肥胖表型与中国中老年人慢性肾脏病发病风险关联研究——基于CHARLS数据

目的：探讨肥胖表型及其转变与中国中老年人慢性肾脏病(CKD)发病风险的关联。方法：基于中国健康与养老追踪调查(CHARLS),纳入参加2011年和2015年两次调查的4 538名[基线时(58.75±8.56)岁]研究对象。根据体质量指数和代谢状态将肥胖表型分为：代谢正常非超重/肥胖组(MHNO)、代谢正常超重/肥胖组(MHO)、代谢异常非超重/肥胖组(MANO)和代谢异常超重/肥胖组(MAO)。采用多因素Cox比例风险回归模型分析肥胖表型及其转变与CKD的发病风险。结果：与MHNO组相比,基线MHO、MANO和MAO组CKD发病风险显著上升,HR(95%CI)分别为：1.42(1.01～2.02)、1.55(1.01～2.36)和1.49(1.06～2.09)。随访期间,631人(62.85%)仍为MHO表型;148人(14.74%)转变为MHNO表型;10人(1.00%)转变成MANO表型;215人(21.41%)转变成MAO表型。以稳定的MHO组作为参比,MHO表型转变与CKD发病风险关联没有统计学意义(P>0.05)。结论：MHO和代谢异常表型(MANO、MAO)均会增加...     

肥胖与大肠腺瘤相关性的Meta分析

目的  综合分析与评价肥胖与大肠腺瘤发病的相关性。方法  系统检索中国知网学术期刊全文数据库（CNKI）、万方数据知识服务平台、中国生物医学文献数据库、维普中文科技期刊数据库、PubMed、EMBase、Cochrane Library等数据库。采用Newcastle-Ottawa Scale （NOS）文献质量评价量表对纳入文献质量进行评价。使用Stata 12.0软件进行Meta分析。结果  最终纳入研究28篇。Meta分析■=1.38（95%CI：1.30,1.47,P = 0.000),提示肥胖人群大肠腺瘤的发病风险较正常人群增加38%。I2 =43%（P =0.009）提示该Meta分析存在中等程度的异质性。剂量关系分析结果也显示高BMI会增加大肠腺瘤的患病风险。敏感性分析显示该Meta分析有较强的稳定性。性别和人种亚组分析表明性别和人种对大肠腺瘤的发病无显著影响。Egger’s和Begg’s检测结果显示该Meta分析不存在发表偏倚。结论  肥胖会增加大肠腺瘤的发病风险,建议在进行大肠腺瘤筛查时将肥胖作为风险因素。

     

造影剂肾病对冠状动脉粥样硬化性心脏病患者短期预后的影响

目的  初步评价造影剂肾病对冠状动脉粥样硬化性心脏病（简称冠心病）患者短期临床预后的影响。方法  回顾性纳入自2010年1月-2014年12月期间于该院心血管内科住院并接受经皮冠状动脉内支架植入术的冠心病患者755例，并进行12个月随访。将所有纳入患者分为造影剂肾病组和非造影剂肾病组，并对其临床特点及12个月随访临床不良事件进行比较。结果  755例患者中，男性466例，女性289例，发生造影剂肾病51例（6.8%）；与非造影剂组患者比较，造影剂肾病组有更多的高龄患者、吸烟患者、糖尿病患者以及急性心肌梗死伴休克患者，差异有统计学意义（P <0.01）。平均Syntax积分在造影剂肾病组为（33.6±10.6）分，非造影剂肾病组为（22.1±6.8）分；造影剂肾病组患者LVEF为（38.5±8.87）%，非造影剂肾病组患者为（42.76±4.35）%，两组比较差异有统计学意义（P <0.01）。12个月随访的主要不良事件率在造影剂组患者中明显高于非造影剂组患者，差异有统计学意义（P <0.05）。多因素Logistic回归分析显示，造影剂肾病是冠心病患者12个月主要不良事件的独立危险因素。结论  造影剂肾病的发生可应用于预测冠心病患者的短期预后。

     

