中老年糖尿病高危人群血脂异常现状调查

目的探讨广州市中老年糖尿病高危人群血脂异常的分布情况及其危险因素。方法选取广州市5个社区年龄≥45岁且无糖尿病史居民619名,采用芬兰糖尿病风险积分(FINDRSC)表筛查糖尿病高危人群,FINDRSC≥9分者即为糖尿病高危人群并纳入研究。结果共208例糖尿病高危人群纳入研究。血脂异常患病率75.0%。单纯型血脂异常者占22.6%,混合型血脂异常者占52.4%。Logistic回归分析显示,WC(OR=1.063,95%CI:1.018~1.111)、臀围(OR=1.077,95%CI:1.022~1.134)、BMI(OR=1.154,95%CI:1.035~1.286)、FPG(OR=2.050,95%CI:1.316~3.195)、2hPG(OR=1.115,95%CI:1.012~1.228)、高血压(OR=2.220,95%CI:1.093~4.513)和FINDRSC(OR=1.320,95%CI:1.093~1.594)进入回归方程。结论广州市糖尿病高危人群血脂异常患病率较高,肥胖、高血压、高血糖和FINDRSC是血脂异常的危险因素。     

老年人群缺血性脑卒中与血脂异常的关系

目的调查分析社区老年人群中血脂异常及其4个组分与缺血性脑卒中患病之间的关系。方法采用病例对照的研究思路,纳入受试者2080例,其中脑卒中组241例,非脑卒中组1839例。采用logistic多元回归分析控制性别、年龄、婚姻状况、受教育年限、吸烟、饮酒、体质量指数和锻炼情况以发现血脂异常及其组分对缺血性脑卒中的独立效应。结果脑卒中组与非脑卒中组年龄、吸烟情况和锻炼时间比较,差异有统计学意义(P0.05,P0.01)。校正前血脂异常者患缺血性脑卒中的危险性是血脂正常者的1.13倍(95%CI:0.86~1.47,P=0.391);高TG血症者患缺血性脑卒中的危险性是血脂正常者的1.51倍(95%CI:1.15~2.00,P=0.004)。女性老年人群中,高TG血症者患缺血性脑卒中的危险性是血脂正常者的1.78倍(95%CI:1.24~2.55,P=0.002)。多因素校正后,与年龄≥80岁的老年人群比较,年龄80岁的老年人群高TG血症造成缺血性脑卒中的危险性增高1.57倍(95%CI:1.10~2.23,P=0.012)。结论老年人群中,高TG血症可增加缺血性脑卒中患病风险,且独立于血脂异常其他3个组分存在,在女性人群和80岁人群中表现更为显著,应加强相关人群的健康宣教和预防干预。     

