 评价腰围(WC)、体重指数(BMI)和高胰岛素血症(HIns)在代谢综合征(MS)评估中的意义.方法 分别收集经糖尿病筛查后行口服葡萄糖耐量试验(OGTT)的中老年人群(A组)和年度查体直接采用OGTT行糖尿病筛查的某单位整体人群(B组)的查体资料,各项体检指标、化验检查均由专人负责测量,收集数据并录入专项数据库,由专人用SAS 5.0软件进行统计分析.WC异常根据国际糖尿病联盟(IDF)标准判定,MS相关代谢异常及BMI异常根据中国糖尿病学会(CDS)提出的标准判定,HIns按空腹胰岛素(FIns)≥15mU/L、糖负荷后2h胰岛素(2hPIns)≥80mU/L判定.结果 WC、BMI和HIns在以上两组中均是影响糖代谢、高血压和血脂紊乱的危险因素.A组糖尿病高危人群中WC异常和HIns的检出率均明显高于B组,总体胰岛素水平也高于B组;BMI异常在B组检出率高,HIns在糖耐量低减和正常血糖人群中检出率高,中老年糖尿病高危人群中WC异常率高,三项异常的检出各有一定的人群特异性.WC和BMI标准评估肥胖的一致性分别为77.5%(A组)和74.3%(B组),在B组单用WC作为诊断MS的指标,比用BMI异常作为标准诊断MS会遗漏约28.2%的患者.结论 WC异常、BMI异常和HIns均是影响糖代谢、高血压和血脂紊乱的危险因素,其在不同人群的检出率有所不同.结合WC异常、BMI指标和HIns对早期MS评估更有益.     

睡眠呼吸暂停综合征与代谢综合征的回顾性研究

目的：研究阻塞性睡眠呼吸暂停综合征（OSAS）与代谢综合征（MS）的相关性。方法：回顾分析323例OSAS患者MS的发病率,并对非肥胖OSAS患者与健康人群MS发病率进行对照研究。结果：323例OSAS患者MS患病率为42.1%,轻、中、重度患者患病率分别为13.5%、37.8%和60.2%。非肥胖OSAS患者中高血压、血脂异常、高血糖的发生率均明显高于健康对照组（P〈0.01）。结论：MS的发生率与OSAS显著相关,且这种关系可能并不依赖于肥胖。     

军队离退休干部高血压现状调查分析

目的分析2004—2005年驻湛部队60~81岁离退休老年干部高血压患病率及有关特点。方法以290例60~81岁心血管病危险因素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危险因素等情况进行分析。结果(1)该人群60~81岁高血压的患病率、治疗率、控制率分别为61.4%,62.8%,23.1%;(2)随着年龄增长,男女高血压患病率呈持续增加趋势(P<0.05);(3)老年人单纯收缩期高血压患病率为27.9%,占老年高血压的45.5%;(4)老年高血压合并至少一个其他心血管危险因素的比例为86.7%。结论高血压是部队老年离退休干部的常见心血管疾病,单纯收缩期高血压是老年高血压的常见类型,老年高血压患者绝大多数合并有其他心血管危险因素。     

Antiphospholipid antibodies: findings at arteriography.

PURPOSEThe purpose of this study was to determine the frequency and types of abnormalities at arteriography in patients with antiphospholipid antibodies (APA) and ischemic cerebrovascular events.METHODSTwenty-three patients with APA and ischemic cerebrovascular events who underwent arteriography were identified. Patients over the age of 65 years were excluded. No patients met diagnostic criteria for systemic lupus erythematosus. All angiograms were reviewed by two neuroradiologists.RESULTSSeventeen patients (74%) between the ages of 28 and 64 years (average age, 40 years) had abnormal angiograms. Sixteen patients had arterial abnormalities and one had dural sinus thrombosis. Ten had solely intracranial abnormalities (nine arterial and one venous), six had solely extracranial arterial abnormalities, and one had both intracranial and extracranial arterial abnormalities. Intracranial arterial abnormalities included stem or branch occlusions of the cerebral or basilar arteries, which were generally solitary (six patients), and findings suggestive of vasculitis (four patients). Four patients had stenoses of the origins of two or more great vessels. Two patients had extracranial internal carotid artery stenoses or occlusions that were not typical of atheromatous disease, considered to be embolic in one patient. In another patient, a stenosis of the origin of the internal carotid artery was present that appeared typical of atheromatous disease. Infarctions were seen on CT or MR studies in 13 of 17 patients with abnormal angiograms.CONCLUSIONIn our group of patients, typical atheromatous lesions at the common carotid artery bifurcation were rare. Some lesions that are infrequent in the general stroke population (eg, vasculitis-like findings and stenoses at the origin of great vessels) were common. Patients with APA and cerebrovascular events appear to differ from the general stroke population with regard to types of arterial abnormalities seen at arteriography.     