尿膀胱肿瘤抗原在膀胱癌中的表达及意义

摘要：目的  探讨膀胱肿瘤抗原（BTA）的临床应用价值。方法  收集46例膀胱癌、35例泌尿系良性疾病、10例健康者尿液,同时做尿脱落细胞学及BTA检测。结果  ①BTA检测的敏感性为86.9%,特异性为82.2%,假阳性率为17.8%（95%CI：0.759,0.924）;尿脱落细胞学检测的敏感性为34.7%,特异性为97.8%,假阳性率为2.2%（95%CI：0.550,0.775）;②BTA表达水平和敏感性与肿瘤分级分期、有无肉眼血尿有关（P <0.05）,与复发或初发无关（P >0.05）;BTA对各级、各期的膀胱癌的敏感性均高于尿脱落细胞学检测（P <0.05）;③BTA在早期膀胱癌（Ta～T1期）中表达水平高于良性疾病组、健康组（P <0.05）。结论  BTA对膀胱癌的诊断、早期筛查及跟踪随访有较高的临床应用价值,但应注意血尿影响BTA检测结果。

     

甲亢患者血清尿酸水平与发生房颤的相关性分析

目的  分析血清尿酸水平与甲状腺功能亢进症患者心房颤动的关系。方法  回顾性收集2013年10月-2015年10月于该院就诊的227例甲亢患者临床资料，根据是否合并房颤，分为甲亢伴房颤组（n =49）和甲亢无房颤组（n =178），排外除甲亢以外其他疾病导致的房颤及其他可以引起尿酸水平变化的因素。记录入选患者的一般资料、实验室检查及心脏彩超结果，并对这些数据与房颤发生之间的关系进行单因素和多因素Logistic回归分析。结果  甲亢伴房颤组的年龄、甲亢病程、尿素氮、肌酐、尿酸、球蛋白、左心房前后径及左心室舒张末期内径均高于甲亢无房颤组（P <0.05），甲亢伴房颤组的肾小球滤过率、总胆固醇、高密度脂蛋白、低密度脂蛋白、白蛋白及左室射血分数低于甲亢无房颤组（P <0.05）。通过多因素Logistic回归分析显示年龄（■：1.097，95%CI：1.036，1.160）、尿酸（■：1.009，95%CI：1.002，1.016）、左心房前后径（■：1.294，95%CI：1.134，1.476）及左室射血分数（■：0.902，95%CI：0.814，1.000）是甲亢患者房颤发生的独立相关因素。结论  尿酸水平是甲亢患者房颤发生的危险因素，年龄、左心房前后径和左室射血分数也与甲亢患者房颤发生存在独立相关性。

     

运动平板试验在胸外科术前筛查冠状动脉粥样硬化性心脏病的应用及意义

目的  回顾性研究运动平板试验（TET）在胸外科非心脏病患者术前筛查冠状动脉粥样硬化性心脏病（CHD）的应用及意义。方法  2009年1月-2013年10月中南大学湘雅二医院胸外科住院的TET异常的336例患者,进行冠状动脉造影（CAG）作为诊断CHD的金标准。比较TET阳性组和可疑阳性组的CHD阳性预测值以及不同年龄、性别、是否合并高血压、糖尿病等对TET阳性预测值的影响。结果  336例患者中,男性252例（75%）,女性84例（25%）;平均年龄（59.77±7.92）岁。TET阳性组对CHD的阳性预测值高于可疑阳性组（36.36% vs 23.04%,P =0.008）;TET老年组（年龄≥60岁）的CHD阳性预测值高于中年组（年龄<60岁）（40.35% vs 15.76%,P =0.000）;TET男性组高于女性组（31.35% vs 19.05%,P =0.030）;高血压组的CHD阳性预测值高于非高血压组（57.69% vs 22.89%,P =0.000）;糖尿病组CHD阳性预测值高于非糖尿病组（62.07% vs 25.08%,P=0.000）,各组差异有统计学意义。结论  TET可作为术前CHD常规筛查手段以评估手术风险,指导制订围手术期的治疗方案。TET阳性较可疑阳性具有更高的CHD阳性预测值。老年人较中年人、男性较女性、高血压或糖尿病较无高血压或无糖尿病的TET阳性预测值高。

     