2型糖尿病患者的心脑血管疾病影响因素的Nomogram分析

目的探讨2型糖尿病患者的心脑血管疾病的影响因素,并对影响因素进行评价。方法纳入2015年1~12月在我院住院符合研究标准的所有2型糖尿病患者(T2DM)936例作为研究对象,填写临床调查病例报告表回顾性采集患者的临床资料,包括患者的一般人口学特征、疾病史、生化检验资料、心脑血管疾病患病情况;以及调查患者入院时相关医疗记录,心脑血管疾病的诊断标准根据中华医学会心血管病学分会及第四届全国脑血管病学术会议制定的标准进行诊断。采用Logistic回归分析法筛选影响心脑血管疾病的因素,并应用Nomogram法对各个因素进行评分,构建评分模型。结果 (1)糖尿病合并心脑血管疾病患者143例(15.3%),未合并心脑血管疾病793例(84.7%);两组患者的年龄、性别构成、病程、收缩压、空腹血糖、餐后血糖、糖化血红蛋白(Hb A1c)、血尿素氮、肌酐清除率和血尿酸差异均有统计学意义(均为P<0.001);(2)单因素Logistic回归分析显示,年龄每增加1岁患心脑血管疾病的相对危险度(OR)为1.04(95%CI:1.02~1.06);女性患心脑血管疾病的风险OR为男性的0.61(95%CI:0.43~0.88);收缩压每增加1 mm Hg患心脑血管疾病的风险OR为1.02(95%CI:1.01~1.03);空腹血糖、餐后血糖、Hb A1c每增加1个测量单位患心脑血管疾病的风险OR分别为1.08(95%CI:1.01~1.15)、1.08(95%CI:1.01~1.11)、1.19(95%CI:1.07~1.33);尿素氮异常的患者患心脑血管疾病的风险OR为正常组的2.16(95%CI:1.32~3.53)(均为P<0.05);(3)多因素Logistic回归分析显示,年龄(OR:1.04,95%CI:1.01~1.06)、性别(OR:1.55,95%CI:1.05~2.30)、收缩压(OR:1.02,95%CI:1.00~1.03)、Hb A1c(OR:1.21,95%CI:1.07~1.37)、尿素氮(OR:1.80,95%CI:1.08~3.01)均为T2DM患者患心脑血管疾病的独立影响因素(均为P<0.05);(4)Nomogram模型分析显示,各因素评分的总分范围为81~208分,对应的风险率范围为0.05~0.60;总分越高T2DM患者患心脑血管疾病的风险越大;(5)Nomogram模型的预测能力曲线下面积为0.688,95%CI:0.617~0.720(P<0.001)。结论年龄、性别、收缩压、Hb A1c和尿素氮为T2DM患者患心脑血管疾病的独立影响因素,Nomogram模型可更直观地评价糖尿病患者患心脑血管疾病的风险,为糖尿病患者的心脑血管疾病预防和治疗提供线索。     

不同BMI水平对新发房颤风险影响的Meta分析

目的系统评价不同体质指数(BMI)水平对普通人群新发心房颤动(房颤)风险的影响。方法计算机检索Pubmed、CNKI数据库中关于BMI与普通人群新发房颤风险关系的观察性研究,检索时间截止至2016年7月。根据预先设定的文献纳入与排除标准,由2名评价员独立进行文献筛选、资料提取、质量评价等工作,将符合标准的文献纳入,利用Rev Man 5.3软件进行Meta分析。结果在初步检索得到的685篇文献中,共纳入12篇符合标准的文献。Meta分析结果显示,与正常组相比,超重组的房颤发病风险增加43%(RR=1.43,95%CI:1.30~1.57,P0.00001),肥胖组的房颤发病风险增加89%(RR=1.89,95%CI:1.69~2.12,P0.00001);与超重组相比,肥胖组的房颤发病风险增加32%(RR=1.32,95%CI:1.25~1.39,P0.00001);与非肥胖组相比,肥胖组的房颤发病风险增加55%(RR=1.55,95%CI:1.41~1.69,P0.00001)。结论超重与肥胖明显增加普通人群新发房颤的风险,随着BMI水平的增加,新发房颤风险也在逐级增加。     

中国人群生命早期经历饥荒暴露与成年后代谢综合征风险的 meta分析

目的分析中国人群生命早期饥荒暴露与代谢综合征风险的关系。方法计算机检索CNKI、维普网、万方、CBM、Web of science 、PubMed等数据库关于我国人群生命早期饥荒暴露与代谢综合征风险的相关文献, 检索时限为建库到2022年10月。由2名研究人员分别对文献数据独立提取和系统评估, 采用Stata 16.0软件进行meta分析。结果共12篇文献符合纳入标准, 包括71 470例研究对象。Meta分析结果显示, 生命早期饥荒暴露可增加中国人群发生代谢综合征的风险(OR=1.28, 95%CI 1.16～1.40)。亚组分析结果显示, 与未暴露组相比, 胎儿期饥荒暴露(OR=1.25, 95%CI 1.03～1.52)和儿童期饥荒暴露(OR=1.29, 95%CI 1.15～1.45)均增加代谢综合征的发病风险, 仅在女性人群中发现这种显著相关性。结论生命早期经历饥荒暴露可能会增加中国人群成年后患代谢综合征的风险, 这主要表现在女性群体中。     

