【作者】 谢朝晖；

【导师】 黄建始； 朱广瑾；

【作者基本信息】 中国协和医科大学 ， 流行病学与卫生统计学， 2008， 博士

【摘要】 目的一、描述中国四省(区)心血管病危险因素边缘增高(正常高值血压、脉压增宽、超重、空腹血糖受损、总胆固醇边缘升高、甘油三脂边缘升高、高密度脂蛋白-胆固醇减低、低密度脂蛋白-胆固醇边缘升高)人群的分布特点。二、探讨中国四省(区)心血管病危险因素边缘增高人群与正常人群其他心血管病危险因素的分布差异。三、探索中国四省(区)成人人群心血管病危险因素边缘增高的相关因素。方法一、本研究采用流行病学横断面研究方法,对2001～2004年中国河北省、浙江省、广西壮族自治区(三省区)18～74岁汉族人群和2007年四川省阿坝藏族羌族自治州松潘县(四川松潘县)18～74岁藏族人群总共13,819人健康体检的数据进行了分析。二、本研究应用t检验对两样本均数进行比较,两个以上样本均数的比较采用单因素方差分析,两样本或多样本率的比较采用χ~2检验。采用多变量线性回归和logistic回归探索中国四省(区)18～74岁人群心血管病危险因素边缘增高的相关因素。结果一、三省(区)成人人群心血管病危险因素边缘增高的分布特点正常高值血压发生率为43.5%。正常高值收缩压发生率为14.4%;正常高值舒张压发生率为33.2%。脉压增宽率为6.7%;超重率为24.2%。空腹血糖受损率为1.9%。总胆固醇边缘升高率为15.0%。甘油三酯边缘升高率为7.5%。高密度脂蛋白-胆固醇减低率为18.5%。低密度脂蛋白-胆固醇边缘升高率为9.5%。二、四川省松潘县成人人群心血管病危险因素边缘增高的分布特点正常高值血压发生率为33.4%。正常高值收缩压发生率为31.0%;正常高值舒张压发生率为19.6%;脉压增宽率为14.7%。超重率为33.4%。空腹血糖受损率4.8%。总胆固醇边缘升高率为17.4%。甘油三酯边缘升高率为7.9%。高密度脂蛋白-胆固醇减低率为12.1%。低密度脂蛋白-胆固醇边缘升高率为7.7%。三、三省(区)心血管病危险因素边缘增高人群与正常人群其他心血管病危险因素的分布差异(一)正常高值血压与TC、TG、LDL-C、BMI、WC和FPG的均值以及TC边缘升高率、LDL-C边缘升高率、超重率、IFG率相关;正常高值血压与HDL-C均值、TG边缘升高率和HDL-C减低率无关。(二)脉压增宽与年龄、体重、BMI、WC、TG、FPG均值相关;而SBP和DBP平均水平在脉压60～组最高。HR和TC平均水平并不随脉压增加而改变。(三)超重与年龄、SBP、DBP、PP、TC、TG、WC和HDL-C均值以及血压高值、IFG率、TC边缘升高率、LDL-C边缘升高率、HDL-C减低率相关;TG边缘升高率,超重组最高,肥胖组次之,正常组最低。超重与FPG和LDL-C均值无关。(四)空腹血糖受损与年龄、TC、TG、腰围均值以及血压高值率、低HDL-C率相关;TG、BMI在空腹血糖6.1～组平均水平最高;其它危险因素与空腹血糖无关。(五)TC边缘升高与年龄、收缩压、舒张压、脉压、TG、HDL-C、LDL-C、BMI、腰围平均水平以及高TG率、低HDL-C率、超重率正相关;FPG平均水平以及血压高值率、高LDL-C率在TC边缘升高组最高;TC边缘升高与空腹血糖受损率无关。(六)TG边缘升高与年龄、TC、LDL-C平均水平以及高TC率、高LDL-C率、超重率相关;HDL-C平均水平在甘油三酯正常组最高;舒张压、LDL-C、BMI、WC平均水平以及低HDL-C率在TG边缘升高率最高;TG边缘升高与空腹血糖受损率无关。(七)HDL-C的减低与TG、BMI、FPG、WC平均水平以及IFG率、TG边缘升高率和超重率相关;HDL-C的减低与收缩压、脉压、LDL-C平均水平以及血压高值率无关。(八)LDL-C边缘升高与年龄、SBP、DBP、PP、FPG、TC、TG、HDL-C、BMI、WC的平均水平以及TG边缘升高率、超重率相关;血压高值率和TC边缘升高率均在LDL-C边缘升高组最高(P＜0.001)、低HDL-C率在LDL-C升高组最低(P＜0.001)。LDL-C边缘升高与空腹血糖受损率无关。四、四川省松潘县心血管病危险因素边缘增高人群与正常人群其他心血管病危险因素的分布差异(一)正常高值血压与TC、TG、HDL-C、LDL-C、BMI、WC和FPG的均值以及TC边缘升高率、TG边缘升高率、LDL-C边缘升高率、超重率和吸烟率相关,正常高值血压与HDL-C减低率无关。(二)脉压增宽与年龄、WC、SBP、TC、TG、FPG的均值相关,而脉压在＜40组心率最高,＞60组最低;脉压在＞60组舒张压平均水平最高,51～60组次之,41～50组最低;体重和BMI并不随脉压增加而改变。(三)超重与年龄、SBP、DBP、PP、FPG、TC、TG、LDL-C和WC均值以及血压高值率、LDL-C边缘升高率、HDL-C减低率相关;TC边缘升高率超重组最高,肥胖组次之,正常组最低。超重与LDL-C均值和TG边缘升高率无关。(四)空腹血糖受损与年龄、DBP、TC、TG、LDL-C、BMI、腰围平均水平以及血压高值率、TC边缘升高率、LDL-C边缘升高率、超重率相关;在空腹血糖受损6.1～组SBP平均水平最高(P＜0.05);在空腹血糖受损6.1～组HDL-C平均水平最低;在空腹血糖受损6.1～组HDL-C减低率最高(P＜0.05);脉压、HDL-C平均水平以及TG边缘升高率与空腹血糖受损无关。(五)TC边缘升高与年龄、收缩压、舒张压、FPG、TG、LDL-C、BMI、腰围平均水平以及血压高值率、空腹血糖受损率、高LDL-C率、超重率相关;脉压和HDL-C平均水平在总胆固醇边缘升高组最高(P＜0.001);TC边缘升高与TG边缘升高率和HDL-C减低率无关。(六)TG边缘升高与SBP、DBP、FPG、BMI、WC平均水平以及血压高值率、空腹血糖受损率、低HDL-C率、超重率相关;TC、LDL-C平均水平以及TC边缘升高率、高LDL-C率在甘油三酯边缘升高组最高;HDL-C在甘油三酯升高组最低(P＜0.001);TG边缘升高与年龄和脉压的平均水平无关。(七)HDL-C边缘升高与年龄、收缩压、TC、TG和BMI的平均水平相关;脉压的平均水平和TC边缘升高率在HDL-C减低组比正常组高。超重率在HDL-C减低组比正常组低。