健康体检人群身体测量指标与2型糖尿病的关系

目的  探讨健康体检人群身体测量指标与2型糖尿病（T2DM）的关系。方法  选取2011年1月-2015年4月在宁夏医科大学总医院进行体检的4 186例成人作为研究对象,根据其血糖情况分为T2DM组和非T2DM组。通过单因素分析和多非条件Logistic多元回归探讨各身体测量指标与T2DM发病的关系。结果  4 186例受试者中220例发现T2DM,占5.3%。T2DM组的体重指数（BMI）、体脂比、腰围（WC）、臀围、腰臀比（WHR）及腰身比（WHtR）均显著高于非T2DM组（P <0.05）。非条件Logistic多元回归分析结果表明调整年龄、文化程度、饮酒、吸烟和糖尿病（DM）家族史等混杂因素影响后,BMI、体脂比、WC、臀围、WHR及WHtR等各身体测量指标均与T2DM患病呈显著正相关（P <0.05）,且以WHR为主的腹型肥胖指标与其关系更密切。结论  对于健康体检人群而言,身体测量指标与T2DM的发病密切相关,其中以WHR为主的腹型肥胖指标的影响更大,故建议通过调整饮食和运动来控制WHR,尽可能预防T2DM的发生。

     

肥胖型儿童安氏Ⅱ类错■畸形的相关因素调查

目的  观察肥胖型儿童骨密度的变化、上气道形态的改变及了解肥胖型儿童饮食、睡眠和口腔疾病既往史。研究肥胖与安氏Ⅱ类错■畸形发生的相关性。方法  对895例11和12岁儿童进行体重指数（BMI）检查。BMI≥23为肥胖组（n =170）；在剩余725例BMI<23的儿童中，随机抽取170例作为配对正常组，对两组儿童进行骨密度检查和统计上气道软、硬组织形态的相关参数。并通过问卷调查了解儿童饮食睡眠和口腔疾病既往史。结果  肥胖组骨量减少，上气道相对狭窄，口呼吸习惯及牙体早失几率较高。结论  肥胖虽然不是安氏Ⅱ类错■畸形发生的直接原因，但与安氏Ⅱ类错■畸形发生存在间接相关性。

     

人类白细胞抗原-B等位基因多态性与江苏地区汉族人群2型糖尿病的相关性研究

目的  探讨人类白细胞抗原（HLA-B）等位基因多态性与江苏地区汉族人群2型糖尿病的相关性。方法  采用聚合酶链反应直接测序分型法（PCR-SBT）对118例江苏地区汉族2型糖尿病（T2DM）个体进行HLA-B等位基因分型，计算各等位基因频率和血清型频率，并与中华骨髓库江苏分库汉族志愿者人群（644例和20 248例）进行统计学比较。结果  HLA-B?鄢1501的等位基因频率在江苏地区汉族T2DM人群中明显升高（8.90% vs 3.03%，Pc = 0.000，■=3.13，95%CI=1.80～5.42，Power=98.23%），而HLA-B?鄢5801的等位基因频率则明显下降（1.69% vs 8.62%，Pc =0.000，■=0.18，95%CI=0.07～0.50，Power=91.07%）；相对应地，HLA-B?鄢15的血清型频率在江苏地区汉族T2DM人群中明显升高（21.18% vs 13.03%，Pc =0.022，■=1.79，95%CI=1.26～2.55，Power=90.15%），而HLA-B?鄢58的血清型频率则明显下降（1.69% vs 8.62%，Pc =0.000，■=0.18，95%CI= 0.07～0.50，Power=91.09%）。结论  HLA-B?鄢1501等位基因可能与江苏地区汉族人群2型糖尿病的易感性有关，而HLA-B?鄢5801则可能有保护作用。这些结果首次提示HLA-I类基因多态性可能与中国人群2型糖尿病有关。

     