载脂蛋白B合成抑制剂治疗血脂异常的有效性与安全性的Meta分析

目的:应用Meta分析系统评价载脂蛋白B(apo B)合成抑制剂(mipomersen)治疗血脂异常的有效性与安全性。方法:计算机检索Pubmed、Embase、Cochrane library截止至2016年10月31日,电子期刊,纳入mipomersen与安慰剂比较的随机对照试验。按照Cochrane Handbook提供的方法对纳入文献进行质量评估并提取有效数据,应用Rev Man5.3软件进行Meta分析。结果:最终纳入9篇文献共505例患者。Meta分析结果显示:与安慰剂对比,mipomersen能显著降低LDL-C水平的百分比(-31.69%,95%CI:-38.30~-25.08,P0.00001);降低apo B水平的百分比(-32.72%,95%CI:-38.05~-27.39,P0.00001),并能降低N-HDL-C、TC、TG、LP(a)等血脂水平。在安全性方面,与对照组相比,mipomersen增加了患者注射部位反应的风险(OR=8.88,95%CI:4.09~19.28,P0.00001);流感综合征的风险(OR=2.08(95%CI:1.28~3.37,P=0.003));肝酶学升高的风险(ALT≥3ULN OR=9.92,95%CI:2.97~33.10,P=0.0002)及脂肪肝的风险(OR=13.56,95%CI:3.02~60.82,P0.0007)。结论:mipomersen能有效降低血脂异常患者的LDL-C、apo B、N-HDL-C、TG、TC、LP(a)的水平,但有明显的不良反应,纳入文献中并未观察到主要心血管事件的发生。     

甲状腺功能正常人群中甲状腺激素敏感性与肥胖表型的关系

目的在一般体检人群中探索甲状腺激素敏感性与肥胖表型的关系。方法本回顾性研究纳入2017年1月至2018年12月在中国医科大学附属第一医院健康管理科进行体检的6 155名甲状腺功能正常人群。根据体重指数和代谢情况分为4种肥胖表型。通过甲状腺反馈分位数指数(TFQI)、参数化TFQI、游离三碘甲状腺原氨酸与游离甲状腺素比值(FT3/FT4)和外周脱碘酶活性总和(SPINA-GD)评估甲状腺激素敏感性。结果与代谢健康型非肥胖(MHNO)组相比, 代谢健康型肥胖(MHO)和代谢异常型肥胖(MUO)组FT3/FT4比值更高;代谢异常型非肥胖(MUNO)和MUO组TFQI更低。调整混杂因素后, FT3/FT4比值与MHO和MUO风险正相关, OR为1.18(95%CI 1.11～1.26)和1.28(95%CI 1.19～1.39);TFQI与MUNO负相关(OR为0.77, 95%CI 0.64～0.94)。参数化TFQI和SPINA-GD的结果分别与TFQI和FT3/FT4比值一致。结论甲状腺功能正常人群中, 甲状腺激素敏感性增加与不健康的肥胖表型风险升高相关。     

同型半胱氨酸与房颤的关联分析——基于如皋衰老队列

目的 探讨中国老年人群房颤(AF)与Hcy的相关性。方法 数据来源于如皋衰老队列70~89岁人群的第四次随访资料。根据Hcy水平的四分位数及推荐的切点15μmol/L进行分组,即Q1、Q2、Q3、Q4组和Hcy高水平组、Hcy正常水平组。采用Logistic回归模型分析不同水平Hcy与AF的相关性。结果 本研究共纳入1798名研究对象,其中男814例,女984例,平均年龄(79.09±4.38)岁,AF者90例(5.0%),Hcy高水平者867例(48.2%)。AF者与非AF者的年龄、吸烟情况、饮酒情况、Hcy水平、Hcy高水平者比例差异均有统计学意义(P<0.05)。Logistic回归分析显示,与Q1组相比,Q2(OR=2.884,95%CI1.201~6.930)、Q3(OR=3.644,95%CI1.547~8.580)、Q4(OR=6.607,95%CI2.932~14.891)组AF发生风险显著增加;与Hcy正常水平组相比,Hcy高水平组AF发生风险显著增加(OR=2.774,95%CI1.742~4.419);logHcy每增加一个标准差,AF发生风险为原来的1.441(95%CI1.227~1.692)倍;在校正年龄、性别、婚姻状况、BMI、教育、职业、吸烟、饮酒、高血压、糖尿病后,上述差异仍有统计学意义(P<0.05)。结论 中国老年人群Hcy水平升高与AF风险增加相关,提示Hcy可能是AF发生的风险因素。     

