河南农村人群体脂率与心血管代谢性疾病的关系及筛检效能评价

发布时间：2018-07-28 08:39

【摘要】：目的了解河南农村地区肥胖、2型糖尿病、高血压和血脂异常等心血管代谢性疾病患病现况;探讨体脂率与2型糖尿病、高血压、血脂异常等疾病的关系,并进一步评价体脂率对心血管代谢性疾病的筛检效能。对象与方法采用整群随机抽样方法对“农村糖尿病、肥胖及生活方式(RuralDiab)”研究中年龄在18至74岁的15885名研究对象进行调查。采用面对面调查法对研究对象进行问卷调查、体格检查和生物标本的采集,体脂率的测量采用生物电阻抗法。采用Epidata 3.1建立数据库进行一致性核查。连续变量用均数±标准差表示,组间比较采用独立样本t检验或方差分析;分类变量用频数和百分比表示,组间比较采用χ2检验。将体脂率按照四分位法分为Q1,Q2,Q3,Q4四组,以Q1组作为参照,采用logistic回归模型评估不同体脂率水平与相关疾病之间的关联,关联强度用OR值和95%CI表示。采用限制性立方样条模型分析体脂率与心血管代谢性疾病关联的剂量-反应关系。采用受试者工作特征(ROC)曲线分析体脂率筛检心血管代谢性疾病的最佳切点值及其筛检效能。结果1.本研究共纳入分析男性5886例,女性9999例;男性人群中肥胖、2型糖尿病、高血压和血脂异常患病率分别为14.70%,9.04%,28.56%,34.79%;女性人群中患病率分别为18.32%,9.72%,29.13%,27.17%。年龄别标化患病率男性人群中分别为19.90%,6.25%,20.85%和41.62%;女性人群中分别为16.28%,5.77%,18.27%和22.42%。2.心血管代谢性疾病在不同体脂率水平的分布:在男性和女性人群中,收缩压、舒张压、空腹血糖、胰岛素水平、总胆固醇水平、甘油三酯水平、低密度脂蛋白胆固醇水平等指标随着体脂率水平的增加而增加(P趋势0.001);高密度脂蛋白胆固醇水平随体脂率增加而降低(P趋势0.001);2型糖尿病、高血压、血脂异常的患病率呈现随体脂率水平的增加而增加的趋势(P趋势0.001)。3.体脂率水平与心血管代谢性疾病的关系:调整相关因素后,与体脂率水平Q1组相比Q2,Q3,Q4组与2型糖尿病,高血压和血脂异常等心血管代谢性疾病的患病情况存在关联,且关联强度随体脂率水平的增加而增加,Q4组关联强度最大(P趋势0.001)。体脂率Q4组与2型糖尿病的关联强度(OR,95%CI)在男性人群为3.62(2.66,4.93),女性人群为3.63(2.07,3.34);与高血压的关联强度在男性人群为4.15(3.43,5.01),女性人群为3.14(2.70,3.65);与血脂异常的关联强度在男性人群为8.12(6.69,9.84),女性人群为4.17(3.57,4.86)。4.体脂率与心血管代谢性疾病的剂量-反应关系:由限制性立方样条图可看出,体脂率与2型糖尿病、高血压和血脂异常的关联强度随体脂率的增加呈非线性增加;男性人群中体脂率与心血管代谢性疾病关联强度的增加幅度和速度均大于女性人群;体脂率与血脂异常关联强度在体脂率达到某一水平后趋于平缓。5.体脂率筛检心血管代谢性疾病的效能评价:在男性人群中,体脂率筛检2型糖尿病、高血压病和血脂异常的最佳切点值分别为25.4%,25.5%和24.2%,曲线下面积分别为0.681,0.661和0.672。女性人群中相应的体脂率最佳切点值分别为33.7%,34.7%和32.5%,相应的曲线下面积分别为0.661,0.677和0.635。结论1.河南农村人群中肥胖、2型糖尿病、高血压和血脂异常等心血管代谢性疾病患病率不容乐观,对心血管代谢性疾病的预防和控制工作应引起关注。2.体脂率与2型糖尿病、高血压和血脂异常等心血管代谢性疾病的患病情况存在关联,关联强度随体脂率水平增加而增加,随着体脂率连续性增加呈非线性增加。因此在基层健康教育工作中应加强对体脂率的管理和控制。3.体脂率对2型糖尿病、高血压和血脂异常患病的鉴别效能有限,筛检切点值尚需在大样本人群研究中进一步验证。
[Abstract]:Objective to understand the prevalence of obesity, type 2 diabetes, hypertension and dyslipidemia in rural areas of Henan, and to explore the relationship between body fat rate and type 2 diabetes, hypertension, dyslipidemia and other diseases, and to further evaluate the screening effectiveness of body fat rate on cardiovascular metabolic diseases. Methods a survey was conducted on 15885 subjects aged 18 to 74 in the study of "rural diabetes, obesity and lifestyle (RuralDiab)". A face-to-face survey was conducted to investigate the subjects, physical examination and collection of biological specimens, the measurement of body fat rate, and the use of Epidata 3.1 to establish a database. The consistency verification was carried out. The continuous variables were represented by mean number and standard deviation, and the group was compared with independent sample t test or variance analysis. The classification variables were expressed by frequency and percentage, and the group was compared by the chi 2 test. The body fat rate was divided into Q1, Q2, Q3, Q4 four groups according to the four division method, and the logistic regression model was used to evaluate the androgyny by the logistic regression model. Association between lipid and related diseases, correlation intensity was expressed with OR and 95%CI. The dose response relationship between body fat rate and cardiovascular metabolic disease was analyzed using a restrictive cubic spline model. The optimal point value and screening efficacy of body fat rate for screening the metabolic diseases of the heart and blood tube were analyzed by the subject work feature (ROC) curve. Results 1. studies were included in 5886 men and 9999 women. The prevalence rates of obesity, type 2 diabetes, hypertension and dyslipidemia were 14.70%, 9.04%, 28.56%, 34.79% in the male population, and the prevalence rates in women were 18.32%, 9.72%, 29.13%, respectively, among men were 19.90%, 6.25%, 20.85%, and 27.17%. years old, respectively. 