HDL-C边缘升高与舒张压、空腹血糖、LDL-C的平均水平以及血压高值率和LDL-C边缘升高率无关。(八)LDL-C边缘升高与年龄、收缩压、舒张压、TC、TG、BMI、WC平均水平以及血压高值率、TC边缘升高率、超重率相关;脉压平均水平在LDL-C边缘升高组最高;LDL-C边缘升高与FPG、HDL-C平均水平及TG边缘升高率、低HDL-C率无关。五、中国三省(区)成人人群心血管病危险因素边缘增高的相关因素三省(区)成人人群心血管病危险因素边缘增高的相关因素有高龄、高体重、女性、干部职业、LDL-C边缘升高、TC边缘升高、饮酒、HDL-C减低、生活在农村、丧偶。具体评估结果如下:(一)高龄者、高体重者、吸烟者、女性、干部职业发生正常高值收缩压的危险性分别估计为1.090、1.079、2.567、0.227、0.166。(二)高龄者、高体重者、LDL-C边缘升高者发生高值舒张压的危险性分别为1.042、1.052、0.114。(三)高龄者发生的脉压增宽的危险性估计为1.066。(四)高龄者、TC边缘升高者、饮酒者、HDL-C减低者发生超重的危险性分别为1.033、3.031、0.541、0.460。(五)高龄者、生活在农村发生TC边缘升高危险性分别为1.055、0.586。(六)TC边缘升高发生TG边缘升高的危险性是5.31。(七)生活在农村、高体重者、丧偶者发生高密度脂蛋白-胆固醇减低的危险性分别为0.246、0.951、0.052。(八)HDL-C减低者发生低密度脂蛋白-胆固醇边缘升高的危险性为0.305。总之,下列因素对三省(区)成人心血管病危险因素边缘增高的关联较大如:吸烟与正常高值收缩压的关联;TC边缘升高与超重的关联;TC边缘升高与TG边缘升高的关联。六、四川省松潘县成人人群心血管病危险因素边缘增高的相关因素四川省松潘县成人人群心血管病危险因素边缘增高的相关因素有:高龄、女性、高中学历、大学学历、HDL-C减低、TC边缘升高、心率快、IFG、脉压增宽、农民、干部。具体评估结果如下:(一)高龄者、女性发生正常高值收缩压的危险性分别为1.03 1、0.404。(二)高龄者、高中学历者发生正常高值舒张压的危险性分别为1.037、4.192。(三)高龄者、HDL-C减低者、大学学历者发生的脉压增宽的危险性分别为1.053、2.690、0.075。(四)高龄者、TC边缘升高者、HDL-C减低者发生超重的危险性分别为1.030、4.936、2.298。(五)HDL-C减低者发生空腹血糖受损的危险性为5.837。(六)高龄者发生TC边缘升高危险性为1.038。(七)TC边缘升高人群发生TG边缘升高的危险性为4.62。(八)心率快者、IFG、脉压增宽、女性、农民、干部职业发生高密度脂蛋白-胆固醇减低的危险性分别为1.031、5.851、2.751、0.425、0.278、0.152。(九)高龄者、大学学历、脉压增宽者发生低密度脂蛋白-胆固醇边缘升高的危险性分别为1.046、2.535、2.371。总之,下列因素与四川松潘县成人人群心血管病危险因素边缘增高的关联较大如:高中学历与正常高值舒张压的关联;HDL-C减低与脉压增宽的关联;TC边缘升高、HDL-C减低与超重的关联;HDL-C减低与空腹血糖受损的关联;空腹血糖受损、脉压增宽与高密度脂蛋白-胆固醇减低的关联;大学学历、脉压增宽与LDL-C边缘升高的关联;TC边缘升高与TG边缘升高的关联。结论中国四省(区)成人人群心血管病危险因素边缘增高的相关因素是:生活在农村、农民、高龄、女性、高中、大学文化程度、干部、丧偶、吸烟、心率快、高体重、脉压增宽、TC边缘升高、HDL-C减低、LDL-C边缘升高、IFG。其中,高中学历、大学学历、吸烟、TC边缘升高、HDL-C减低、IFG、脉压增宽与心血管病危险因素边缘增高的关联较大。因此,建议对心血管病边缘增高人群进行相关因素干预,降低心血管病发生的危险。更多还原

【Abstract】 ObjectivesThe goal of this study is to describe the characteristics in the distribution of high-normal values of the risk factors in cardiovascular disease such as the high-normal BP,wider PP, over weight,IFG,high-normal TC,high-normal TG,low HDL-C and high-normal LDL-C and to delineate their relationship with regards to the other risk factors.of the cardiovascular diseases.Based on data collected from normal adults aged 18-74 years this study also makes sure the related factors and estimates the relation on high-normal BP,wider PP,over weight, IFG,high-normal TC,high-normal TG,low HDL-C and high-normal LDL-C in three provinces and one autonomous region of China.MethodsA cross-section study was carried out in three provinces and one autonomous region of China from 2001 to 2004 and 2007.The health examination data from 13,819 normal adults aged 18-74 years were analyzed.Two groups were compared by t tests.For over two groups one-way analysis of variance was used.and X~2 tests for two independent proportions. Multivariable analysis