肝硬化与骨折发生风险相关性的Meta分析

目的从循证医学角度探讨肝硬化与骨折发生风险的相关性。方法通过计算机全面检索PubMed、Web of Science、Embase、CNKI、万方、中国生物医学文献、维普等数据库已发表的肝硬化与骨折发生风险相关的观察性研究,对文献质量进行评价,采用Rev Man5.3软件对骨折风险进行Meta分析,计算比值比(OR)和95%可信区间(95%CI)。结果最终纳入3个队列研究,2个横断面研究,肝硬化组28 820例,对照组214 313例。肝硬化组与对照组比较,总体骨折发生风险增加(合并研究:OR=2.07,95%CI:1.52~2.83,P0.000 01;队列研究:OR=2.00,95%CI:1.93~2.07,P0.000 01);按骨折类型进行分组分析,相比对照组,肝硬化组椎体骨折和非椎体骨折(上肢)发生风险均增加,(OR=2.10,95%CI:1.30~3.40,P=0.003;OR=1.61,95%CI:1.53~1.69,P0.000 01)。结论肝硬化可增加骨折的发生风险,但由于所纳入的各研究间存在异质性,上述结论尚需更细致的研究来进一步证实。     

肥胖与大肠腺瘤相关性的研究

目的 初步探讨体重指数(BMI)、腰围(WC)、腰臀比(WHR)与大肠癌的癌前病变腺瘤的相关性.方法 2006年12月至2007年12月选择无大肠癌病史且年龄在25～88岁的结肠镜检查患者,测量身高、体重、腰围、臀围,根据肠镜检查及活检病理结果纳入大肠腺瘤组(250例)和正常对照组(289例),利用多因素Logistic回归进行相关性分析.结果 肥胖或腹型肥胖(以WC划分)患大肠腺瘤的调整后OR值分别为2.48(95%CI=1.19～5.20)和1.75(95%CI=1.15～2.66),P<0.05和P<0.01,其中男性调整后的OR值分别为4.10(95%CI=1.26～13.31)和1.70(95%CI=1.00～2.88),P均<0.05,超重组未达到统计学差异;肥胖者患进展期和非进展期腺瘤的调整后OR值分别为2.71(95%CI:1.01～7.29)和2.39(95%CI:1.05～5.47),P均<0.05;腹型肥胖者(以WC划分)患非进展期腺瘤的调整后OR值为2.03(95%CI=1.25～3.28),P<0.01;但在进展期腺瘤组未达到统计学差异.超重组在进展期和非进展期腺瘤的患病风险较正常人群均无明显统计学差异.以WHR划分的腹型肥胖在各种分析中均无统计学意义.结论 肥胖尤其是腹型肥胖与大肠腺瘤的发生显著相关,肥胖男性患病风险明显大于女性,肥胖对各期腺瘤的发生均显著相关.     