依那普利叶酸片治疗H型高血压疗效观察

目的:探讨依那普利叶酸片治疗H型高血压的疗效.方法:选取98例H型高血压患者随机分治疗组51例和对照组47例,治疗组和对照组均通过查房随访和健康讲座提倡合理的生活方式和规范化药物治疗.治疗组给与依那普利叶酸片(10 mg/0.8 mg),1次/d.随访3个月后观察两组患者血浆中同型半胱氨酸(Hcy)水平的变化和随访期间心脑血管事件发病情况.结果:治疗组在3个月治疗后血浆中Hcy水平明显下降(P＜0.05),对照组血浆中Hcy水平无明显变化.随访期间对照组心脑血管事件发生率为27.7%,治疗组为9.8%,两组之间有统计学差异(P＜0.05).结论:依那普利叶酸片治疗H型高血压可以显著降低H型高血压患者血浆中Hcy水平,同时有效可以减少心脑血管事件发生率.     

代谢综合征不同诊断标准在老年人群的比较研究

目的 在老年人群中对代谢综合征(MS)的不同诊断标准(WHO、IDF和CDS标准)进行比较分析.方法 对1996～2005年连续10年在解放军总医院院查体的2 456例北京老年人进行MS相关指标的检查,比较WHO、IDF和CDS三种诊断标准的差异,以及老年人中MS各组分的发生情况.结果 使用WHO、IDF和CDS诊断标准,总人群MS的患病率分别是27.2%、27.0%、42.6%,Kappa检验显示IDF和CDS两种诊断标准的符合率为79.0%;其中有腰围资料的1 759例患者使用WHO、IDF和CDS标准诊断MS的患病率分别是32.3%、37.8%、53.8%,Kappa检验显示IDF和CDS两种诊断标准的符合率为76.5%.使用WHO、IDF和CDS标准诊断中心性肥胖的诊断率分别是35.9%、49.6%、52.2%,高血压的诊断率分别是61.6%、72.4%、61.6%,糖代谢异常的诊断率分别是24.9%、40.5%、24.9%.本组MS最常见的代谢异常组合为血压、血糖及血脂紊乱.结论 尽管IDF和CDS两种诊断标准的符合率较高,但在老年人群中使用CDS标准诊断MS的比例高于WHO和IDF标准.要重视对老年人群腰围的检查,老年男性人群CDS标准中腰围从85cm调整到90cm可能更为合理,但还需要进行大规模的流行病学研究进一步确认.     

Prévention et traitement du syndrome métabolique : rôle de l'activité physique

AimsTo describe the various components of the metabolic syndrome (MS) and to show that regular physical activity has favourable effects on component of the MS.Current knowledgeThe term metabolic syndrome represents a constellation of metabolic abnormalities and of cardiovascular risk factors: abdominal obesity, dyslipidemia, insulin resistance, and hypertension. MS predicts the development of cardiovascular disease; type 2 diabetes and all-cause mortality in non-diabetic individuals. It now affects up to a quarter of men and women in Europe.ProspectsEpidemiological studies have shown that regular physical activity has favourable effects on each individual component that constitute the MS. Although few randomised controlled trials have been published, several large epidemiological prospective studies provide strong evidence that regular physical activity is effective in the prevention or treatment of the MS. Walking is the most common form of physical activity and its effectiveness in the primary or secondary prevention of the MS has been proven. If there are no contraindications, more vigorous physical activity or resistance training should also be considered to obtain additional health benefits.     

