【作者】 张明芝；

【导师】 张永红；

【作者基本信息】 苏州大学 ， 卫生毒理学， 2010， 博士

【摘要】 研究目的:了解内蒙古通辽市农牧区蒙古族人群代谢综合征(MS)的流行状况;探讨MS的危险因素及MS与炎症和内皮功能标志物的关联性;探讨MS以及炎症和内皮功能标志物与心脑血管事件的关联性,为MS和心脑血管疾病的防治提供依据。研究方法:横断面研究:于2002-2003年,选择内蒙古通辽市科左后旗朝鲁吐乡和奈曼旗固日班花乡的32个村作为研究现场,现场内所有20岁以上者均作为研究对象,采用面对面调查方法,收集人口统计学以及生活方式资料,测量血压和人体测量指标。采集血标本,并检测血糖、血脂、C反应蛋白(CRP)、细胞间黏附分子-1(ICAM-1)、E选择素(E-selectin)、胰岛素(Ins)、血浆肾素活性(PRA)和血管紧张素II(Ang II)等指标。随访研究:于2008年和2009年两次对基线调查的人群进行入户随访,收集基线以来的心脑血管事件的发生情况,包括发生的时间、诊断情况及治疗情况。统计分析:描述蒙古族人群MS的患病情况和分布特征;比较MS组和非MS组危险因素的暴露水平。用两分类反应变量的Logistic回归模型分析各危险因素与MS的关联性,计算比值比(OR)及其95%可信区间(CI)。将标志物CRP、ICAM-1和E-selectin按四分位数划分为四个组,用Logistic回归模型分析不同标志物水平与MS的关联性,计算OR及95%CI。以各标志物的各四分位组的中位数和OR值为连续变量,用线性回归模型分析各标志物与其对MS危险性的线性趋势。用累积发病率和发病密度描述心脑血管事件的发生情况;用COX比例风险模型分析MS、CRP、ICAM-1和E-selectin对各心脑血管事件的关联性,计算相对危险度(RR)和95% CI。所有统计分析用SPSS15.0和SAS9.01软件完成,检验水准α=0.05。研究结果:1、研究人群的MS的患病率为20.9%(IDF),其中男性为12.8%,女性为26.6%。2、单因素分析结果显示,年龄、性别(女性)、高血压家族史、高载脂蛋白b、高Ins、PRA异常、高CRP、高ICAM-1、高E-selectin与MS相关联;吸烟和饮酒与MS负相关。多因素分析结果显示,年龄、性别、高CRP、高Ins、PRA异常是MS的危险因素,其OR值(95%CI)分别为1.21(1.07,1.38)、2.39(1.68,3.42)、2.76(2.08,3.66)、1.38(1.04,1.84)、1.35(1.04,1.75),均有P<0.05。吸烟与MS呈负的关联关系,其OR为0.74(0.55,0.99),P<0.05。3、MS组的CRP、E-selection和ICAM-1的水平显著高于非MS组,均有P<0.05。与最低的CRP水平者相比,经多变量调整后,处于较高CRP水平者(第3和4分位组)对MS的OR(95%CI)分别为1.64(1.00,2.44)和4.36(2.97,6.42),呈剂量反应关系。与最低ICAM-1水平者相比,处于较高ICAM-1水平者(第2、3和4分位组)对MS的OR(95%CI)分别为1.45(1.00,2.10)、1.57(1.09,2.26)和1.72(1.19,2.48),呈显著的剂量反应关系。4、研究人群随访期间心脑血管疾病累积发病率为3.01%,发病密度为476.9/10万人年;缺血性脑卒中发病率为1.58%,发病密度为250.8/10万人年;出血性脑卒中累积发病率为1.35%,发病密度为213.4/10万人年;冠心病累积发病率为1.31%,发病密度为207.9/10万人年。5、经多因素调整,MS人群发生心脑血管事件的相对危险度RR值(95%CI)为1.34(0.86,2.08);MS对缺血性脑卒中RR值为2.44(1.21,4.90)。结论:1、农牧区蒙古族人群具有较高的MS患病率和心脑血管疾病的发病率,MS和心脑血管疾病已成为影响当地蒙古族居民健康的重要公共卫生问题;2、高CRP和ICAM-1水平可增加MS危险性,提示炎症和内皮功能异常可能在多代谢异常的发生和发展过程中发挥了重要作用;3、MS是蒙古族人群心脑血管疾病(尤其是缺血性脑卒中)的重要危险因素。更多还原