老年急性冠状动脉综合征患者预后危险因素分析

目的 探讨急性冠状动脉综合征(ACS)患者的近期预后与影响临床预后的危险因素,为ACS患者的预后风险评估提供依据.方法 入选ACS患者156例.采用无序多分类Logistic回归分析ACS患者的基线特征因素与30 d好转、死亡、心绞痛、心力衰竭的相关性.结果 将全部变量进行多因素Logistic回归分析,显示年龄(OR=1.20,95%CI:1.07～1.34)、糖尿病(OR=19.41,95%CI:3.02～124.70)、白细胞升高(OR=11.36,95%CI:1.87～69.11)及血小板升高(OR=7.72,95%CI:1.29～46.15)是30 d死亡的独立危险因素;白细胞升高(OR=2.35,95%CI:0.89～6.17)及血脂异常(OR=6.25,95%CI:2.11～18.48)是30 d心绞痛发作的独立危险因素;年龄(OR=1.10,95%CI:1.03～1.17)、男性(OR=4.18,95%CI:0.81～21.51)、白细胞升高(OR=2.97,95%CI:1.09～8.14)及血脂异常(OR=7.69,95%CI:2.39～24.76)是30 d发生心力衰竭的独立危险因素.结论 年龄、糖尿病史、血小板升高及白细胞升高是影响ACS患者30 d死亡的独立危险因素;白细胞升高及血脂异常是影响ACS患者30 d心绞痛发作的独立危险因素;年龄、男性、白细胞升高及血脂异常是影响ACS患者30 d心力衰竭的独立危险因素.

Abstract：

Objective To explore short-term prognosis of patients with acute coronary syndrome (ACS) and prognostic risk factors, and to provide information for prognostic risk assessment. Methods A total of 156 patients with acute coronary syndrome were enrolled. The correlations of baseline characteristics with 30-day improvement, death, angina pectoris and heart failure were analyzed using unordered multivariate logistic regression. Results Logistic regression analysis showed that the independent risk factors for 30-day death included age (OR=1.20, 95%CI: 1.07-1.34), diabetes (OR=19.41, 95%CI: 3.02-124.70), leukocytosis (OR=11.36, 95%CI: 1.87-69.11) and increased platelet (OR=7.72, 95%CI: 1.29-46.15). The independent risk factors for 30-day angina pectoris included leukocytosis (OR=2.35, 95%CI: 0.89-6.17) and dyslipidemia (OR=6.25, 95%CI: 2.11-18.48). The independent risk factors for the occurrence of heart failure during 30-day post-ACS included age (OR=1.10, 95%CI: 1.03-1.17), male (OR=4.18, 95%CI: 0.81-21.51), leukocytosis (OR=2.97, 95%CI: 1.09-8.14) and dyslipidemia (OR=7.69, 95%CI: 2.39-24.76). Conclusions Age, diabetes, leukocytosis and increased platelet are independent risk factors associated with 30-day death; Leukocytosis and dyslipidemia are independent risk factors associated with 30-day angina pectoris; Age, male, leukocytosis and dyslipidemia are the independent risk factors associated with 30-day heart failure.     

老年多器官衰竭发病危险因素病例对照研究

目的探讨老年多器官功能衰竭(MOFE)患者发病危险因素。方法采用1∶3配比病例对照研究方法。共纳入MOFE患者153例,以年龄(±5岁)、性别、居住地、就诊时间(±1个月)为配比条件,选取对照459例。OR值及其95%CI的计算采用条件logistic回归分析方法。结果 MOFE发病危险因素,经过多因素条件logistic回归模型拟合结果表明,免疫功能低下、肠道营养摄入障碍、感染、电解质紊乱、心律失常、心肌缺血发作、出血性脑卒中、低蛋白血症等8个因素进入模型,其OR(95%CI)分别为4.45(1.42～13.94)、5.34(1.47～19.41)、10.87(3.40～34.97)、33.42(4.7～237.63)、5.31(1.72～16.43)、3.89(1.28～11.85)、50.00(2.86～874.46)、9.31(1.30～66.49),此8个因素为MOFE发生的重要危险因素(P0.026～0.001)。结论对有上述因素的老年人群应视为MOFE高危对象,重点防范,并控制重要危险因素。     

Asociación de obesidad general y abdominal con hipertensión,dislipemia y presencia de prediabetes en el estudio PREDAPS

Introduction and objectives

Some anthropometric measurements show a greater capacity than others to identify the presence of cardiovascular risk factors. This study estimated the magnitude of the association of different anthropometric indicators of obesity with hypertension, dyslipidemia, and prediabetes (altered fasting plasma glucose and/or glycosylated hemoglobin).