北京部分社区干部人群代谢综合征的流行病学研究

目的调查北京部分社区中老年干部人群代谢综合征的患病率。方法于2003年9月和2004年5月对136个驻京部队干休所社区随机抽取共计2335人进行调查,以中国糖尿病协会的建议为诊断标准,对中老年干部人群的代谢综合征的患病率进行了统计分析。结果北京部分社区中老年干部人群代谢综合征的患病率为28．7％,老年组和高龄老年组分别为29．9％和29．6％,较中年组(24．3％)高。整个人群的肥胖占40．2％、高血压病为56．7％、糖代谢紊乱为64．1％、高甘油三酯血症为38％。老年和高龄老年组的肥胖和高甘油三酯患病率显著低于中年组,而糖代谢异常和高血压病的患病率则明显高于中年组。代谢综合征、糖代谢异常和高血压病随年龄的增长逐步增加,而甘油三酯和肥胖的患病率50～60岁为高峰,65岁后则逐步下降。结论北京部分社区中老年干部人群具有较高的代谢综合征患病率,代谢综合征和各组分的患病率在不同的年龄段有所不同。     

民航飞行人员视网膜血管病变的动态观察

目的 动态了解民航飞行人员眼底血管的变化,探索眼底照像作为预测飞行人员心脑血管意外客观依据的可能性. 方法 采用免散瞳眼底照相机对参与体检的东方航空公司西北分公司飞行人员进行检查,通过眼底照片分析3年来视网膜血管病变的相关因素,对比飞行人员3年间视网膜血管变化及其与代谢综合征的关系. 结果 共904人接受了眼底检查,视网膜动脉硬化患病率最高,为9.62%(87人).高血压是视网膜动脉硬化最显著的危险因素,视网膜微血管瘤和视网膜出血与飞行人员代谢综合征有关.重新会诊飞行人员3年来视网膜血管病变眼底照片新发现2例视网膜微血管瘤. 结论 眼底照相技术能客观记录视网膜血管的动态变化情况,可用于监测代谢综合征对靶器官损害的发生、发展过程. Abstract： Objective To investigate dynamic changes of civil flying personnel's ocular fundus blood vessel and explore the possibility of taking ocular fundus photograph as an objective evidence for predicting cardiovascular and cerebrovascular diseases. Methods In past 3 years the ocular fundus photographs of 904 flying personnel's, who were from the Northwest Branch of China Eastern Air Holding Company, were examined by fundus camera without mydriatic during annual physical examination. The correlation factors of retinal micro-vascular changes were analyzed and compared.Results Retinal arteriosclerosis was diagnosed from 87 f1ying personnel (9. 62%) and took the highest prevalence. Hypertension was the most hazardous to retinal arteriosclerosis. Retinal microaneurysm and retinal hemorrhage were related with metabolic syndrome. Two cases of retinal microaneurysm were newly found by reviewing fundus photographs that gathered in past 3 years.Conclusions The mydriatic-free fundus camera technique can objectively record the development of ocular retinal vessel change and can be used to monitor the occurrence and progress of the metabolic syndrome induced harm to target organ.     

Cardiopulmonary pathology among children resident at high altitude in Tintaya, Peru: a cross-sectional study

Symptomatic high-altitude pulmonary hypertension and structural cardiac abnormalities related to high altitude have been reported previously. However, their true prevalence has not been systematically determined. We assessed clinical indicators of cardiovascular health or disease and correlated them with anatomic and physiologic cardiovascular features in preschool and schoolchildren living at 4000 m. We also estimated the prevalence of cardiovascular problems in the population, with emphasis on symptomatic high altitude pulmonary hypertension and structural cardiopathies. Three hundred and twenty-six children residents of Tintaya, Peru, were cross-sectionally studied. Methods included structured interviews, anthropometry and physical examination, arterial oxygen saturation, hemoglobin determination, electrocardiography, and echocardiography. The prevalence of structural cardiac problems was 1.5%, with less than 1% possibly attributable to high altitude. All children with structural cardiac abnormalities were identified by a focused physical exam prior to echocardiography. None were identified by the health interview. No symptomatic high altitude pulmonary hypertension was identified in the absence of underlying structural anomalies. The prevalence of structural cardiac problems was consistent with data from sea level. Active monitoring of the health status of a pediatric population at high altitude is valuable in the timely detection of cardiac abnormalities. Although our study children enjoyed generally excellent health, comparative, longitudinal studies are warranted to determine the incidence of high altitude cardiopulmonary problems and to identify risk factors and early markers for later disorders associated to life at high altitude. Our findings are applicable to children with some degree of high altitude genetic background and high mobility patterns to lower altitudes and living in comparatively good nutritional and socioeconomic conditions.