was performed with a linear regression and a logictic regression model.The risk prediction model was used to estimates the relation on high-normal blood pressure,wider PP,over weight,IFG,high-normal TC,high-normal TG,low HDL-C and high-normal LDL.ResultsThe characteristics in the distribution of high-normal values in three provinces (autonomous region)In Hebei,Zhejiang and Guangxi the distribution rate of the high-normal blood pressure, high-normal SBP,high-normal DBP,wider PP,over weight,IFG,high-normal TC, high-normal TG,low HDL-C and high-normal LDL were 43.5%,14.4%,33.2%,6.7%,24.2%, 1.9%,15.0%,7.5%,18.5%and 9.5%,respectively.The characteristics in the distribution of high-normal values in Songpan County In Songpan County the distribution rate of the high-normal blood pressure,high-normal SBP, high-normal DBP,wider PP,over weight,IFG,high-normal TC,high-normal TG,low HDL-C,high-normal LDL-C were 33.4%,31.0%,19.6%,14.7%,33.4%,4.8%,17.4%,7.9%, 12.1%and 7.7%,respectively.The relations to the other risk factors in cardiovascular disease in Hebei,Zhejiang and Guangxi High-normal blood pressure was statistically significantly related to the mean of TC,TG, LDL-C,BMI,WC,FPG and the prevalence of high-normal TC,high-normal LDL-C, overweight,IFG and smoking in cardiovascular disease(P＜0.05).No significant difference in the mean of HDL-C and the prevalence of high-normal TG and low HDL-C was found as compared to high-normal blood pressure(P＞0.05).There was signifiacnt difference in the mean of age,body weight,BMI,WC,TG and FPG in cardiovascular disease with wider PP(P＜0.05).The mean of SBP and DBP come to the first place in 60～group of wide PP(P＜0.05).The prevalence of HR and TC did not differ significantly with wide PP(P＞0.05).Overweight was significantly related to the mean of age,SBP,DBP,PP、TC、TG、WC and HDL-C and the prevalence of high-normal BP,IFG、high-normal TC,high-normal LDL-C and low HDL-C in cardiovascular disease(P＜0.05).High-normal TG rated in the first place in the overweight group,that of came to the next in the obesity group,and that of the third in the norm group(P＜0.05).No significant difference in the mean of FPG and LDL-C was found as compared to overweight(P＞0.05).The mean of age,TC,TG,WC and the prevalence of high-normal pressure,low HDL-C differed significantly from the norm with IFG(P＜0.05) except the other did not differ significantly(P＞0.05).The mean of TG and BMI was the highest in 6.1～group of FPG.There was significant difference in mean of age,SBP,DBP,PP,TG,HDL-C,LDL-C,BMI, WC,and the prevalence of high-normal TG,low HDL-C and overweight between high-normal TC from the norm(P＜0.05).The mean of FPG and the prevalence of high-normal