Chronic Pain and Obesity in Elderly People: Results from the Einstein Aging Study

OBJECTIVES: To determine the prevalence of chronic pain in elderly people and its relationship with obesity and associated comorbidities and risk factors.
DESIGN: Cross-sectional.
SETTING: Community.
PARTICIPANTS: A representative community sample of 840 subjects aged 70 and older.
MEASUREMENTS: The prevalence of chronic pain and its relationship with obesity (categories defined according to body mass index (BMI)), other medical risk factors, and psychiatric comorbidities were examined. Chronic pain was defined as pain of at least moderate severity (≥4 on a 10-point scale) some, most, or all of the time for the previous 3 months.
RESULTS: The sample was mostly female (62.8%), and the average age was 80 (range 70–101). The prevalence of chronic pain was 52% (39.7% in men; 58.9% in women). Subjects with chronic pain were more likely to report a diagnosis of depression (odds ratio (OR)=2.5, 95% confidence interval (CI)=1.40–4.55) and anxiety (OR=2.3, 95% CI=1.22–4.64). Obese subjects (BMI 30–34.9) were twice as likely (OR=2.1, 95%CI=1.33–3.28) and severely obese subjects (BMI≥35) were more than four times as likely (OR=4.5, 95% CI=1.85–12.63) as those of normal weight (BMI 18.5–24.9) to have chronic pain. Obese subjects were significantly more likely to have chronic pain in the head, neck or shoulder, back, legs or feet, and abdomen or pelvis than subjects who were not obese. In multivariate models, obesity (OR=2.0, 95% CI=1.27–3.26) and severe obesity (OR=4.1, 95% CI=1.57–10.82) were associated with chronic pain after adjusting for age, sex, diabetes mellitus, hypertension, depression, anxiety, and education.
CONCLUSION: Chronic pain is common in this elderly population, affects women more than men, and is highly associated with obesity.     

Concealed renal insufficiency and adverse drug reactions in elderly hospitalized patients

BACKGROUND: Adverse drug reactions (ADRs) are common causes of in-hospital complications for elderly people. The purpose of the present study is to verify whether concealed renal insufficiency, that is, reduction of the estimated glomerular filtration rate (GFR) in people with normal serum creatinine levels, is a risk factor for ADRs in elderly hospitalized patients. METHODS: We used data on 11,687 hospitalized patients enrolled in the Gruppo Italiano di Farmacovigilanza nell'Anziano study. The outcomes of the study were any ADR, ADR to hydrosoluble drugs, and ADR to any other drug during the hospital stay. We compared 3 groups: normal renal function (normal serum creatinine levels and normal estimated GFRs), concealed (normal serum creatinine levels and reduced estimated GFRs), or overt (increased creatinine levels and reduced estimated GFRs) renal insufficiency. The relationship between renal function and ADR was evaluated using contingency tables and multiple regression analysis including potential confounders. RESULTS: Concealed renal insufficiency was detected in 1631 (13.9%) patients and was frequently associated with male sex and poor nutritional status. Hydrosoluble drugs were responsible for 301 of the 941 recorded ADRs. After adjusting for potential confounders, both concealed (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.15-1.25) and overt (OR, 2.02; 95% CI, 1.54-2.65) renal failure were associated with ADR to hydrosoluble drugs, but not with ADR to other drugs (OR, 0.83 [95% CI, 0.65-1.08], and OR, 1.01 [95%CI, 0.83-1.23], respectively). CONCLUSION: Older hospitalized patients frequently have impaired renal function despite normal serum creatinine levels and are exposed to an increased risk of ADRs to hydrosoluble drugs.     

