【作者】 崔兰；

【导师】 孙东植；

【作者基本信息】 延边大学 ， 病理学与病理生理学， 2008， 博士

【摘要】 目的:分析延边地区成人胰岛素抵抗与多代谢异常的相关性。方法:①于2005年8月至2006年8月在延边朝鲜族自治州安图县内采用简单随机抽取的方法抽取1235名常住居民进行调查。选择研究对象时,排除患有严重的代谢异常性疾病和其他器质性疾病的人群:被纳入的研究对象均对调查内容知情同意。②在被选社区及其卫生院,采用家访的方法和健康体检的形式收集本次调查的相关信息。③调查前对所有调查人员严格培训,规范调查内容、操作流程和方法,并按统一的调查表(内容包括研究对象的一般情况、心脑血管疾病的既往史及家族史等)进行家访询问调查。④测量身高、体重、腰围、臀围、血压等。⑤取清晨空腹(禁食12h)静脉血,测量胰岛素、血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、血糖等指标。用放射免疫法检测空腹胰岛素(FIns),采用稳态模式评估法(Homeostasismodel assessment,HOMA)估测人体胰岛素抵抗(IR)。血脂及血糖指标均用全自动生化分析仪测定。⑥计量资料行ANOVA检验,计数资料的比较采用x~2检验。胰岛素抵抗与代谢相关指标相关性采用简单相关分析和偏相关分析。胰岛素抵抗影响因素的分析采用多因素回归分析,以HOMA-IR为因变量,以高血糖、高血压、血脂异常、整体型肥胖及腹型肥胖为自变量进行Logistic回归分析,BACKWARD法选择变量,以α=0.05为入选变量的显著性水准,α=0.01为删除变量的显著性水准。结果:进入本次结果分析的总例数为1235名,其中男性为450名,占36.4%,平均年龄50.7岁;女性为785名,占63.6%,平均年龄50.1岁。①收缩压(SBP)、舒张压(DBP)、总胆固醇(TC)、甘油三酯(TG)、体质指数(BMI)、腰围身高比值(WHtR)、空腹血糖(FBG)的平均水平均呈逐渐升高趋势(P＜0.01),而空腹胰岛素(FINS)和胰岛素抵抗指数(HOMA-IR)的年龄别差异均无统计学意义。②本研究人群中,有胰岛素抵抗、高血糖、高血压、血脂异常、整体型肥胖及腹型肥胖者的比例分别为25.0%、14.4%、37.5%、23.8%、34.5%及61.3%。③调整民族、性别及年龄因素的影响后,SBP、DBP、TC、TG、BMI、WHtR、FBG、FINS的均值随着IR水平增高而上升(P＜0.01)。高血压、血脂异常、高血糖、整体型肥胖及腹型肥胖患者所占百分比随着IR水平增高而上升(P＜0.01)。胰岛素抵抗者伴发高血压、血脂异常、高血糖、整体型肥胖及腹型肥胖的频率分别为49.5%、32.4%、30.4%、68.0%及82.5%。具有2种以上代谢异常者比例随着胰岛素抵抗水平增高而上升,具有2种、3种及4种代谢异常者比例也随着胰岛素抵抗水平增高而上升(P＜0.01)。④简单相关分析及调整民族、性别及年龄因素的影响后的结果均显示,SBP、DBP、TC、TG、BMI、WHtR、FBG、FINS与IR均相关(P＜0.01)。调整民族、性别、年龄及BMI因素的影响后,差异仍有统计学意义的有TC、TG、BMI、WHtR、FBG、FINS。⑤1种代谢异常者的18.8%伴发胰岛素抵抗,2种代谢异常者的32.7%伴胰岛素抵抗,3种代谢异常者的42.6%伴胰岛素抵抗,4种代谢异常者的68.2%伴胰岛素抵抗。本研究人群中,仅有1种代谢异常者中高血糖、肥胖、高血压及血脂异常伴发胰岛素抵抗分别为43.8%,22.3%,7.7%及2.6%。有2种代谢异常者中高血糖+肥胖,高血糖+高血压,肥胖+高血压,肥胖+血脂异常,高血糖+血脂异常,高血压+血脂异常组合伴发胰岛素抵抗分别为52.1%,45.5%,31.7%,28.4%,22.2%及14.3%。有3种代谢异常者中高血糖+肥胖+血脂异常,高血糖+肥胖+高血压,肥胖+高血压+血脂异常,高血糖+高血压+血脂异常组合伴发胰岛素抵抗分别为61.1%,48.8%,37.5%及33.3%。有4种代谢异常者中68.2%伴胰岛素抵抗。⑥多因素分析结果表明,IR与高血糖、高血压、血脂异常、整体型肥胖及腹型肥胖均有密切的关系。结论:1)本地区一般人群中胰岛素抵抗和常见的代谢异常病患病水平较高。2)胰岛素抵抗者伴发常见代谢异常病的现状普遍存在,具有2种以上代谢异常者比例随着胰岛素抵抗水平增高而上升。3)胰岛素抵抗的发生频率随代谢异常组合成分的增加而显著升高,不同代谢异常及其不同组合成分伴发胰岛素抵抗的频率有差异。4)胰岛素抵抗与高血糖、高血压、血脂异常、整体型肥胖及腹型肥胖均有密切的关系。更多还原

