中国成人脂质蓄积指数与高血压、糖尿病及心血管疾病的关系
发布时间：2018-07-25 19:03
【摘要】：第一部分:北京市居民脂质蓄积指数与高血压、糖尿病患病关系的横断面研究背景研究者发现脂肪组织有复杂的功能,不同解剖区域的脂肪功能不同,一些特定区域的脂肪对人体是有益的,比如可以储存能量和缓冲压力,而另一些区域脂肪的过度蓄积可能会造成胰岛素抵抗、非酒精性脂肪性肝炎、代谢综合征等不良后果。为了评估出这种异常的可能带来不良结局的脂肪积累,研究人员设计了基于腰围和空腹甘油三酯的综合指标:脂质蓄积指数(lipid accumulation product,LAP)。本研究探讨北京地区居民脂质蓄积指数适用公式,并进一步评估LAP与高血压、糖尿病患病的关系。方法研究对象来自2011年“北京市心脑肾及糖尿病慢性病流行病学综合调查研究”,本研究共纳入19606名18～79岁北京市常住居民,其中男性8869人,女性10737人。通过对18～24岁人群的腰围进行分析,分别计算北京地区成年男性和女性的最小腰围,得到LAP适用公式。使用受试者工作特征曲线(receiver operating characteristic,ROC)比较LAP和BMI两个指标筛检高血压、糖尿病的价值。采用多因素logistic回归分析男性和女性不同LAP水平(三分位数分组)与高血压、糖尿病患病的关系;按照身体质量指数(body mass index,BMI)进行分组,以低水平LAP合并非超重组(BMI24.0kg/m2)为参照,计算男性和女性不同LAP和BMI组合下的高血压和糖尿病患病风险(odds ratio,OR)和95%置信区间(confidence interval,CI)。结果北京地区成人LAP适用公式为:LAP(男)=[腰围(cm)-61.3 cm]×TG(mmol/L),LAP(女)=[腰围(cm)-55.6cm]×TG(mmol/L)。LAP对于男性糖尿病、女性高血压和糖尿病患病情况的ROC曲线下面积(AUC)均0.59,并且均超过BMI的AUC,差异有统计学意义(P0.001)。男性和女性的高血压、糖尿病患病风险均随着LAP水平升高而增加(P趋势0.001),以LAP最低水平组为参照,LAP最高水平组的男性和女性高血压患病风险OR(95%CI)值分别为3.62(3.11,4.22)和5.79(4.84,6.93),其糖尿病患病风险分别为 3.47(2.73,4.41)和 4.10(2.90,5.80);LAP与BMI分组组合后,与低LAP水平和非超重组相比,高LAP水平合并高BMI水平的男性和女性的高血压和糖尿病患病风险更高;LAP最高水平合并肥胖组的男性和女性高血压患病风险最高,OR(95%CI)值分别为6.79(5.50,8.37)和9.75(7.76,12.25),其糖尿病患病风险较高OR(95%CI)值分别为3.97(2.87,5.49)和 4.13(2.78,6.14)。结论北京居民LAP与高血压和糖尿病患病密切相关,有待开展更深入的研究证实其对高血压、糖尿病发病风险的预测价值。第二部分:中国成人脂质蓄积指数与动脉粥样硬化性心血管病发病关系的前瞻性队列研究背景一些前瞻性队列研究发现高LAP水平增加糖尿病、脑卒中的发病风险,然而这些研究均使用Kahn提出的LAP计算公式,这个公式是基于美国人群的数据,并不一定适用其他人群。本研究旨在通过2000年中国健康与营养调查的数据,提出适用于我国成人的LAP公式,并通过前瞻性队列随访,探讨我国成人LAP水平与动脉粥样硬化性心血管病(atherosclerotic cardiovascular disease,ASCVD)发病风险的关系。方法本研究首先利用2000年中国健康与营养调查(China Health and Nutrition Survey,CHNS)的研究数据得出LAP计算公式。然后选取中国心血管病流行病学多中心协作研究(China Multicenter Collaborative Study of Cardiovascular Epidemiology,ChinaMUCA)和中国心血管健康多中心合作研究(International Collaborative Study of Cardiovascular Disease in Asia,InterAsia)的调查对象,该两项研究分别于1998年和2000-2001年开展基线调查,共纳入年龄在35～74岁之间的研究对象共27020人,于2007-2008年和2013～2015年开展两次随访调查。本研究最终分析纳入23227名研究对象,其中男性11112人,女性12115人。将研究对象分性别按照LAP四分位数分组,以LAP第一分位组为参照,使用Cox比例风险回归模型分析男性和女性不同LAP水平组的动脉粥样硬化性心血管病发病风险比。结果中国成人LAP 适用公式为:LAP(男)=[WC(cm)-59.1 cm]×TG(mmol/L),LAP(女)=[WC(cm)-56.4cm]×TG(mmol/L)。本研究队列平均随访 12.3 年,有1081例研究对象发生ASCVD,其中男性657人,女性424人。男性第一分位LAP水平组至第四分位LAP水平组动脉粥样硬化性心血管病发病率分别为3.74/1000人年、4.18/1000人年、5.71/1000人年和5.98/1000人年,女性分别为1.25/1000 人年、2.21/1000 人年、2.82/1000 人年和 5.12/1000 人年。以第一分位 LAP水平组为参照,经过调整协变量包括年龄、城乡、南北方、高中及以上教育水平、心血管病家族史、工作相关中-重度体力活动水平、吸烟、饮酒、空腹血糖和基线收缩压水平,男性人群第二分位、第三分位以及第四分位LAP水平组发生ASCVD的HR 值(95%CI)分别为 0.97(0.76,1.25)、1.17(0.92,1.49)和 1.10(0.85,1.41),线性趋势检验 P=0.407;女性分别为 1.42(0.98,2.06)、1.30(0.90,1.87)和 1.72(1.21,2.44),线性趋势检验P=0.003。将对数转换后的LAP值作为连续性变量代入模型,结果显示LnLap每增加一个单位,女性动脉粥样硬化性心血管病的发病风险增加24%(95%CI:8.9%,41.2%),男性的发病风险增加5.3%,但未达到统计学显著水平。结论女性动脉粥样硬化性心血管病发病风险随LAP水平增加呈逐渐增加的趋势,LAP是女性动脉粥样硬化性心血管病发病的危险因素,LAP对于女性ASCVD发病具有预测价值。动脉粥样硬化性心血管病在男性中未呈现此趋势,仍需更多研究。
[Abstract]:The first part: the cross-sectional study on the relationship between the lipid accumulation index of Beijing residents and hypertension and diabetes mellitus, the researchers found that the adipose tissue has complex functions, the fat function of different dissecting regions is different, and the fat in some specific areas is beneficial to the human body, such as the storage of energy and buffer pressure, and the other areas. Excessive accumulation of fat may cause insulin resistance, nonalcoholic steatohepatitis, metabolic syndrome and other adverse consequences. In order to assess the fat accumulation that may lead to adverse outcomes, the researchers designed a comprehensive index based on the waist and fasting triglycerides: lipid accumulation product, LA P). This study explored the applicable formula of the residents' lipid accumulation index in Beijing, and further assessed the relationship between LAP and hypertension and diabetes. The object of the study came from the 2011 "comprehensive epidemiological investigation of the heart and brain kidney and diabetes chronic diseases in Beijing". The study included 19606 residents aged 18~79 years in Beijing. 