代谢健康型肥胖与动脉粥样硬化的相关性研究

目的探讨在40岁以上的中国社区人群中,代谢健康型肥胖与动脉粥样硬化患病风险的相关性。方法来自上海嘉定社区共9525名不伴有心血管疾病的居民(男性3621名、女性5904名)参与了本项研究。每位参与者均完成了调查问卷、体格检查[包括肱踝脉搏波传导速度(brachial-ankle pulse wave velocity,baPWV)和血压(blood pressure,BP)的测量],以及实验室检查。根据体重指数(body mass index,BMI)和代谢水平,将参与者分为4组,分别是代谢健康型非肥胖(metabolically healthy non-obese,MHNO)、代谢不健康型非肥胖(metabolically unhealthy non-obese,MUNO)、代谢健康型肥胖(metabolically healthy obese,MHO)和代谢不健康型肥胖(metabolically unhealthy obese,MUO)。baPWV>1400 mm/s被定义为高baPWV水平,脉压差(pulse pressure,PP)高于人群上四分位数被定义为高PP水平。利用多元logistic回归分析模型探究MHO与高baPWV水平以及高PP水平之间的相关性。结果多元logistic回归分析显示,在校正性别、年龄、当前吸烟、当前饮酒及受教育程度之后,与MHNO组比较,MHO组人群与高baPWV水平(OR=1.18,95%CI 1.02~1.37)和高PP水平(OR=1.72,95%CI 1.43~2.08)有显著相关性。另外,MUNO和MUO组人群的高baPWV水平(MUNO为OR=3.02,95%CI 2.60~3.50;MUO为OR=3.26,95%CI 2.87~3.70)和高PP水平(MUNO为OR=2.56,95%CI 2.17~3.02;MUO为OR=3.49,95%CI 3.01~4.06)患病风险显著升高。结论中国社区中老年人群中,MHO与动脉粥样硬化患病风险升高有显著相关性。     

恩施土家族人群eNOS rs1799983基因多态性和肥胖在原发性高血压中的交互作用

目的 探讨恩施土家族人群内皮型一氧化氮合酶(eNOS)rs1799983多态性与原发性高血压(EH)关联性及其与肥胖交互作用。方法 采用多聚酶链反应-限制性片段长度多态性(PCR-RFLP)方法分析127例EH患者和127名正常对照eNOS rs1799983基因型。非条件Logistic分析各基因型与发病中易感性关系以及与肥胖的交互作用。结果 携带C(CC/CT)基因个体患病风险较非C基因携带者(TT)风险明显增加1.35倍(OR=1.35,95%CI: 1.22,2.56,P<0.01;校正OR=1.61,95%CI: 1.21,3.01,P<0.01);非条件Logistic分析表明携带CC/CT基因型肥胖个体EH罹患风险是携带TT基因非肥胖个体的3.39倍(OR=3.39,95%CI:2.66,5.36,P=0.000)(RERI=1.94,95%CI:1.41,2.77;API=0.59,95%CI:0.33,0.84;S=1.46,95%CI:1.37,2.66)。结论 eNOS rs1799983多态性增加恩施土家族个体原发性高血压罹患风险,且与肥胖存在原发性高血压发病中存在协同效应。     

The association between BMI and metabolically unhealthy status with COVID-19 mortality: Based on 3019 inpatients from Wuhan,China

Background and aimsPatients with multiple metabolic diseases are at high risk for the occurrence and death of COVID-19. Little is known about patients with underweight and metabolically healthy obesity. The aim of this study is to evaluate the impact of BMI and COVID-19 mortality in hospitalized patients, and also explore the association in different metabolically healthy (MHS) and unhealthy status (MUS).Methods and resultsA retrospective cohort study based on 3019 inpatients from Wuhan was conducted. Included patients were classified into four groups according the BMI level (underweight, normal weight, overweight and obesity), and patients with at least one of the metabolic abnormalities (diabetes, hypertension, dyslipidemia) was defined as MUS. Multiple Cox model was used to calculate the hazard ratio (HR). Compared to patients with normal weight, the HRs of overweight and obesity for COVID-19 mortality were 1.91 (95%CI:1.02–3.58) and 2.54 (95%CI:1.22–5.25) respectively in total patients, and 2.58 (95%CI:1.16–5.75) and 3.89 (95%CI:1.62–9.32) respectively in the elderly. The HR of underweight for COVID-19 mortality was 4.58 (95%CI:1.56–13.48) in the elderly. For different metabolic statuses, both underweight, overweight and obesity had obviously negative association with COVID-19 mortality in total and elderly patients with MUS. However, no significance was found in non-elderly and patients with MHS.ConclusionNot only overweight or obesity, but also underweight can be associated with COVID-9 mortality, especially in the elderly and in patients with MUS. More large-scale studies are needed for patients with underweight and metabolically healthy overweight or obesity.     

