【作者】 陈丽竹；

【导师】 胡大一；

【作者基本信息】 重庆医科大学 ， 内科学， 2013， 博士

【摘要】 第一部分农村居民高血压患病率、知晓率、治疗率、达标率流行病学调查及其影响因素分析目的：了解河北省香河农村居民高血压患病率、知晓率、治疗率、达标率及其影响因素。方法：于2011.7-2011.8对河北省香河农村年满35周岁的830例农村居民进行体格检查及包含年龄、文化程度、婚姻状态、吸烟、饮酒、和高血压家族史、收入等信息的问卷调查。结果：香河农村居民高血压患病率、知晓率、治疗率、达标率分别为42.4%、54.8%、50.0%、11.9%。Logistic回归分析显示，影响香河农村高血压知晓率和治疗率的主要因素是年龄、体重指数、家族史及文化程度，影响达标率的主要因素是年龄、家族史及饮酒。结论：在本调查人群中，高血压患病率高，知晓率、治疗率、达标率低，提示我国农村地区高血压防控水平亟待提高。第二部分农村居民心血管疾病及危险因素流行病学调查目的：调查河北省香河农村人群心血管疾病及其危险因素流行情况，并分析该人群未来10年缺血性心血管病（ICVD）发生风险。方法：应用横断面调查方法，于2012.8-2012.10对河北省香河县2532例受检者行问卷调查，口服75g葡萄糖耐量试验，血脂检测，测量身高、体重、血压、腰围。对其中35-59岁人群采用“国人缺血性心血管病10年发病危险度评估表”评估10年缺血性心血管病（ICVD）发生风险。结果：共获得2532例有效调查资料（≥35岁），其中女性1524人，男性1008人。本研究人群脑卒中、冠心病患病率分别为2.2%、6.9%，按2002年全国35岁以上农村人口年龄构成比标化后的患病率分别为1.3%和5.9%。心血管疾病危险因素如高血压、糖尿病、血脂异常、超重、肥胖、中心性肥胖的患病率分别为59.9%、26.9%、68.6%、40.9%、14.8%、49.5%，标化后的患病率分别为43.8%，19.9%，56.5%，35.1%，15.6%，41.9%。此外，男性吸烟率高达41.4%。研究人群中35-59岁者共1336例，采用“国人缺血性心血管病10年发病危险度评估表”分析显示，该部分人群10年缺血性心血管病（ICVD）危险度≥10%的检出率为14.1%。结论：本研究人群中心血管疾病及其危险因素患病率高，35-59岁人群10年缺血性心血管病（ICVD）发病风险大，提示应加强对心血管病危险因素（如糖尿病等）的早期检测及早期干预。第三部分EZSCAN在糖代谢异常筛查中的价值目的：评估EZSCAN用于中国人群血糖代谢异常（IGM）筛查中的价值。方法：本研究于2012.8-2012.10共纳入876例受试者。全部受试者均接受体格检查、生化检查及EZSCAN检测。其中体格检查包括身高、体重、血压、腰围；生化检查包括糖化血红蛋白（HbA1c）、空腹血糖（FPG）、口服葡萄糖耐量试验（OGTT）及血脂（甘油三酯TG，胆固醇TC，低密度脂蛋白LDL，高密度脂蛋白HDL）检测。按OGTT检测结果将受试者分为正常糖耐量组（NGT）、空腹血糖受损组（IFG）、糖耐量受损组（IGT）、新诊糖尿病组（NDM）。两组间均数比较采用t检验，率的比较采用卡方检验，非正态分布、方差不齐的两组资料间比较采用Mann-Whitney U检验。多组间均数比较采用方差分析，非正态分布、方差不齐的多组资料间比较采用Kruskal-Wallis检验。Pearson相关系数用于评价EZSCAN检测皮肤电导率（ESC）与血糖水平之间的相关性。ROC曲线用于评价EZSCAN的检测效能。Bland-Altman用于评价EZSCAN检测的重复性。结果：876名受试者中，53%受试者糖耐量正常（NGT），47%受试者血糖代谢异常（IGM）。NGT组受试者EZSCAN检测手、足皮肤电导率（ESC）分别为72±10μS和75±7μS，IGM组ESC偏低，分别为64±13μS和67±11μS，两组间的差异均有统计学意义（p<0.001，p<0.001）。NGT组受试者EZSCAN检测风险综合百分比为33±11%，明显低于IGM组（44±12%，p<0.001）。ROC曲线分析提示，EZSCAN检测出IGM的ROC曲线下面积（AUC）为0.794，当最佳诊断切点值为40%时，检测灵敏度为80%，特异度为72%。将IGM组再分为IGT+IFG组和新诊糖尿病组（NMD）后，两组受试者的EZSCAN检测风险综合百分比分别为43±13%和48±12%，两组间差异有统计学意义（P<0.001）。ROC曲线分析提示，EZSCAN检测IGT+IFG的ROC曲线下面积（AUC）为0.79，当最佳诊断切点为39%时，检测灵敏度和特异度分别为80%和73%；EZSCAN检测新诊糖尿病（NDM）的AUC为0.72，当最佳诊断切点为37%时，检测灵敏度为80%，特异度为57%。Pearson相关性分析提示，受试者手、足ESC均与2h-OGTT（r手=-0.282，r足=-0.354）和FPG（r手=-0.203，r足=-0.281）呈显著负相关（p<0.001）。Bland-Altman重复性检验提示，EZSCAN检测的变异系数为5.9%。将研究人群按性别分层后分析，结果提示EZSCAN检测不受性别差异影响。结论：EZSCAN检测血糖代谢异常（IGM）的灵敏度高，重复性良好，且不受性别影响，有望作为一项新型的用于发现血糖代谢异常（IGM）及糖尿病高危人群的筛查工具。本研究结果建议EZSCAN检测结果大于40%的人群需进一步行葡萄糖耐量试验（OGTT）以明确诊断。更多还原