8869 men and 10737 women. Through the analysis of the waist circumference of 18~24 years old people, the minimum waist circumference of adult male and female in Beijing area was calculated, and the LAP formula was obtained. Using the receiver operating characteristic (ROC), two indexes of LAP and BMI were compared to examine the value of hypertension and diabetes. Multiple factor Logistic regression analysis was used to analyze the relationship between male and female different LAP levels (three quantile groupings) with hypertension and diabetes; groups according to the body mass index (body mass index, BMI), with low level LAP combined with non super recombination (BMI24.0kg/m2), to calculate the hypertension and diabetes in men and women with different LAP and BMI combinations. The risk of disease (odds ratio, OR) and 95% confidence interval (confidence interval, CI). Results the formula for adult LAP in Beijing is LAP (male) = [waist circumference (CM) -61.3 cm] x TG. The difference was statistically significant (P0.001). The difference was statistically significant (P0.001). The risk of hypertension in men and women increased with the level of LAP (P trend 0.001), with the lowest level of LAP as the reference, and the risk of hypertension in the highest level group of LAP was 3.62 (3.11,4.22) and 5.79 (4.84,6.93), respectively, in the highest level group of LAP. The risk of diabetes was 3.47 (2.73,4.41) and 4.10 (2.90,5.80); after the combination of LAP and BMI, the risk of hypertension and diabetes was higher in men and women with high LAP levels and high BMI levels compared with the low LAP level and non super recombination, and the highest risk of hypertension in men and women at the highest level of LAP and the obesity group was the highest risk of hypertension, O The values of R (95%CI) were 6.79 (5.50,8.37) and 9.75 (7.76,12.25) respectively, and the higher risk of diabetes was OR (95%CI) 3.97 (2.87,5.49) and 4.13 (2.78,6.14). Conclusion LAP in Beijing residents was closely related to hypertension and diabetes. Further studies were needed to confirm their predictive value for the risk of hypertension and diabetes. The two part: prospective cohort study on the relationship between Chinese adult lipid accumulation index and atherosclerotic cardiovascular disease background some prospective cohort studies have found that high LAP levels increase the risk of diabetes and stroke, however, these studies use the LAP formula proposed by Kahn, based on the number of American populations. According to the data of the 2000 China Health and nutrition survey, the purpose of this study was to propose a LAP formula for adults in China, and to explore the risk of the LAP level of adult and atherosclerotic cardiovascular disease (atherosclerotic cardiovascular disease, ASCVD) in China through prospective cohort follow-up. Method this study first obtained the LAP calculation formula using the research data of the China Health and Nutrition Survey (CHNS) in 2000, and then selected the Chinese cardiovascular epidemiology multi center collaborative research (China Multicenter Collaborative Study of) and the Chinese heart. International Collaborative Study of Cardiovascular Disease in Asia, InterAsia). The two studies conducted a baseline survey in 1998 and 2000-2001 respectively. A total of 27020 subjects aged 35~74 years were included in the study, and two times were carried out in 2007-2008 and 2013~2015 years. The final analysis included 23227 subjects, of which 11112 men and 12115 women were divided into groups according to the LAP four digits and the LAP first division was used as a reference. The Cox proportional risk regression model was used to analyze the atherosclerotic cardiovascular disease wind in men and women in different LAP groups. The results showed that the applicable formula for Chinese adult LAP was: LAP (male) =[WC (CM) -59.1 cm] x TG (mmol/L), LAP (female) =[WC (CM) -56.4cm] X. The study cohort was followed up for 12.3 years, including 657 men and 424 women. The incidence of sexual cardiovascular disease was 3.74/1000 year, 4.18/1000 year, 5.71/1000 year and 5.98/1000 year, women were 1.25/1000 year, 