pressure and high-normal LDL-C come to the first in high-normal TC group(P＜0.05).No significant difference in the prevalence of IFG was found with high-normal TC(P＞0.05). High-normal TG was significantly related to the mean of age,TC,LDL-C and the prevalence of high-normal TC,high-normal LDL-C and overweight in cardiovascular disease(P＜0.05). The mean of HDL-C was the highest in normal TG as well as the mean of DBP,LDL-C,BMI, WC and the prevalence of low HDL-C was the highest in high-normal TG group(P＜0.05).No significant difference in the prevalence IFG was found with high-normal TG(P＞0.05). Mean of TG,BMI,FPG,WC and the prevalence of IFG,high-normal TG,overweight was significantly higher in low HDL-C than that in norm(P＜0.05).No significant difference in the mean of SBP,PP,LDL-C and the prevalence of high-normal pressure was found with low HDL-C(P＞0.05).Those with high-normal LDL-C had more risk factors such as the mean of age,SBP,DBP,PP, FPG,TC,TG,HDL-C,BMI,WC and the prevalence of high-normal TG,overweight of CVD than those with normal LDL-C(P＜0.05).The prevalence of high-normal pressure and high-normal TC came to the first place in high-normal LDL-C group.Low HDL-C came to the last in higher LDL-C(P＜0.05).No significant difference in the prevalence of IFG with high-normal LDL-C(P＞0.05).The relations to the other risk factors in cardiovascular disease in Songpan County High-normal blood pressure was significantly related to the mean ofTC,TG,HDL-C,LDL-C, BMI,WC,FPG and the prevalence of high-normal TC,high-normal TG,high normal LDL-C, overweight,and smoking in cardiovascular disease(p＜0.05).No significant difference in the the prevalence of low HDL-C was found as compared to the high-normal pressure(P＞0.05).There was signifiacnt difference in mean of 6 cardiovascular risk factors of age,WC,SBP,TC, TG and FPG with wider PP(P＜0.05).The mean of HR was the highest in＜40 group as well as the lowest in＞60 group of PP.The mean of DBP came to the first place in＞60 group of PP, the second place in 51～60 group,the third place in 41～50 group of PP.The mean of body weight and BMI did not differ significantly with wide PP(P＞0.05).Those with overweight had more cardiovascular risk factors such as mean of age、SBP、DBP、PP、FPG、TC、TG、LDL-C,WC and the prevalence of high-normal pressure,high-normal LDL-C,low HDL-C of CVD than those with normal BMI.High-normal TC rated in the first place in the overweight group,that of came to the next in the obesity group,and that of the third in the norm group(P＜0.05).No significant difference in the mean of LDL-C and the prevalence of high-normal TG was found as compared to overweight(P＞0.05).The mean of age,DBP,TC,TG,LDL-C,BMI,WC