2型糖尿病合并甲状腺功能减退相关危险因素的Logistic回归分析

目的  探讨2型糖尿病合并甲状腺功能减退的相关危险因素。方法  选取2013年1月-2015年1月于贵州省铜仁市人民医院内分泌科病房住院的2型糖尿病合并甲状腺功能减退患者64例作为病例组研究对象,随机抽取同期本院住院的2型糖尿病患者128例作为对照组研究对象,收集两组研究对象的临床资料,并进行相关危险因素的Logistic回归分析。结果  单因素非条件Logistic回归分析发现：胰岛素治疗及二甲双胍治疗是2型糖尿病合并甲状腺功能减退的保护因素（■=0.195、0.541,95%CI：0.084,0.232;0.216,0.838）;糖尿病肾病、脂代谢紊乱、高纤维蛋白原血症、吸烟史、HbAlc高以及TPO-Ab阳性是2型糖尿病合并甲状腺功能减退的危险因素（■=8.440、4.276、6.678、6.266、1.813、6.131,95%CI：3.140,13.467;1.106,5.978;2.340,9.015;2.135,8.249;1.017,2.826;2.338,9.059）;多因素非条件Logistic回归分析发现胰岛素治疗是2型糖尿病合并甲状腺功能减退的保护因素（■=0.198,95%CI：0.081,0.246）;糖尿病肾病、吸烟史、TPO-Ab阳性均是2型糖尿病合并甲状腺功能减退的危险因素（■=8.398、6.240、6.080,95%CI：3.132,13.514;2.101,8.568;2.324,8.942）。结论  胰岛素治疗、糖尿病肾病、吸烟史、TPO-Ab阳性均与2型糖尿病合并甲状腺功能减退有相关性,对于患有糖尿病肾病、有吸烟史和TPO-Ab阳性的2型糖尿病患者,应定期监测甲状腺功能。

     

Joint Association of Metabolic Health and Obesity with Ten-Year Risk of Cardiovascular Disease among Chinese Adults

Objective This study aims to investigate the association of metabolic phenotypes that are jointly determined by body mass index(BMI)or fat mass percentage and metabolic health status with the tenyear risk of cardiovascular disease(CVD)among Chinese adults.Methods Data were obtained from a cross-sectional study.BMI and body fat mass percentage(FMP)combined with the metabolic status were used to define metabolic phenotypes.Multiple linear regression and logistic regression were used to examine the effects of metabolic phenotypes on CVD risk.Results A total of 13,239 adults aged 34-75 years were included in this study.Compared with the metabolically healthy non-obese(MHNO)phenotype,the metabolically unhealthy non-obese(MUNO)and metabolically unhealthy obese(MUO)phenotypes defined by BMI showed a higher CVD risk[odds ratio,OR(95% confidence interval,CI):2.34(1.89-2.89),3.45(2.50-4.75),respectively],after adjusting for the covariates.The MUNO and MUO phenotypes defined by FMP showed a higher CVD risk[OR(95%CI):2.31(1.85-2.88),2.63(1.98-3.48),respectively]than the MHNO phenotype.The metabolically healthy obese phenotype,regardless of being defined by BMI or FMP,showed no CVD risk compared with the MHNO phenotype.Conclusion General obesity without central obesity does not increase CVD risk in metabolically healthy individuals.FMP might be a more meaningful factor for the evaluation of the association of obesity with CVD risk.Obesity and metabolic status have a synergistic effect on CVD risk.     

血清microRNA-155、microRNA-21、趋化素、瘦素与糖尿病肥胖患者胰岛素抵抗的相关性

目的 探讨糖尿病肥胖患者血清microRNA-155(miR-155)、microRNA-21(miR-21)、趋化素、瘦素水平与胰岛素抵抗（IR）的相关性。方法 选取2022年1月—2023年4月山东中医药大学第二附属医院收治的138例2型糖尿病（T2DM）患者为研究对象,其中肥胖患者73例（肥胖组）,非肥胖患者65例（非肥胖组）。肥胖组中有IR 45例（IR组）,无IR 28例（非IR组）。收集患者一般资料,包括性别、体质量指数（BMI）、年龄、颈围（NC）、腰围（WC）、空腹血糖（FPG）、甘油三酯（TG）、空腹胰岛素（FINS）、高密度脂蛋白胆固醇（HDL-C）、miR-155、miR-21、趋化素、瘦素、胰岛素抵抗指数（HOMA-IR）水平;通过多因素逐步Logistic回归模型分析T2DM肥胖患者发生IR的危险因素;绘制受试者工作特征（ROC）曲线,分析miR-155、miR-21、趋化素、瘦素诊断T2DM肥胖患者IR的效能;Pearson法分析miR-155、miR-21、趋化素、瘦素与HOMA-IR的相关性。结果 肥胖组miR-155相对表达量低于非肥胖组（P <...     