【Abstract】 PART I PREVALENCE, AWARENESS, TREATMENT,CONTROL OF HYPERTENTION IN RURAL XIANGHEObjective: To investigate the prevalence, awareness, treatment,control and associated risk factors of hypertension in a rural population inXianghe.Methods: A total of830adults (aged>=35) from Xianghe wereexamined during2011.7-2011.8. Blood pressure was obtained using astandardized sphygmomanometer after a5-minute sitting rest. Informationon gender, age, education level, marital status, smoking, drinking, income,family history of hypertension and use of antihypertensive medications wasobtained.Results:42.4per cent of all subjects had hypertension. Amonghypertensives,54.8per cent were aware of their high blood pressure,50percent were taking antihypertension medication and11.9per cent achieved blood pressure control (<140/90mm Hg). Lower age and education level,smaller body mass index, negative family history of hypertension wereassociated with poor awareness of hypertension and worse compliance withtreatments. Older age, positive family history and alcohol consumptionwere associated with poor blood pressure control.Conclusions: Hypertension is highly prevalent in Xianghe rural area.The percentages of those with hypertension who are aware, treated, andcontrolled are low. These results underscore an urgent need forcomprehensive strategies to improve prevention, detection, and treatmentof hypertension in rural China. PART II PREVALENCE OF CARDIOVASCULAR DISEASEAND ITS RISK FACTORS IN RURAL XIANGHEObjective: To investigate the prevalence of cardiovascular disease(CVD) and its risk factors, and evaluate10-year risk of ischemiccardiovascular disease (ICVD) among a rural population in XiangHe.Methods: A cross-sectional design was used in this study. During2012.8-2012.10,2532adults (>=35) were surveyed by face-to-faceinterview, physical examination and biochemical test(2h-OGTT and bloodlipid test). Subjects aged35to59were evaluated using the National10-year Risk Assessment for ICVD.Results: The prevalence of stroke and coronary heart disease was2.2%and6.9%respectively, the age-and sex-standardized was1.3%and5.9%respectively. The prevalence of hypertension, diabetes, dyslipidaemia,overweight, obese and central obesity was59.9%,26.9%,68.6%,40.9%,14.8%and49.5%respectively, the age-and sex-standardized was43.8%，19.9%，56.5%，35.1%，15.6%，41.9%respectively. Up to41.4%malerespondents smoke. There are1336subjects aged35-59,14.1%respondents’(aged35to59)10-year ICVD risk was higher than10%.Conclusions: CVD and its risk factors were highly prevalent inXianghe, and10-year risk of ICVD was high in respondents aged35-59. Strategies for early detection and intervention are urgent needed toattenuate the CVD risk factors (such as diabetes) in rural China. PART III VALIDATION OF EZSCAN AS A SCREENINGTOOL FOR ABNORMAL GLUCOSE METABOLISMObjective: To evaluate the performance of EZSCAN as a screeningtool for impaired glucose metabolism (IGM), including impaired glucosetolerance, impaired fasting glucose and undiagnosed diabetes in a Chinesepopulation.Methords:876subjects participated in the study during2012.8-2012.10. All subjects underwent tests of EZSCAN, glycatedhemoglobin, fasting plasma glucose (FPG), and oral glucose tolerance test(OGTT). T test, chi-square test and Mann-Whitney U were used tocompare mean values. Correlation between electrical skin conductance(ESC) and glucose level was evaluated by Pearson correlation coefficient.EZSCAN performance was assessed by receiver operating characteristiccurve. Bland-Altman was used to evaluate the reproducibility of EZSCANtest.Results: Among the876subjects,53%had normal glucose tolerance(NGT), and47%had IGM. The ESC for the hands and feet was72±10μSand75±7μS, respectively, in NGT group; and64±13μS and67±11μS,respectively, in IGM group. The ESC at hands and feet was significantlycorrelated with both2h-OGTT and FPG (p<0.001). NGT groupdemonstrated a EZSCAN score of33±11%, which is significantly lower than that of IGM group (44±12%, p<0.001). The cut-off point of EZSCANfor IGM detection was40%with a sensitivity of80%and a specificity of72%. The coefficient of variation of EZSCAN for detection of IGM was5.9%. The result of EZSCAN test is not affected by gender difference.Conclusions: EZSCAN is a useful screening tool for identifyingsubjects at increasing risk for impaired glucose metabolism in prediabetesand diabetes. Diagnostic laboratory test should be performed in subjectswith EZSCAN scores greater than40%.更多还原