2.21/1000 year, 2.82/1000 year and 5.12/1000 man year respectively. With the first fractional LAP level group as reference, the age, urban and rural, South and North, high school and above education water were included. The family history of cardiovascular disease, working related moderate to severe physical activity levels, smoking, drinking, fasting blood glucose and baseline systolic blood pressure, second, third, and fourth LAP levels in the male group were 0.97 (0.76,1.25), 1.17 (0.92,1.49) and 1.10 (0.85,1.41), and a linear trend test P=0.407. Women were 1.42 (0.98,2.06), 1.30 (0.90,1.87) and 1.72 (1.21,2.44), and the linear trend test P=0.003. replaced the logarithmic LAP value as a continuous variable. The results showed that each additional unit of LnLap increased the risk of atherosclerotic cardiovascular disease by 24% (95%CI:8.9%, 41.2%), and the risk of male disease. The increase of 5.3%, but not statistically significant. Conclusion the risk of atherosclerotic cardiovascular disease in women is gradually increasing with the increase of LAP level. LAP is a risk factor for the onset of atherosclerotic cardiovascular disease in women. LAP has a pretest value for female ASCVD. Atherosclerotic cardiovascular disease is in men. More research is still needed in the absence of this trend.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R181.3
本文编号：2144781
[Abstract]:The first part: the cross-sectional study on the relationship between the lipid accumulation index of Beijing residents and hypertension and diabetes mellitus, the researchers found that the adipose tissue has complex functions, the fat function of different dissecting regions is different, and the fat in some specific areas is beneficial to the human body, such as the storage of energy and buffer pressure, and the other areas. Excessive accumulation of fat may cause insulin resistance, nonalcoholic steatohepatitis, metabolic syndrome and other adverse consequences. In order to assess the fat accumulation that may lead to adverse outcomes, the researchers designed a comprehensive index based on the waist and fasting triglycerides: lipid accumulation product, LA P). This study explored the applicable formula of the residents' lipid accumulation index in Beijing, and further assessed the relationship between LAP and hypertension and diabetes. The object of the study came from the 2011 "comprehensive epidemiological investigation of the heart and brain kidney and diabetes chronic diseases in Beijing". The study included 19606 residents aged 18~79 years in Beijing. 8869 men and 10737 women. Through the analysis of the waist circumference of 18~24 years old people, the minimum waist circumference of adult male and female in Beijing area was calculated, and the LAP formula was obtained. Using the receiver operating characteristic (ROC), two indexes of LAP and BMI were compared to examine the value of hypertension and diabetes. Multiple factor Logistic regression analysis was used to analyze the relationship between male and female different LAP levels (three quantile groupings) with hypertension and diabetes; groups according to the body mass index (body mass index, BMI), with low level LAP combined with non super recombination (BMI24.0kg/m2), to calculate the hypertension and diabetes in men and women with different LAP and BMI combinations. The risk of disease (odds ratio, OR) and 95% confidence interval (confidence interval, CI). Results the formula for adult LAP in Beijing is LAP (male) = [waist circumference (CM) -61.3 cm] x TG. The difference was statistically significant (P0.001). The difference was statistically significant (P0.001). The risk of hypertension in men and women increased with the level of LAP (P trend 0.001), with the lowest level of LAP as the reference, and the risk of hypertension in the highest level group of LAP was 3.62 (3.11,4.22) and 5.79 (4.84,6.93), respectively, in the highest level group of LAP. The risk of diabetes was 3.47 (2.73,4.41) and 4.10 (2.90,5.80); after the combination of LAP and BMI, the risk of hypertension and