肥胖与偏头痛发病相关性的meta分析

目的探究肥胖是否与偏头痛发病存在相关性。方法按照Cochrane 系统评价的方法,通过计算机检索PubMed, EMBASE英文数据库以及万方、中国期刊全文数据库(CNKI)、中国生物医学数据库,收集所有研究肥胖与偏头痛发病相关性的 文献。使用Stata12.0软件进行Meta分析,采用比值比（OR）和95%可信限（CI）评估肥胖和偏头痛发病的相关性。结果共纳入 14个研究,包含193274个研究对象。Meta分析结果显示,肥胖人群对比体质量正常人群,偏头痛发生风险增加19%（OR,1.19; 95% CI,1.02~1.38;P=0.029）,肥胖人群对比非肥胖人群,偏头痛发生风险增加19%（OR, 1.19;95% CI,1.02~1.38;P=0.024）。结 论肥胖与偏头痛发病存在相关性,肥胖人群偏头痛发病风险升高。     

Relationship of physical activity vs body mass index with type 2 diabetes in women

Context  Physical inactivity and body mass index (BMI) are established independent risk factors in the development of type 2 diabetes; however, their comparative importance and joint relationship with diabetes are unclear. Objective  To examine the relative contributions and joint association of physical activity and BMI with diabetes. Design, Setting, and Participants  Prospective cohort study of 37 878 women free of cardiovascular disease, cancer, and diabetes with 6.9 years of mean follow-up. Weight, height, and recreational activities were reported at study entry. Normal weight was defined as a BMI of less than 25; overweight, 25 to less than 30; and obese, 30 or higher. Active was defined as expending more than 1000 kcal on recreational activities per week. Main Outcome Measure  Incident type 2 diabetes, defined as a new self-reported diagnosis of diabetes. Results  During the follow-up, 1361 cases of incident diabetes occurred. Individually, BMI and physical activity were significant predictors of incident diabetes. Compared with normal-weight individuals, the multivariate-adjusted hazard ratio (HR) was 3.22 (95% confidence interval [CI], 2.69-3.87) for overweight individuals and 9.09 (95% CI, 7.62-10.8) for obese individuals. For overall activity (kilocalories expended per week), compared with the least active first quartile, the multivariate-adjusted HRs were 0.91 (95% CI, 0.79-1.06) for the second quartile, 0.86 (95% CI, 0.74-1.01) for the third, and 0.82 (95% CI, 0.70-0.97) for the fourth (P for trend = .01). In the combined analyses, overweight and obese participants, whether active or inactive, had significantly elevated risks, compared with normal-weight active individuals. The multivariate-adjusted HRs were 1.15 (95% CI, 0.83-1.59) for normal-weight inactive, 3.68 (95% CI, 2.63-5.15) for overweight active, 4.16 (95% CI, 3.05-5.66) for overweight inactive, 11.5 (95% CI, 8.34-15.9) for obese active, and 11.8 (95% CI, 8.75-16.0) for obese inactive participants. Conclusions  Although BMI and physical inactivity are independent predictors of incident diabetes, the magnitude of the association with BMI was greater than with physical activity in combined analyses. These findings underscore the critical importance of adiposity as a determinant of diabetes.      