The association between early-life famine exposure and adulthood obesity on the risk of dyslipidemia

Background and aimsThe joint effect of famine exposure and adulthood obesity on risk of dyslipidemia remains unclear. Thus, we aim to explore the joint effect of famine exposure and adulthood obesity on the risk of dyslipidemia, and the potential effect of adult general or abdominal obesity on the association between famine exposure and dyslipidemia.Methods and resultsWe conducted a community-based cohort study in 8880 subjects aged 40 years or older. Participants were divided into nonexposed, fetal-exposed, childhood-exposed, adolescent-exposed according to birth date. General obesity and abdominal obesity were defined according to body mass index (BMI: overweight≥24.0 kg/m², obesity≥28.0 kg/m²) and waist-to-hip ratio (WHR, men/women: moderate≥0.90/0.85, high≥0.95/0.90). Dyslipidemia was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria. Compared with nonexposed participants, fetal-exposed individuals had significantly increased risk of dyslipidemia (OR:1.24, 95%CI: 1.03–1.50) in the whole study. Significant increased risk of dyslipidemia related to famine exposure was observed in women [ORs (95%CIs) were 1.36 (1.05–1.76) and 1.70 (1.22–2.37) for the fetal and childhood-exposed group, respectively] but not in men. Moreover, both general and central obesity had significant multiplicative interactions with famine exposure for the risk of dyslipidemia (P for interaction = 0.0001 and < 0.0001, respectively). Significant additive interaction was found between famine exposure and WHR on risk of dyslipidemia in women, with the relative excess risk due to interaction (RERI) and 95% CI of 0.43 (0.10–0.76).ConclusionCoexistence of early-life undernutrition and adulthood obesity was associated with a higher risk of dyslipidemia in later life.     

Prevalence of geriatric syndrome and risk factors associated with obesity in community-dwelling elderly women

AIM: To evaluate the prevalence of geriatric syndrome and risk factors associated with obesity in community-dwelling elderly women. METHODS: The baseline survey was conducted in November 2006. Subjects were 925 women aged 70 years and older who participated in a comprehensive health examination which included a face-to-face interview, body composition, and physical fitness tests. The participants were classified, the based on percentage of body fat, as normal (<30.0), mild obesity (30.0 to 34.9), and obesity (>or=35.0) groups. To evaluate the differences among the groups with regard to the physical fitness and the interview data, one-way analysis of variance performed for continuous variables and the chi-square test for categorical variables. Multivariate logistic regression models were used to assess the factors associated with obesity in elderly women. RESULTS: Although obese women had a higher prevalence of urinary incontinence than the normal and mild obese women, there were no significant differences in history of falls during the last year, or fear of falling. A high percentage of body fat was significantly associated with a higher level of instrumental activities of daily living (IADL) and intellectual activity disability, use of 3 or more medications, pain, and circumference (abdominal, hip, calf), and was associated with a lower level of balance and walking ability. According to the logistic model, history of hypertension (odds ratio (OR)=1.70, 95%confidence intervals (CI)=1.25-2.32), pain (OR=1.46, 95%CI=1.07-2.01), urinary incontinence (OR=1.44, 95%CI=1.08-1.92), SBP (OR=1.02, 95%CI=1.01-1.03), and usual walking speed (OR=0.43, 95%CI=0.24-0.75) were independent variables significantly associated with obesity. CONCLUSIONS: These cross-sectional data show that a higher percentage of body fat is associated with high prevalence of urinary incontinence, IADL and intellectual activity disability, and is related to lower level of walking ability and balance. The present study suggests that regular physical activity and weight control may contribute to the prevention of IADL disability and improvement of physical fitness in obese elderly women.