多囊卵巢综合征痰湿证患者的舌象与胰岛素抵抗指标分析

目的:分析多囊卵巢综合征(polycystic ovarian syndrome,PCOS)痰湿证患者的胰岛素抵抗(insulin resistance,IR)指标、舌象特点及两者关系.方法:运用SmartTCM-1型中医生命信息分析系统采集PCOS患者舌象144例,得到舌象判读结果,对PCOS患者辨证分型为痰湿证和非痰湿证组,分析其胰岛素抵抗指标特点,并探讨和舌象的关系.结果:临床144例PCOS患者中伴胰岛素抵抗(PCOS-IR)患者93例,占64.14％;PCOS痰湿证组PCOS-IR患者所占比例为80.30％,高于PCOS非痰湿证组(51.28％),差异有统计学意义;PCOS痰湿证组胰岛素抵抗的稳态模型指数(HOMA-IR)与胰岛素释放曲线下面积(area under curve,AUC)显著高于PCOS非痰湿证组,差异有统计学意义.临床采集144例PCOS患者舌象图像,机读结果显示舌色以淡红舌为主,占85.71％;舌形以胖舌、齿痕舌多见,分别占60.42％和44.44％,其次为正常舌形,占31.94％;苔色以白苔为主,占87.50％,苔质主要为薄苔、厚腻苔、薄腻苔、厚腐苔,其中可并见剥苔.PCOS痰湿证组中厚腻苔+薄腻苔+厚腐苔所占比例为78.79％,明显高于PCOS非痰湿证组(14.10％),差异有统计学意义;舌色、舌形和苔色无明显差异;PCOS-IR组中厚腻苔+薄腻苔+厚腐苔所占比例为50.54％,高于PCOS-NIR组(31.37％),差异有统计学意义;舌色、舌形和苔色无明显差异.结论:PCOS痰湿证与IR相关,舌象腻苔、腐苔在一定程度上可能反映了IR情况.     

按不同肥胖标准诊断的肥胖多囊卵巢综合征患者内分泌和代谢特征的比较

目的:比较按不同肥胖标准诊断的肥胖多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者的内分泌和脂代谢情况,为PCOS患者的个性化诊治提供依据。方法:选择2012年1月—2013年1月诊治的98例PCOS患者,以体质量指数(BMI)≥24 kg/m2为肥胖标准,将PCOS患者分为肥胖A组(n=72)和非肥胖组A组(n=26);以腰臀比(WHR)≥0.8为肥胖标准,将PCOS患者分为肥胖B组(n=84)和非肥胖B组(n=14);以BMI≥24 kg/m2且WHR≥0.8为肥胖标准,将PCOS患者分为肥胖C组(n=64)和非肥胖C组(n=6,BMI24kg/m~2且WHR0.8)。记录各组PCOS患者的临床指标,并检测空腹血糖(FBS)、空腹胰岛素(FIN),测定基础性激素促卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、睾酮(T)以及脂代谢相关指标甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)的水平。结果:肥胖A组的LH/FSH、FIN、HOMA-IR、TG显著高于非肥胖A组,并且肥胖A组月经初潮年龄提前(P0.05);肥胖B组FIN、HOMA-IR、TG、LDL-C显著高于非肥胖B组,但肥胖B组的HDL-C水平较低(P0.05);肥胖C组FIN、HOMA-IR显著高于非肥胖C组,且肥胖C组月经初潮年龄提前、HDL-C水平降低(P0.05)。多重线性相关性分析结果显示,WHR、BMI均与FBS相关。结论:按同肥胖标准诊断的肥胖PCOS患者的内分泌和脂代谢水平有差异,肥胖会加重患者的内分泌紊乱和脂代谢异常,从而增加远期并发症的风险。     

Informal caregiving and Body Mass Index among older adults

The authors sought to obtain nationally representative estimates of the time of informal caregiving provided to older adults classified into the four standard Body Mass Index (BMI) classifications. They estimated multivariate regression models using data from the 2000 Health and Retirement Study to determine the weekly hours of informal caregiving for older adults classified into the four standard BMI classifications. In the fully adjusted models, being underweight was associated with receiving significantly more informal care, however, obesity was not associated with more informal care. The implications of these findings are discussed in terms of nursing practice and research to prevent weight loss and frailty.     