41.62%; the distribution of cardiovascular metabolic diseases at different body fat rates of 16.28%, 5.77%, 18.27%, and 22.42%.2. in women: systolic pressure, diastolic blood pressure, fasting blood glucose, insulin levels, total cholesterol levels, triglycerides, low density lipoprotein cholesterol levels, and low density lipoprotein cholesterol levels in men and women. Increased (P trend 0.001); high density lipoprotein cholesterol levels decreased with the increase of body fat (P trend 0.001); the prevalence of type 2 diabetes, hypertension, and dyslipidemia increased with the increase of body fat rate (P trend 0.001) the relationship between the level of.3. body fat and cardiovascular metabolic diseases: after adjusting the related factors, Compared with the body fat rate Q1 group, Q2, Q3, Q4 were associated with the prevalence of cardiovascular metabolic diseases such as type 2 diabetes, hypertension and dyslipidemia, and the association intensity increased with the increase of body fat rate and the strongest association intensity in the Q4 group (P trend 0.001). The association intensity of the body fat rate Q4 group with type 2 diabetes (OR, 95%CI) was in the male population. 3.62 (2.66,4.93), the female population was 3.63 (2.07,3.34); the intensity of association with hypertension was 4.15 (3.43,5.01) and 3.14 (2.70,3.65) in the female population; the intensity of the association with dyslipidemia was 8.12 (6.69,9.84) in the male population and the dose response relationship between the 4.17 (3.57,4.86).4. body fat rate and the cardiovascular metabolic disease in the female population: The restrictive cubic spline shows that the association between body fat rate and type 2 diabetes, hypertension and dyslipidemia increases linearly with the increase of body fat; the increase and speed of the increase and speed of the association intensity of body fat and cardiovascular metabolic diseases in male population is greater than that in the female population; the intensity of body fat rate and blood lipid abnormality is at the body fat rate. Evaluation of the efficacy of a leveling.5. body fat rate screening for cardiovascular metabolic diseases at a certain level: in male populations, the best cut points of somatic fat rate screening for type 2 diabetes, hypertension and dyslipidemia were 25.4%, 25.5% and 24.2% respectively, and the area under the curve was the best cut point of the body fat rate in 0.681,0.661 and 0.672. women, respectively. The values were 33.7%, 34.7% and 32.5% respectively. The areas under the corresponding curves were 0.661,0.677 and 0.635. respectively. Conclusion 1. Henan rural people were obese, type 2 diabetes, hypertension and dyslipidemia and other cardiovascular metabolic diseases were not optimistic. The prevention and control of cardiovascular metabolic diseases should pay attention to the body fat rate of.2. and type 2 diabetes. The incidence of cardiovascular metabolic diseases, such as disease, hypertension, and dyslipidemia, is associated with an increase in the body fat rate and a nonlinear increase with the increase in the body fat rate. Therefore, the management of body fat rate and the control of the.3. body fat rate for type 2 diabetes, hypertension and blood should be strengthened in the health education work at the grass-roots level. The discriminating efficacy of lipid abnormality is limited, and the cut-off value of screening needs further validation in large sample population studies.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R181.3

【相似文献】