and the prevalence of high-normal pressure,high-normal TC,high-normal LDL-C,overweight differed significantly from the norm with IFG(P＜0.05).Mean of SBP was the highest in 6.1～group while the mean of HDL-C was the lowest in 6.1～group of FPG.The prevalence of low HDL-C was the highest in 6.1～group of FPG.No significant difference in the mean of PP,HDL-C and the prevalence of high-normal TG was found as compared to IFG(P＞0.05).There was significant difference in the mean of age,SBP,DBP,FPG,TG,LDL-C,BMI,WC, and the prevalence of high-normal pressure,IFG,high-normal LDL-C and overweight between high-normal TC from the norm(P＜0.05).The mean of PP and HDL-C come to the first in high-normal TC group.No significant difference in the prevalence of low HDL-C and high-normal TG was found with high-normal TC(P＞0.05).High-normal TG was significantly related to the mean of SBP,DBP,FPG,BMI,WC and the prevalence of high-normal pressure,IFG,low HDL-C and overweight in cardiovascular disease.The mean of TC,LDL-C and the prevalence of high-normal TC and high-normal LDL-C was the highest in high-normal TG as well as the prevalence of HDL-C was the lowest in high-normal TG group(P＜0.05).No significant difference in mean of age and PP was found with high-normal TG(P＞0.05).The mean of age,SBP,TC,TG and BMI was significantly related with low HDL-C than that in norm(P＜0.05).The mean of PP and the prevalence of high-normal TC,overweight was significantly higher in low HDL-C than that in norm(P＜0.05).The prevalence of overweight was significantly lower in low HDL-C than that in norm(P＜0.05).No significant difference in the mean of DBP,FPG,LDL-C and the prevalence of high-normal pressure and high-norrnal LDL-C was found with high-normal HDL-C(P＞0.05).Those with high-normal LDL-C had more cardiovascular risk factors such as the mean of age, SBP,DBP,TC,TG,BMI,WC and the prevalence of high-normal pressure,high-normal TC, overweight of CVD than those with normal LDL-C.The mean of PP came to the first place in high-normal LDL-C group No significant difference in the mean of FPG,HDL-C and the prevalence of high-normal TG,low HDL-C with high-normal LDL-C(P＞0.05).Assessment with related factors on high-normal values in Hebei,Zhejiang and Guangxi The related factors on high-normal values in cardiovascular disease were higher age, overweight,female,cardre,high-normal LDL-C,high-normal TC,drinking,low HDL-C, lived in county,losing spouse.The detail was shown in the following:The odds ratio of high-normal SBP was 1.090,1.079,2.567,0.227,0.166 among those with higher age,overweight,smoking,female,cadre.The odds ratio of high-normal DBP was 1.042,1.052,0.114 among those with higher