多囊卵巢综合征超声影像特征及与性激素、胰岛素抵抗指数的相关性分析

[目的]探讨多囊卵巢综合征(PCOS)患者超声影像特征与性激素、胰岛素抵抗指数(HOMA-IR)的相关性.[方法]选取2014年2月至2016年5月本院收治的PCOS患者90例(观察组),另选取同时期在本院进行健康体检者53例(对照组),对两组患者进行超声影像检查,检查指标包括卵巢总面积(TA)、卵巢间质面积(SA),同时计算SA/TA比值,检测两组患者的性激素水平及血糖等相关指标水平,并分析观察组患者的超声影像特征与性激素指标、HOMA-IR的相关性.[结果]与对照组对比,观察组患者的黄体生成素(LH)、睾酮(T)、雌二醇(E2)及空腹血糖(FBG)、HOMA-IR明显升高,其差异均有统计学意义(P＜0.05);与对照组对比,观察组患者的TA、SA及SA/TA明显升高,差异有统计学意义(P＜0.05);Person相关性分析显示,观察组患者的SA与LH、T、E2呈显著正相关(r=0.280、0.610、0.389,P＜0.05),SA/TA与LH、LH、T、E2也呈显著正相关(r=0.265、0.378、0.332,P＜0.05),TA与E2存在显著正相关(r=0.315,P＜0.05).SA/TA比值与HOMA-IR呈显著正相关(r=0.712,P＜0.05).[结论]PCOS患者卵巢SA及TA明显高于健康体检者,且超声影像特征与性激素、HOMA-IR存在显著相关性.     

Associations of Various Family Characteristics and Time Use With Children's Body Mass Index

This study used multiple regression models to estimate associations of various family characteristics and time use with the body mass index (BMI) z-scores of 734 boys and 725 girls aged 5–18y from the Panel Study of Income Dynamics Child Development Supplement 2003. The strongest relationship in the data was between the BMI of the head of household and a child's BMI z-score (p < 0.001). Time spent sleeping, performing sedentary behaviors, and participating in physical activities was not associated with a child's BMI z-score. This suggests that a family-oriented approach to prevent and treat childhood and adolescent overweight is required.     

Trends in Metabolic Phenotypes According to Body Mass Index Among US Adults, 1999-2018

ObjectiveTo examine the prevalence, distribution, and temporal trends of metabolic phenotypes that are jointly determined by obesity and metabolic health status among US adults, overall and in key population subgroups.Participants and MethodsA nationally representative sample of civilian, noninstitutionalized US adults aged 20 years and older from the National Health and Nutrition Examination Survey between 1999-2000 and 2017-2018 were included. Metabolic phenotypes were characterized jointly by body mass index and metabolic health: metabolically healthy underweight, normal weight, overweight, and obese (MH-OB); and metabolically unhealthy underweight, normal weight, overweight, and obese (MU-OB). Metabolic health was defined using the 2009 joint scientific statement for metabolic syndrome from the International Diabetes Federation Task Force on Epidemiology and Prevention, National Heart, Lung, and Blood Institute, American Heart Association, World Heart Federation, International Atherosclerosis Society, and International Association for the Study of Obesity as having 2 or less components (primary analysis) or no components (secondary analysis) of the following: waist circumference of 102 cm or greater in men and 88 cm or greater in women, fasting plasma glucose level of 100 mg/dL or greater, blood pressure of 130/85 mm Hg or greater, triglyceride level of 150 mg/dL or greater, and high-density lipoprotein cholesterol level of less than 40 mg/dL in men and less than 50 mg/dL in women.ResultsOf 19,941 adults, the mean age was 46.9 years; 10,005 (50.6%) were female. From 1999 to 2018, the prevalence in primary analysis declined from 33.2% (465465 of 1646) to 25.1% (454454 of 2058) (difference, ?8.09%; 95% CI, ?12.5% to ?3.70%) for metabolically healthy normal weight, whereas it increased from 9.92% (178178 of 1646) to 14.1% (277277 of 2058) (difference, 4.17%; 95% CI, 1.13% to 7.21%) for MH-OB (both P<.001 for trend). The prevalence of metabolically healthy underweight and overweight remained stable at about 1.62% (298298 of 19,94119,941) (95% CI, 1.38% to 1.89%; P=.34 for trend) and 22.2% (4,275 of 19,941) (95% CI, 21.4% to 23.0%; P=.14 for trend), respectively. The prevalence declined from 3.77% (72 of 1646) to 2.10% (68 of 2058) (difference, ?1.67%; 95% CI, ?3.22% to ?0.12%; P=.006 for trend) for metabolically unhealthy normal weight, whereas it increased from 19.0% (343 of 1646) to 26.4% (574 of 2058) (difference, 7.41%; 95% CI, 2.67% to 12.2%; P<.001 for trend) for MU-OB. The prevalence of metabolically unhealthy underweight and overweight remained stable at 0.06% (11 of 19,941) (95% CI, 0.03% to 0.15%; P=.84 for trend) and 11.2% (2528 of 19,941) (95% CI, 10.6% to 11.8%; P=.29 for trend), respectively. Persistent differences in the prevalence of metabolic phenotypes were identified across multiple sociodemographic subgroups. For example, the prevalence of MH-OB increased from 7.58% (53 of 754) to 12.0% (79 of 694) (P<.001 for trend) for non-Hispanic Whites and 12.2% (60 of 567) to 18.4% (76 of 493) for Hispanics (P=.01 for trend) and remained stable at 22.6% (756 of 3,825) for non-Hispanic Blacks (P=.62 for trend and P=.05 for interaction). Results in secondary analyses revealed similar patterns.ConclusionFrom 1999 to 2018, US adults experienced major increases in the prevalence of both MH-OB and MU-OB, largely due to decreases in MH-N. The prevalence of MU-OB increased across all subgroups, with higher values observed in older adults and those with lower education and income levels.     