diabetes was higher in men and women with high LAP levels and high BMI levels compared with the low LAP level and non super recombination, and the highest risk of hypertension in men and women at the highest level of LAP and the obesity group was the highest risk of hypertension, O The values of R (95%CI) were 6.79 (5.50,8.37) and 9.75 (7.76,12.25) respectively, and the higher risk of diabetes was OR (95%CI) 3.97 (2.87,5.49) and 4.13 (2.78,6.14). Conclusion LAP in Beijing residents was closely related to hypertension and diabetes. Further studies were needed to confirm their predictive value for the risk of hypertension and diabetes. The two part: prospective cohort study on the relationship between Chinese adult lipid accumulation index and atherosclerotic cardiovascular disease background some prospective cohort studies have found that high LAP levels increase the risk of diabetes and stroke, however, these studies use the LAP formula proposed by Kahn, based on the number of American populations. According to the data of the 2000 China Health and nutrition survey, the purpose of this study was to propose a LAP formula for adults in China, and to explore the risk of the LAP level of adult and atherosclerotic cardiovascular disease (atherosclerotic cardiovascular disease, ASCVD) in China through prospective cohort follow-up. Method this study first obtained the LAP calculation formula using the research data of the China Health and Nutrition Survey (CHNS) in 2000, and then selected the Chinese cardiovascular epidemiology multi center collaborative research (China Multicenter Collaborative Study of) and the Chinese heart. International Collaborative Study of Cardiovascular Disease in Asia, InterAsia). The two studies conducted a baseline survey in 1998 and 2000-2001 respectively. A total of 27020 subjects aged 35~74 years were included in the study, and two times were carried out in 2007-2008 and 2013~2015 years. The final analysis included 23227 subjects, of which 11112 men and 12115 women were divided into groups according to the LAP four digits and the LAP first division was used as a reference. The Cox proportional risk regression model was used to analyze the atherosclerotic cardiovascular disease wind in men and women in different LAP groups. The results showed that the applicable formula for Chinese adult LAP was: LAP (male) =[WC (CM) -59.1 cm] x TG (mmol/L), LAP (female) =[WC (CM) -56.4cm] X. The study cohort was followed up for 12.3 years, including 657 men and 424 women. The incidence of sexual cardiovascular disease was 3.74/1000 year, 4.18/1000 year, 5.71/1000 year and 5.98/1000 year, women were 1.25/1000 year, 2.21/1000 year, 2.82/1000 year and 5.12/1000 man year respectively. With the first fractional LAP level group as reference, the age, urban and rural, South and North, high school and above education water were included. The family history of cardiovascular disease, working related moderate to severe physical activity levels, smoking, drinking, fasting blood glucose and baseline systolic blood pressure, second, third, and fourth LAP levels in the male group were 0.97 (0.76,1.25), 1.17 (0.92,1.49) and 1.10 (0.85,1.41), and a linear trend test P=0.407. Women were 1.42 (0.98,2.06), 1.30 (0.90,1.87) and 1.72 (1.21,2.44), and the linear trend test P=0.003. replaced the logarithmic LAP value as a continuous variable. The results showed that each additional unit of LnLap increased the risk of atherosclerotic cardiovascular disease by 24% (95%CI:8.9%, 41.2%), and the risk of male disease. The increase of 5.3%, but not statistically significant. Conclusion the risk of atherosclerotic cardiovascular disease in women is gradually increasing with the increase of LAP level. LAP is a risk factor for the onset of atherosclerotic cardiovascular disease in women. LAP has a pretest value for female ASCVD. Atherosclerotic cardiovascular disease is in men. More research is still needed in the absence of this trend.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R181.3
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