【Abstract】 Objective: To understand the prevalence and distribution characteristics of Metabolic Syndrome (MS) among Mongolian population in rural and animal husbandry Area, Tongliao city, Inner Mongolia; to explore risk factors of MS and association of MS with inflammatory and endothelial biomarkers; to analyze the association between MS, inflammatory and endothelial biomarkers and cardio-cerebrovascular events to provide a basis for prevention and control for MS and cardio-cerebrovascular disease .Study Methods: A cross sectional study was carried out during 2002-2003. 32 villages of Kezuohou and Naiman banners (counties) were selected as study fields, and all Mongolian people aged 20 or more were served as subjects. Demographic data and lifestyle factors were investigated, anthropometric parameters and blood pressure were measured and blood sample was collected for all subjects. Fasting plasma glucose (FPG) ,blood lipids, CRP、ICAM-1,E-selectin, insulin, plasma rennin activity (PRA), angiotensin II (Ang II) were examined for all subjects. In 2008 and 2009, a follow-up study was conducted for all subjects to collect the data about incidence of cardio-cerebrovascular diseases.Statistics analysis: Prevalence and distribution characteristics of MS was described among Mongolian population, and levels of risk factors were compared between subjects with MS and without MS. Association of MS with risk factors was analyzed with Logistic regression, and odds ratios (OR) and 95% confident interval (95%CI) were calculated. Levels of CRP、ICAM-1 and E-selectin were grouped according to quartiles, respectively, ORs and 95% CIs of MS associated with CRP、ICAM-1 and E-selectin were calculated using Logistic regression, and trends of OR with level of the biomarkers were analyzed with linear regression model. Accumulative incidence and incidence density for cardio-cerebrovascular diseases were calculated for the Mongolian population; Association of MS, biomarkers including CRP、ICAM-1 and E-selectin with cardio-cerebrovascular diseases were analyzed with Cox regression model, OR and 95%CI were calculated. All analyses were conducted with SAS 9.01 and SPSS 15.0.Results:1. Prevalence of MS was 20.9% among the Mongolian people, and 12.8% for males and 26.6% for females.2. Un-multivariate adjusted results showed that age, gender, family history of hypertension, Apo-b, high Ins, abnormal PRA, high CRP, high ICAM-1, high E-selectin were all associated with MS (all P<0.05). Multivariate adjusted results showed that age, gender, high CRP, high Ins and abnormal PRA were associated with MS, OR(95%CI) of MS associated with age, gender, high CRP, high Ins and abnormal PRA were 1.21 (1.07, 1.38)、2.39(1.68, 3.42)、2.76(2.08, 3.66)、1.38(1.04, 1.84) and 1.35(1.04, 1.75),respectively, all P<0.05.3. Levels of CRP, E-selectin and ICAM-1 were all higher in MS group than that in non-MS group, all P<0.05. Compared with lowest CRP, the ORs(95%CIs) of MS associated with higher CRP (3 and 4 quartiles ) were 1.64 (1.00, 2.44) and 4.36 (2.97, 6.42), respectively, there was a dose–response relationship between CRP and MS. Compared with lowest ICAM-1 , the ORs (95%CIs) of MS associated with higher ICAM-1 levels ( 2, 3 and 4 quartiles ) were 1.45 (1.00, 2.10), 1.57(1.09, 2.26) and 1.72 (1.19,2.48) , respectively, there was also a dose–response relationship between ICAM-1 levels and MS.4. Cumulative incidence (CI) and incidence density (ID) of cardio-cerebrovascular disease was 3.01% and 476.9 /100, 000 (person-years), respectively; CI and ID of Ischemic stroke was 1.58% and 250.8/100, 000 (person-years), respectively; CI and ID of hemorrhagic stroke was 1.35%, and 213.4 /100, 000 (person-years), respectively; CI and ID of coronary heart disease was 1.31%, and 207.9 /100, 000 (person-years), respectively.5. Multivariate adjusted results showed that RR (95 % CI ) of cardio- cerebrovascular events was 1.34 (0.86, 2.08) among the Mongolian population; RR (95 %CI) of Ischemic stroke was 2.44(1.21, 4.90)among the Mongolian population, P<0.05.Conclusions:1. There was higher prevalence for MS and higher incidence of cardio-cerebrovascular diseases among the Mongolian population in rural and animal husbandry area, MS and cardio-cerebrovascular diseases have been important public health issue in local area.2. Elevated CRP and ICAM-1 increase the risk of MS; those findings suggest that inflammation and endothelium dysfunction could play important role in development of MS.3. MS was an important risk factor of cardio-cerebrovascular diseases, especially ischemic stroke among Mongolian population.更多还原