合并多囊卵巢综合征产妇胎盘肥胖相关基因多态性研究

目的:研究多囊卵巢综合征(polycystic ovarian syndrome,PCOS)患者胎盘肥胖相关基因(fat mass and obesity associated gene,FTO)rs1421085(C/T)的单核苷酸多态性(single nucleotide polymorphism,SNP),探讨PCOS患者子代再次发生P-COS及相关疾病的风险。方法:运用聚合酶链反应-限制性片段长度多态性(Polymerase chain reaction-restriction fragmentlength polymorphism,PCR-RELF)分析及基因测序的方法,在26例PCOS患者(研究组)和27例健康志愿者(对照组)的胎盘组织中,检测FTO基因rs1421085(C/T)位点的SNP。结果:研究组胎盘FTO基因rs1421085(C/T)等位基因频率与对照组比较有显著差异(P=0.0072)。两组基因型频率相比也有显著差异(P=0.0285)。结论:PCOS患者胎盘组织中FTO基因rs1421085(C/T)位点SNP变异的发生率较正常人群高,PCOS患者后代再次发生PCOS及相关疾病的风险可能会增加。     

克罗米酚、尿促性素、来曲唑治疗多囊卵巢综合征不孕患者的疗效比较

【目的】探讨克罗米酚（CC）、尿促性素（HMG）、来曲唑（LE）三种药物对治疗多囊卵巢综合征（P—COS）不排卵患者的临床疗效的区别。【方法】回顾分析本院2005年5月至2008年5月PCOS的不孕已婚患者,按治疗方法分成三组：CC组、HMG组、LE组,记录患者年龄、治疗时间、卵泡发育的情况、子宫内膜的厚度、妊娠率和并发症等,并加以比较。【结果】LE组HCG日的卵泡平均大小小于CC组和HMG组（P〈0．05）和卵泡数少于CC组和HMG组（P〈O．05）;CC组HCG日的子宫内膜厚度在3组中最薄（P〈0．05）;HMG组的妊娠率比其他两组要高（P〈0．05）,其余各组各项比较差异均无显著性（P〉0．05）。【结论】来曲唑促进多囊卵巢综合征不排卵患者排卵是较为安全、有效的药物,HMG有较高的妊娠率,但容易引起卵巢过度刺激综合征（OHSS）和多胎妊娠。     

某高校教职工代谢综合征的患病率及其与腰臀比值和体重指数的相关性研究

目的了解东南大学2006年教职工代谢综合征(metabolicsyndrome,MS)患病率及流行病学特征,分析腰臀比值、体量指数与代谢综合征的相关性。方法对东南大学2006年进行健康体检的1979名教职工体检资料进行分析。MS采用2005年国际糖尿病联盟(IDF)的诊断标准。结果东南大学成人总人群、男性及女性MS的粗患病率分别为21.7%、26.4%和14.2%,相应的标化患病率分别为14.7%、19.0%和9.4%。男性患病率显著高于女性(P<0.05)。中心性肥胖与外周肥胖者都与代谢综合征的患病率呈正相关(r=0.295,0.248,P=0.000)。结论东南大学2006年教职工代谢综合征的患病率明显增高。腰臀比值、体量指数与代谢综合征的患病率呈正相关。     