【Abstract】 Objective:To analyze the relationship between adult insulin resistance(IR) and multiple metabolic disorders in Yanbian Korean Autonomous Prefecture area.Methods:①Using a simple random sampling method,1,235 permanent residents selected in the Antu County of Yanbian were carried out an investigation from August 2005 to August 2006.All of subjects was selected after eliminating the cases suffered from serious abnormal metabolic disorders and the other organic diseases and knew the informed consent.②Using the home visit and health examination,the relevant informations for this study were collected in the selected communities and health centeres.③The investigators were trained, and it was standardized that the survey contents,operational procedures and methods,and the home visit and inquiries were performed in accordance with unified questionnaire (including the general information,past history and family history of cardiocerebral vascular diseases,etc.).④It was measured that the height,weight,waist circumference,hip circumference and blood pressure,etc.⑤The fasting vein blood(fasting for 12 h) was taken in early morning,and it was measured that the insulin,serum total cholesterol(TC), triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),blood glucose and other indexes.The fasting insulin(FIns) was detected by radioimmunoassay,and human IR was estimated by the homeostasis model assessment method(Homeostasis model assessment, HOMA),and blood lipids and blood glucose were measured by automatic biochemical analyzer.⑥The measurement data were examined by ANOVA test;the numeration data were compared with the Chi square test:the correlation between IR and metabolism relative index was analyzed by a simple correlation analysis and partial correlation analysis;the IR influencing factors were analyzed by the multi-regression analysis;HOMA-IR as the dependent variable and hyperglycemia,hypertension,dyslipidemia,overall obesity and abdominal obesity as independent variable were analyzed by the Logistic regression analysis; the variables were selected by BACKWARD,selected variables were significant level asα= 0.05 and deleted variables were’significant level asα=0.01.Results:Out of 1,235 cases,male was 450(36.4%) and avarage age was 50.7 years, female was 785(63.6%) and avarage age was 50.1 years.①The average level of systolic blood pressure(SBP),diastolic blood pressure(DBP),TC,TG,body mass index(BMI), waist height ratio(WHtR),fasting blood glucose(FBG) were progressively higher with the increases of age(P＜0.01),and the ages in FIns and HOMA-IR were not statistically significant.②In this study population,the proportion of IR,hyperglycemia,hypertension, dyslipidemia,overall obesity and abdominal obesity was 25.0%,14.4%,37.5%,23.8%, 34.5%and 61.3%,respectively.③After adjusting the influencing factors for ethnicity, gender and age,the mean value of SBP,DBP,TC,TG,BMI,WHtR,FBG and FIns increased along with the.increase of IR level(P＜0.01).The prevalence rates of hypertension, dyslipidemia,hyperglycemia,overall obesity and abdominal obesity increased along with the increase of IR level(P＜0.01).The frequency of IR patients with hypertension,dyslipidemia, hyperglycemia,overall obesity and abdominal obesity was 49.5%,32.4%,30.4%,68.0%and 82.5%,respectively.The proportion of patients suffered from two or over two kinds of abnormal metabolism increased along with the increase of IR level(P＜0.01).④After simple correlation analysis and adjusting influencing factors for ethnicity,gender and age,the SBP, DBP,TC,TG,BMI,WHtR,FBG and FIns was all correlated with IR(P＜0.01).After adjusting the influencing factors for ethnicity,gender,age and BMI,there were still significant differences in the TC,TG,WHtR,FBG and FIns.⑤It was accompanied IR that 18.8%of patients with one kind of abnormal metabolism,32.7%with two kinds of abnormal metabolism with IR,42.6%with three kinds of abnormal metabolism and 68.2%with four kinds of abnormal metabolism,respectively.In this study population,patients with only one kind of metabolic disorder of hyperglycemia,obesity,hypertension and dyslipidemia accompanied with IR were 43.8%,22.3%,7.7%and 2.6%,and one with two kinds of metabolic disorders of hyperglycemia and obesity,hyperglycemia and hypertension,obesity and hypertension,obesity and dyslipidemia,hyperglycemia and dyslipidemia,hypertension and dyslipidemia accompanied with IR were 52.1%,45.5%,31.7%,28.4%,22.2%and 14.3%,and one with three kinds of metabolic disorders of hyperglycemia,obesity and dyslipidemia,hyperglycemia,obesity and hypertension,obesity,hypertension and dyslipidemia,hyperglycemia,hypertension and dyslipidemia accompanied with IR were 61.1%,48.8%,37.5%and 33.3%,respectively,and 68.2%of cases with four kinds of metabolic disorders accompanied with IR.⑥The results of multifactor analysis showed that IR was closely related with hyperglycemia,hypertension,dyslipidemia,overall obesity and abdominal obesity.Conclusion:①The prevalence of IR and common metabolic disorders in the general population is relatively high in Yanbian area;②The insulin resisters with common dysbolism are ubiquity,and the proportion of population with over two kinds of dysbolism increases along with the increase of IR level;③The frequency of IR increases significantly along with increase of dysbolism composition,and of different metabolic disorders and its different compositions with IR is different;④IR is clo(?)ely related with hyperglycemia, hypertension,dyslipidemia,overall obesity and abdominal obesity.更多还原