Relationship of physical activity vs body mass index with type 2 diabetes in women

CONTEXT: Physical inactivity and body mass index (BMI) are established independent risk factors in the development of type 2 diabetes; however, their comparative importance and joint relationship with diabetes are unclear. OBJECTIVE: To examine the relative contributions and joint association of physical activity and BMI with diabetes. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of 37 878 women free of cardiovascular disease, cancer, and diabetes with 6.9 years of mean follow-up. Weight, height, and recreational activities were reported at study entry. Normal weight was defined as a BMI of less than 25; overweight, 25 to less than 30; and obese, 30 or higher. Active was defined as expending more than 1000 kcal on recreational activities per week. MAIN OUTCOME MEASURE: Incident type 2 diabetes, defined as a new self-reported diagnosis of diabetes. RESULTS: During the follow-up, 1361 cases of incident diabetes occurred. Individually, BMI and physical activity were significant predictors of incident diabetes. Compared with normal-weight individuals, the multivariate-adjusted hazard ratio (HR) was 3.22 (95% confidence interval [CI], 2.69-3.87) for overweight individuals and 9.09 (95% CI, 7.62-10.8) for obese individuals. For overall activity (kilocalories expended per week), compared with the least active first quartile, the multivariate-adjusted HRs were 0.91 (95% CI, 0.79-1.06) for the second quartile, 0.86 (95% CI, 0.74-1.01) for the third, and 0.82 (95% CI, 0.70-0.97) for the fourth (P for trend =.01). In the combined analyses, overweight and obese participants, whether active or inactive, had significantly elevated risks, compared with normal-weight active individuals. The multivariate-adjusted HRs were 1.15 (95% CI, 0.83-1.59) for normal-weight inactive, 3.68 (95% CI, 2.63-5.15) for overweight active, 4.16 (95% CI, 3.05-5.66) for overweight inactive, 11.5 (95% CI, 8.34-15.9) for obese active, and 11.8 (95% CI, 8.75-16.0) for obese inactive participants. CONCLUSIONS: Although BMI and physical inactivity are independent predictors of incident diabetes, the magnitude of the association with BMI was greater than with physical activity in combined analyses. These findings underscore the critical importance of adiposity as a determinant of diabetes.     

胎盘植入性疾病危险因素的决策树预测模型的建立

目的 分析胎盘植入性疾病（placenta accreta spectrum disorders, PAS）的危险因素并初步构建PAS的决策树预测模型,旨在识别高危人群并为临床防治提供参考依据。方法 通过查阅电子病历系统,回顾性分析成都市某医院中2020年1月–2020年9月分娩的2 022例产妇的相关信息。采用单因素、多因素logistic回归方法对PAS的危险因素进行分析。运用SPSS Clementine12.0软件初步探索PAS危险因素的决策树预测模型。结果 logistic回归提示PAS发生风险前三的是：本次妊娠合并前置胎盘的孕产妇发生PAS的风险是无前置胎盘产妇的8.00倍（95%CI:5.24～12.22）;多胎妊娠者发生PAS的风险是单胎妊娠者的2.52倍（95%CI:1.72～3.69）;三次及以上的人流史的孕产妇发生PAS的风险是未进行过人流手术者的1.89倍（95%CI:1.11～3.20）。C5.0决策树法预测模型结果：前置胎盘是最重要的危险因素,当合并有前置胎盘时,高达93.33%(140/150)患者发生PAS;只存在体外受精-胚胎移植（in vitro f...     

Metabolic syndrome in non-obese Taiwanese: new definition of metabolically obese, normal-weight individual

Background Not only the obese, but also the non-obese adults have the high prevalence of metabolic syndrome in the upper normal weight. The aim of this study was to assess the prevalence rates of metabolic syndrome and its individual components in non-obese adult Taiwanese （body mass index （BMI） ≤ 26.9 kg/m^2）. Methods A cross-sectional study was conducted from January 2006 to December 2007. One thousand six hundred and fifty-nine subjects （aged 47.5±12.4 years）, 60.8% of which were men, were enrolled. The prevalence and odds ratios of metabolic syndrome, defined by the American Heart Association/National Heart, Lung and Blood Institute （2005）, were analyzed in the BMI category according to 2.0 unit increments, in individuals seeking a health examination. Results The higher the BMI categories, the more prevalent the metabolic syndrome was in women and in men （P 〈0.001）. Compared with those women with a BMI ≤20.9 kg/m^2, the odds ratios for metabolic syndrome in women were 1.3 （95% CI： 0.5-3.2） with BMI 21.0-22.9 kg/m^2, 3.0 （1.3-7.1） with BMI 23.0-24.9 kg/m^2, and 8.6 （3.6-20.8） for women with BMI 25.0-26.9 kg/m^2, after controlling for age, smoking status, alcohol consumption, betel nut chewing, blood routine, biochemical data, hepatitis B virus surface antigen and anti-hepatitis C virus. The corresponding odds ratios in men were 1.6 （0.6-4.2）, 3.7 （1.6-8.8）, and 9.9 （4.2-23.2）. Conclusions Individuals in the upper normal weight and slightly overweight BMI range have relatively high prevalence and increased risk of having metabolic syndrome. Therefore, physicians should screen metabolic syndrome in not only obese but also non-obese individuals for the prevention of cardiovascular disease.     

