【作者】 陈刚；

【导师】 王莉；

【作者基本信息】 遵义医学院 ， 肾病内科， 2010， 硕士

【摘要】 目的：调查四川地区(城市和农村)18岁以上人群代谢综合征的流行情况及相关危险因素,分析代谢综合征与慢性肾脏病之间的相关性。方法：在四川地区采用分层多次随机抽样方法,抽取成都市武侯区(代表城市地区),德阳市广汉(代表农村地区)18岁以上常住居民3300人,通过问卷调查包括人口学资料,慢性病史等；体格检查：身高、体重、腰围、臀围、血压和脉搏等；实验室检查：小便常规检查、尿肌酐和尿微量白蛋白,空腹静脉血检查血肌酐、血糖、血尿酸、胆固醇、甘油三酯、高密度脂蛋白和低密度脂蛋白等。采用国际糖尿病联盟(IDF)标准确定代谢综合征诊断,采用K/DOQI有关慢性肾脏病的诊断标准确定慢性肾脏疾病(ACR,血尿、及eGFR降低)。结果：在资料完善的3204名调查对象(应答率为91.6%),经年龄、性别标化后(人口学校正)代谢综合征的患病率为8.6%(95%CI:7.6～9.6%)。男女之间差异有统计学意义(男女分别为6.1%和13.8%,P<0.001),城市与农村之间差异无统计学意义(分别为9.9%和10.0%,P=0.971)。代谢综合征各代谢异常组份：中心性肥胖、血压升高、高甘油三酯(TG)、低高密度脂蛋白胆固醇(HDL-C)和高空腹血糖(FPG)的患病率分别为26.1%、28.5%、64.7%、43.0%和16.8%,标化后的患病率分别为22.4%、22.7%、64.5%、45.4%和13.4%。MS、血压升高、高FPG和中心性肥胖是随着年龄增加而升高,HDL随着年龄增加而下降。在18～49岁之间主要是血脂紊乱为主；50～59岁之间是以血脂紊乱、血压升高、血糖升高为主;60～95岁是以血压升高、血糖升高为主。经logistic多元回归分析提示肾病史、LDL-C、年龄、BMI和女性是代谢综合征的独立危险因素。在MS患病人群中,CKD有79例,患病率为26.2%,与非MS人群的CKD患病率(18.4%)之间差异有统计学意义(P=0.001);白蛋白尿有44例,患病率为14.6%,与非MS人群的CKD患病率(11.1%)之间差异无统计学意义(P=0.068)。在分析单个用于诊断MS的代谢异常组份与ACR增高的关系时：HDL-C降低、高FPG、血压升高、中心性肥胖均有统计学意义(P<0.05)(与无代谢异常组份相比较),OR值(95%CI)分别为0.647(0.511～0.818)、3.285(2.571～4.198)、2.892(2.303～3.633)、1.433(1.126～1.824),其中高FPG对于ACR增高影响最大(OR=3.285)；中心性肥胖+1个代谢异常组份、中心性肥胖+2个代谢异常组份、中心性肥胖+3个代谢异常组份和中心性肥胖+4个代谢异常组份均有统计学意义(P<0.05)(与无代谢异常组份相比较),OR值(95%CI)分别为：1.722(1.031～2.872)、3.075(1.944～4.864)、2.330(1.294～4.194)和2.884(1.78～7.827)。随着代谢异常组份的增加,ACR增加患病风险增加,当中心性肥胖+2个代谢异常组份患病风险最高(OR=3.075)。在分析单个用于诊断MS的代谢异常组份与CKD的关系时：HDL-C降低、高FPG、血压升高、中心性肥胖均有统计学意义(P<0.05),OR值(95%CI)分别为0.524(0.432～0.636)、3.499(2.838～4.312)、2.138(1.771～2.582)、1.502(1.234～1.828);其中高FPG对于CKD影响最大(OR=3.499)。中心性肥胖+1个代谢异常组份、中心性肥胖+2个代谢异常组份、中心性肥胖+3个代谢异常组份和中心性肥胖+4个代谢异常组份差异均有统计学意义(P<0.05),OR值(95%CI)分别为：1.737(1.105～2.731)、2.236(1.542～3.509)、2.093(1.263～3.466)和2.700(1.279～5.698)。随着代谢异常组份的增加,CKD患病风险明显增加,当中心性肥胖+4个代谢异常组份患病风险最高(OR=2.700)。经Logostic多元回归分析,结果提示：年龄、性别、HDL-C降低、高FPG、LDL-C和高尿酸是CKD的独立危险因素。结论：1.四川地区代谢综合征患病率为8.6%,女性高于男性,农村与城市无差异。MS随着年龄增加而升高,在18～49岁之间主要是血脂紊乱为主；50～59岁之间是以血脂紊乱、血压升高、血糖升高为主；60～95岁是以血压升高、血糖升高为主。肾病史、LDL-C、年龄、BMI和女性是代谢综合征的独立危险因素。2.代谢综合征患者CKD的患病率明显高于非代谢综合征人群,代谢综合征患者ACR增加的患病率与非代谢综合征人群无差异。中心性肥胖的基础上随着代谢异常的增多,ACR增加的患病率和CKD的患病率增加；年龄、女性、HDL-C降低、高FPG、LDL-C、血压升高和高尿酸是CKD的独立危险因素。更多还原