异丙酚靶控输注用于肥胖人群的可行性研究

[目的]探讨异丙酚靶控输注(TCI)用于肥胖人群的可行性.[方法]将本院80例行腹腔镜胆囊切除术患者根据体质量指数(BMI)不同分为两组,正常体质量组(BMI＜25 kg/m2)38例,肥胖组(BMI 30～40 kg/m2)42例,两组均静脉注射芬太尼2～3 μtg/kg,靶控输注异丙酚,异丙酚初始血浆靶浓度(Ct)为3.0μg/mL,达到血浆靶浓度30 s后增加0.3 μg/mL,OAA/S评分-1分后静脉注射罗库溴铵0.6 mg/kg,2 min后进行气管插管;记录比较两组各阶段异丙酚Ct的脑电双频谱指数(BIS)值、麻醉时间、手术时间和苏醒时间.[结果]两组手术时间及麻醉时间相比较差异无显著性(P＞0.05),肥胖组苏醒时间较正常体质量组延长,且两组比较差异有显著性(P＜0.05).两组患者异丙酚Ct与BIS值均呈负相关(P＜0.05),但肥胖患者的相关程度要显著低于正常体质量患者,且两组相比较差异有显著性(P＜0.05).[结论]异丙酚TCI可用于肥胖患者,但是较正常体质量患者且性能相对降低.     

宝鸡地区健康体检人群空腹血糖与体重指数的相关分析

目的：探讨宝鸡地区健康体检人群空腹血糖与体重指数（BMI）的相互关系。方法对55328例18岁以上健康体检者进行 FPG检测,同时测量身高、体重,计算BMI,并对检查结果进行统计分析。结果 FPG,BMI水平在不同年龄组、不同性别组间差异存在统计学意义（P＜0.005）;男性及女性 FPG异常者检出率分别为9.90％,5.50％;男性 FPG异常检出率高于女性（χ2＝335.47,P＜0.005）;消瘦、体重正常、超重、肥胖4组 FPG异常检出率分别为2.71％,5.93％,11.65％和13.75％,DM检出率分别为1.38％,3.18％,6.02％和6.39％,IFG 检出率分别为0.8％,2.75％,5.64％和7.37％。FPG异常检出率及 IFG,糖尿病的检出率均随BMI水平升高而增高（P＜0.005）。结论血糖水平随BMI数升高而增高,超重及肥胖人群的糖尿病患病率增加,应将中年人作为肥胖问题的重点监测及干预人群,控制 BMI是减少糖尿病发生的一个有效措施。     

成都地区中老年人群体质量指数及腹型肥胖对糖尿病患病率及空腹血糖水平的影响

目的研究成都地区中老年人群体质量指数(BMI)及腹型肥胖对糖尿病患病率及空腹血糖水平的影响。方法 2007年5月,采用随机抽样方法抽取50～80岁中老年人685人进行心血管危险因素调查,其男394人,女291人,年龄(63.3±0.2)岁。结果成都地区中老年人群的超重和肥胖所占的比例较大(约44.3%),按BMI分组(BMI<24 kg/m2;24 kg/m2≤BMI<28 kg/m2;BMI≥28 kg/m2)的糖尿病患病率分别为14.0%、18.7%及23.3%,组间差异有统计学意义(P=0.031)。男女分别按腹型肥胖标准分组(男性切点=85 cm,女性切点=80 cm),男性糖尿病患病率在非腹型肥胖及腹型肥胖组分别为17.9%及18.7%组间差异无统计学意义(P=0.849),女性糖尿病患病率分别为9.7%及18.4%,组间差异有统计学意义(P=0.034)。整个人群中,空腹血糖无随BMI增加而升高的趋势(P=0.071);女性人群中,空腹血糖随腰围的增加而升高(P=0.001);而在男性人群中无此趋势。在调整相关指标后,logistic回归分析提示BMI对糖尿病患病率独立影响,以BMI正常为参照,超重及肥胖的OR值分别为:1.412[95%CI(0.818,2.437),P=0.215]及2.200[95%CI(1.034,5.178),P=0.046]。在调整相关指标后,腹型肥胖在女性人群中对糖尿病患病率独立影响,以非腹型肥胖为参考,腹型肥胖的OR值为:1.394[95%CI(1.080,3.205),P=0.041],而在男性人群中无此关系。结论成都地区中老年人群超重及肥胖所占的比重较大,BMI可影响糖尿病患病率及空腹血糖水平;腹型肥胖能够影响女性人群糖尿病患病率及空腹血糖水平,但在男性人群中无此关系。     

彩超检测血管内皮功能与体质指数、腰臀比的关系

目的应用高分辨率彩超检测血管内皮功能,探讨血管内皮功能与体质指数、腰臀比的关系。方法应用彩超检测血管内皮功能。测量并计算体质指数、腰臀比。结果血管内皮功能障碍组体质指数、腰臀比高于正常组(P<0.05)。结论体质指数、腰臀比与血管内皮功能有关。     