age, overweight,high-normal LDL-C.The odds ratio of wider PP was 1.066 among those with higher age.The odds ratio of overweight was 1.033,3.031,0.541,0.460 among those with higher age, high-normal TC,drinking,low HDL-C.The odds ratio of high-normal TC was 1.055,0.586 among those with higher age,lived in county..The odds ratio of high-normal TG was 5.31 among those with high-normal TC..The odds ratio of low HDL-C was 0.246、0.951、0.052 among those with lived in county, overweight,losing spouse..The odds ratio of high-normal LDL-C was 0.305 among those with high-normal HDL-C. In a word,the following related factors have more relation on the high-normal values in Hebei, Zhejiang and Guangxi such as smoking and High-normal TC.Assessment with related factors on high-normal values in Songpan CountyThe related factors on high-normal values in cardiovascular disease were higher age,female, senior high schoo,college culture level,low HDL-C,high-normal TC,fast heart rate,IFG, wider PP,farmer,cardre.The detail was shown in the following:The odds ratio of high-normal SBP was 1.031,0.404 among those with higher age,female.The odds ratio of high-normal DBP was 1.037,4.192 among those with higher age,senior school culture level.The odds ratio of wider PP was 1.053,2.690,0.075 among those with higher age,low HDL-C, college culture level.The odds ratio of overweight was 1.030,4.936,2.298 among those with higher age, high-normal TC,low HDL-C.The odds ratio of IFG was 5.837 among those with low HDL-C.The odds ratio of high-normal TC was 1.038 among those with higher age.The odds ratio of high-normal TG was 4.62 among those with high-normal TC.The oddsratiooflowHDL-Cwas 1.031、5.851、2.751、0.425、0.278、0.152 among those with higher HR,IFG,wider PP,female,farmer,cadre.The odds ratio of high-normal LDL-C was 1.046、2.535、2.371 among those with higher age, college culture level,wider PP.In a word,the following related factors have more relation on the high-normal values in Songpan county such as senior school or college culture level,low HDL-C,high-normal TC, IFG and wider PP.ConclusionsHigh-normal BP,overweight,IFG,high-normal TC,high-normal TG,high-normal LDL-C and low HDL-C have the following related factors such as town and county,age,sex,culture level,occupation,marriage,smoking,heart rate,weight,waistline,PP、TC、TG、HDL-C、LDL-C、FPG.Among them senior school or college culture level,smoking,high-normal TC, low-normal HDL-C,IFG and wider PP have more relation on the high-normal values of cardiovascular disease.This result suggests that the health intervention of related factors on adults with high-normal values should be done to reduce the risk of CVD at the early time.更多还原