【Abstract】 Objective:To investigate the prevalence of metabolic syndrome and its related risk factors in adults (age≥18 years old) at the urban and rural areas in Sichuan Province, and to analyze the correlationship between metabolic syndrome and chronic kidney disease. Method:Stratified random sampling method was used to select 3300 permanent residents (age≥18 years old) in the Wuhou district in Chengdu city (the urban areas) and the Guanghan district in Deyang city (the rural areas). The risk factors for metabolic syndrome and chronic kidney disease are tested, including:①the medical examinations:height, weight, waist circumference, hip circumference, blood pressure and pulse rate;②the laboratory examination:urine routine examination, serum creatinine and fasting blood examination, blood sugar, uric acid, cholesterol, triglycerides, high density lipid protein and low-density lipoprotein) and questionnaire survey (demographic data, history of chronic diseases, etc.).Results:In the 3204 investigated adults, response rate was 91.6%after the normalization of the ages and sex(the school population normalization was adopted), The prevalence of metabolic syndrome is 8.6%(95% CI is 7.6%～9.6%). The difference between men and women has statistical significance (the prevalence of the men is 6.1% and the prevalence of the women is 13.8%, P<0.001). However, the difference between urban and rural areas has no statistical significance (the prevalence at the rural area is 10.0% and the prevalence at the urban area is 9.9%, P=0.971). For five components of metabolic syndrome diagnosis; central obesity, high blood pressure, high triglyceride (TG), low high-density lipoprotein cholesterol (HDL-C) and high prevalence rate of PFG, the prevalence’s are 26.1%,28.5% 64.7%,43.0% and 16.8% respectively. After normalization, the prevalence are 22.4%, 22.7%,64.5%,45.4% and 13.4% respectively. The MS, high blood pressure, high FPG, and central obesity increased with the increment of the age. HDL decreased with the increment of the age. From 18 to 49 years, the hyperlipemia is the mainly abnormality. From 50 to 59 years old, the hyperlipemia, the high blood pressure, and the high FPG are the mainly abnormality. From 60 to 95 years, the high blood pressure, the high FPG are the mainly abnormality. The logistic regression analysis shows that the renal history, the LDL-C, the age, the BMI and the gender (female) are the independented risk factors for metabolic syndrome. In the 3024 survey patients,579 have CKD and 2445 have not. The prevalence of CKD after the normalization of ages and genders(the school population normalization) is 16.5%. In the 3024 survey patients,346 have albuminuria and 2678 have not. The prevalence of the albuminuria after the normalization of ages and genders (the school population normalization) is 9.5%. In the MS patients,79 are CKD; and the prevalence rate is 26.2%. To be compared with the non-MS patients(the prevalence is 18.4%), the prevalence rate has statistical significance (P=0.001); In the MS patients,44 have white albuminuria and the prevalence rate is 14.6%. To be compared with non-MS patients(the prevalence of CKD is 11.1%), the prevalence rate has no statistical significance(P=0.068). The corelationship analyses between individual components of metabolic abnormalities and elevated ACR, low HDL-C, high FPG, high blood pressure, and central obesity have correlation(P<0.05). the values of OR(95%CI) are 0.647(0.511～0.818),3.285(2.571～4.198),2.892(2.303～3.633),1.433(1.126～1.824). The high-FPG was the greatest effective factor for the elevated ACR (OR=3.285). The central obesity+1 component, the central obesity+2 components, the central obesity+3 components and the central obesity +4 components have significant correlation with the elevated ACR (P<0.05). The factor OR values(95%CI) are 1.722(1.031～2.872),3.075(1.944～4.864),2.330(1.294～4.194)and 2.884(1.78～7.827) respectively. With the increase of metabolic components, the risk of elevated ACR increasing; It was the highest risk (OR=3.075) that the central obesity+2 composition for elevated ACR. The corelationship between individual components of metabolic abnormalities and CKD, low HDL-C, high FPG, high blood pressure, and central obesity have significant correlations(P<0.05). the OR values(95%CI) are0.524(0.432～0.636),3.499(2.838～4.312),2.138(1.771～2.582),1.502(1.234～1.828). The high-FPG is the greatest impact for the CKD (OR=3.499). The central obesity+1 component, the central obesity+2 components, the central obesity+3 components and the central obesity+4 components have significant correlations with the elevated ACR (P <0.05). The factor OR values(95%CI) are 1.737(1.105～2.731),2.236(1.542-3.509), 2.093(1.263～3.466)和2.700(1.279～5.698) respectively. With the increase of metabolic components, the risk of CKD increasing; The highest risk (OR=2.700) for CKD is the central obesity+4 composition. Multiple logistic regression analysis indicates that the age segmentation, the gender, the low HDL-C, the high FPG, the LDL-C, and the high uric acid are independent risk factors of CKD.Conclusions:1. In Sichuan province, the prevalence rate of metabolic syndrome is 8.6%; and the prevalence rate of the women is higher than that of the men, but no difference was found between the rural and the urban. The renal history, the LDL-C, the age section, the BMI segmentation and g the ender (female) are the independent risk factors of metabolic syndrome.2. In the metabolic syndrome, the prevalence of CKD is significantly higher than that of the non-metabolic syndrome; the metabolic syndrome prevalence may increase the ACR and non-metabolic syndrome has no difference. With the increase of the central obesity within the metabolic basis the prevalence of CKD and the ACR increases; and the MS metabolic syndrome group is lower HDL-C, higher FPG and blood pressure are independent risk CKD factors.更多还原