Association between Waist-to-Height Ratio and Metabolic Risk Factors in Korean Adults with Normal Body Mass Index and Waist Circumference

There is little consensus on the best obesity index associated with metabolic risk factors among the population with normal both body mass index (BMI) and waist circumference (WC). We therefore evaluated the association between anthropometric indices and metabolic risk factors in a Korean population with normal BMI and WC. This cross-sectional study involved 2,952 participants aged 20-79 years who had normal BMI and WC, based on the Fourth Korea National Health and Nutrition Examination Surveys conducted in 2008. The receiver operating characteristic (ROC) curves were generated to identify the optimal measurement of obesity for the prediction of metabolic risk factors in this population. The area under the ROC curve value for waist-to-height ratio (WHtR) in prediction of metabolic syndrome (MetS) and its components was higher than that for BMI and WC. Among individuals with normal BMI and WC, prevalence of all metabolic risk factors and MetS significantly increased across the quartiles of WHtR in both men and women. After adjustment for potential confounders, the Odds Ratios (95% confidence intervals) for MetS in the second, third, and fourth quartiles of WHtR compared to the first quartile of WHtR were 3.53 (2.12-5.89), 6.06 (3.52-10.43), and 7.11 (4.08-12.38) in men, and 1.66 (1.01-2.72), 2.79 (1.81-4.30), and 2.82 (1.76-4.52) in women, respectively. In conclusion, WHtR has the best predictive value for evaluating the metabolic risk factors compared to BMI or WC alone among subjects with normal BMI and WC.     

老年高血压患者痰湿体质与体质量指数、腰围、血脂的相关性分析

目的探讨老年高血压患者的痰湿体质与体质量指数、腰围、血脂的相关性。方法采取随机抽样的方法,在杭州市上城区社区卫生服务中心收集已确诊的老年高血压患者,判定患者的中医体质类型后,将患者分为痰湿体质组和平和体质组,两组各74例,分别测量患者的腰围、身高、体质量并计算体质量指数,测定患者的血清胆固醇、甘油三酯、高密度脂蛋白和低密度脂蛋白。结果痰湿体质组的患者的体质量指数、腰围高于平和体质组(P<0.05),血清胆固醇、甘油三酯、低密度脂蛋白高于平和体质组,而高密度脂蛋白低于平和体质组(P<0.05)。结论痰湿体质影响高血压患者的体质量指数、腰围及血脂的变化。因此,在治疗高血压时,应该重视调理患者的偏颇体质。     

Relationship of Body Mass Index With Total Mortality,Cardiovascular Mortality,and Myocardial Infarction After Coronary Revascularization: Evidence From a Meta-analysis

ObjectiveTo investigate the relationship of body mass index (BMI) with total mortality, cardiovascular (CV) mortality, and myocardial infarction (MI) after coronary revascularization procedures (coronary artery bypass grafting [CABG] and percutaneous coronary intervention [PCI]).Patients and MethodsSystematic search of studies was conducted using PubMed, CINAHL, Cochran CENTRAL, Scopus, and the Web of Science databases. We identified studies reporting the rate of MI, CV mortality, and total mortality among coronary artery disease patients' postcoronary revascularization procedures in various BMI categories: less than 20 (underweight), 20-24.9 (normal reference), 25-29.9 (overweight), 30-34.9 (obese), and 35 or more (severely obese). Event rates were compared using a random effects model assuming interstudy heterogeneity.ResultsA total of 36 studies (12 CABG; 26 PCI) were selected for final analyses. The risk of total mortality (relative risk [RR], 2.59; 95% CI, 2.09-3.21), CV mortality (RR, 2.67; 95% CI, 1.63-4.39), and MI (RR, 1.79; 95% CI, 1.28-2.50) was highest among patients with low BMI at the end of a mean follow-up period of 1.7 years. The risk of CV mortality was lowest among overweight patients (RR, 0.81; 95% CI, 0.68-0.95). Increasing degree of adiposity as assessed by BMI had a neutral effect on the risk of MI for overweight (RR, 0.92; 95% CI, 0.84-1.01), obese (RR, 0.99; 95% CI, 0.85-1.15), and severely obese (RR, 0.93; 95% CI, 0.78-1.11) patients.ConclusionAfter coronary artery disease revascularization procedures (PCI and CABG), the risk of total mortality, CV mortality, and MI was highest among underweight patients as defined by low BMI and CV mortality was lowest among overweight patients.