Ten-year incidence of diabetes in older Australians: the Blue Mountains Eye Study

OBJECTIVE: To estimate the incidence of diabetes and impaired fasting glucose (IFG), and increased risk associated with the metabolic syndrome, in a representative population-based sample of older Australians. DESIGN, SETTING AND PARTICIPANTS: The Blue Mountains Eye Study examined 3654 residents aged 49 + years (82.4% response rate) during 1992-1994, and re-examined 2335 (75.1% of survivors) during 1997-1999 and 1952 (75.6% of survivors) during 2002-2004; 2123 participants with normal blood glucose levels at baseline were considered at risk of developing incident diabetes. Main outcome measures: Incident diabetes (or IFG) was defined in participants at risk who were newly diagnosed by a physician during the follow-up or found to have a fasting blood glucose level >or= 7.0 mmol/L (or 5.6-6.9 mmol/L). Kaplan-Meier cumulative 10-year incidence was calculated. RESULTS: The overall 10-year incidence of diabetes and IFG was 9.3% and 15.8%, respectively. Participants with metabolic syndrome at baseline had a higher risk of incident diabetes than those without metabolic syndrome (29.2% v 8.6%). Baseline factors associated with incident diabetes were elevated fasting glucose level (adjusted odds ratio [OR], 4.5; 95% CI, 3.4-6.1 per mmol/L), obesity (OR, 2.0; 95% CI, 1.3-2.8), diabetes family history (OR, 1.7; 95% CI, 1.2-2.5), current smoking (OR, 1.6; 95% CI, 1.0-2.7) and high density lipoprotein cholesterol level < 1.0 mmol/L (OR, 2.4; 95% CI, 1.5-3.8). Similar baseline factors were associated with incident IFG. CONCLUSION: This population-based study provides data on the incidence of diabetes and IFG in an older, predominantly white population, and confirms that metabolic and lifestyle factors are major risk factors for diabetes.     

辽宁中年汉族人群IRS-2G1057D突变筛查及其意义

目的筛查中国辽宁地区中年汉族人群IRS-2基因G1057D突变并探讨其意义。方法选取辽宁汉族40-60岁健康者221人，其中肥胖组113人，非肥胖组108人。运用PCR-RFLP方法，筛查IRS-2G1057D突变。同时结合2型糖尿病（T2DM）发病机制相关的胰岛素分泌及其作用的8项参数水平的检测，明确该突变与T2DM的相关性。结果IRS-2G1057DHae Ⅱ限制酶切的电泳结果为：正常纯合子GG型为183和102bp两条带；杂合子GD型为285、183和102bp三条带；突变纯合子DD型为285bp一条带；IRS-2G1057D的D等位基因频率在总研究人群中为29．6％，在肥胖及非肥胖人群中分别为24．3％和35.2％；非肥胖组DD基因型的FPG及OGTT的2hCP均低于同组GG基因型（P〈0．05，P〈0．01），HOMAB高于同组GG基因型（P〈0．01）；肥胖组DD基因型的OGTT的2hCP及HOMAIR均高于同组GG基因型（P〈0．01，P〈0．01）；肥胖组DD基因型的WHR高于同组GG基因型（P〈0．05）。结论携带DD基因型的非肥胖者胰岛素敏感性增高，而携带DD基因型的肥胖特别是中心性肥胖者的胰岛素敏感性却降低，提示IRS-2G1057D突变以肥胖为中介与T2DM相关联。