不同水碘地区人群血流变现状调查及其影响因素分析

发布时间：2018-06-13 03:16

本文选题：水碘 + 尿碘　；参考：《山东大学》2017年硕士论文

【摘要】：目的:本文通过对山东省不同水碘地区的人群进行现场调查,描述血流变指标分布情况;分析引起血流变异常的影响因素,对制定心血管疾病防控策略具有重要指导意义;探讨不同水碘水平对血液流变性的作用,为高碘致血管损伤和动脉粥样硬化的机制研究提供科学依据。方法:在山东省调查现场,取水碘浓度不同的4个调查点:低碘组(LI):水碘浓度小于10μg/L;适碘组(NI):水碘浓度50～150μg/L;高碘组(HI):水碘浓度150～300μg/L;碘过量组(EI):水碘浓度大于300μg/L。采用分层抽样的方法,每个调查点随机选择3～5个调查村,选择符合纳入标准的成年人作为调查对象。此次调查内容共有问卷调查、体格检查、实验室检查三部分内容。问卷调查包括个人基线调查和3天24小时膳食问卷调查;体格检查包括身高、体重、血压。实验室检查包括尿碘、血脂、血流变等指标。3天24小时膳食调查问卷由《营养计算V2.65》软件录入,采用Epidata3.1建立数据库,SPSS20.0软件进行数据分析。结果:1.一般情况此次现场调查共完成有效问卷1984份,其中LI组409人,NI组325人,HI组478人,EI组772人。男女各占总数的37.30%和62.70%,各组间性别、年龄分布无显著性差异,各调查组年龄呈负偏态分布。各组间文化水平、职业分布不同(P0.05),职业分布比例最高的均为农民。各组间饮酒状况分布未见显著性差异。各组间吸烟状况分布不同(P0.05),LI组过去吸烟比例组间最高;NI组从未吸烟的比例组间最高,现在吸烟比例组间最低;HI组从未吸烟比例组间最低,现在吸烟比例组间最高;EI组过去吸烟比例组间最低。2.不同水碘地区膳食营养素摄入状况对调查对象各膳食营养素摄入情况和达标率(膳食营养素摄入量大于等于RNI或AI的80%,小于UL的人群占总人数的比例)进行评价。各组间能量、蛋白质、维生素A、维生素E、硫胺素、烟酸、维生素C、钙、磷、钾、镁、铁、锌、硒、铜、锰的摄入量和碳水化合物供能比、脂肪供能比的达标率不同(P0.05)。各组间核黄素、维生素B6、维生素B12、叶酸、钠、碘的摄入量的达标率组间无显著性差异(P0.05)。3.体格检查各组间身高、体重、BMI分布无显著性差异。各组间收缩压分布无显著性差异。各组间舒张压分布不同(P0.05),LI组、HI组、EI组间舒张压分布无显著性差异且均低于NI组(P0.05)。4.实验室检测4.1不同水碘地区尿碘分布情况LI组、NI组、HI组、EI组尿碘中位数依次为93.10μg/L、235.60μg/L、291.50μg/L和807.25μg/L,各组间尿碘分布不同(P0.05)。根据WHO、UNICEF、ICCIDD共同制定的以尿碘浓度中位数监测群体碘营养水平的流行病学评价标准,LI组人群处于碘缺乏状态;NI组和HI组人群碘摄入量大于碘需要量但未达到碘过量的标准;EI组人群处于碘过量状态。4.2不同水碘地区血脂分布情况各组间甘油三酯(TG)、高密度脂蛋白胆固醇、载脂蛋白B分布无显著性差异。各组间总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-CH)、载脂蛋白A Ⅰ(ApoAⅠ)、ApoA Ⅰ/ApoB分布不同(P0.05)。LI组和NI组TC高于HI组和EI组(P0.05);LI 组 LDL-CH 高 NI 组和 HI 组(P=0.05),EI 组 LDL-CH 组间最低(P0.05)。EI 组 ApoA Ⅰ 高于 LI 和 HI 组(P0.05),NI 组 ApoA Ⅰ 组间最低(P0.05)。EI组ApoaⅠ/ApoB组间最高(p0.05),LI组、NI组、HI组间无显著性差异。4.3不同水碘地区血流变分布情况各组间红细胞压积、全血粘度低切(ηb-Lγ)、全血粘度中切(ηb-Mγ)分布无显著性差异(P0.05),各组其他各指标分布不同(P0.05)。组间两两比较,HI组和EI组全血粘度高切(ηb-Hγ)高于LI组和NI组(P0.05)。LI组血浆表观粘度水平高于NI组、HI组和EI组(P0.05)。LI组红细胞刚性指数、细胞变形指数低于NI组、HI组和EI组(P0.05)。EI组红细胞聚集指数、红细胞电泳指数低于LI组、NI组和HI组(P0.05)。5.血流变指标异常Logistic回归分析多分类logistic回归分析得出性别、年龄、舒张压(DBP)、水碘、TG、TC、ApoAⅠ、ApoB、膳食维生素A和铁摄入量均为全血粘度异常分布的影响因素。男性出现低ηb-Lγ、低ηb-Mγ和低ηb-Hγ的风险显著低于女性,出现高ηb-Lγ、高ηb-Mγ和高ηb-Hγ的风险显著高于女性。年龄表现有升高ηb-Mγ的趋势,是低ηb-Mγ的保护因素。随着DBP水平升高,出现高ηb-Lγ高ηb-Mγ和高ηb-Hγ的风险显著增加。随着TG水平的升高,出现高ηb-Mγ、高ηb-Hγ的风险显著增加。随着TC水平的升高,出现低ηb-Hγ的风险显著降低。ApoA Ⅰ是高ηb-Lγ、高ηb-Mγ的保护因素。ApoB是低ηb-Lγ、低ηb-Mγ的保护因素,是高ηb-Lγ、高ηb-MY的危险因素。随着膳食维生素A摄入量增加,出现高ηb-Lγ的风险显著降低;随着膳食铁摄入量增加,出现高ηb-Lγ的风险显著增加。低水碘地区的人群出现低ηb-Lγ、低ηb-Mγ和低ηb-Hγ的风险显著高于适碘地区的人群;碘过量地区的人群出现低ηb-Hγ的风险显著低于适碘地区的人群。结论:1.各组间红细胞压积、全血粘度低切、全血粘度中切分布无显著性差异,各组其他各指标分布不同。组间两两比较,HI组和EI组全血粘度高切高于LI组和NI组。LI组血浆表观粘度水平高于NI组、HI组和EI组。LI组红细胞刚性指数和红细胞变形指数低于NI组、HI组和EI组。EI组红细胞聚集指数和红细胞电泳指数低于LI组、NI组和HI组。2..影响ηb异常分布的因素有性别、年龄、DBP、水碘、TG、TC、ApoAⅠ、ApoB、膳食维生素A和铁摄入量。男性ηb水平显著高于女性;年龄、DBP、TG、TC、ApoB、膳食铁是ηb升高的危险因素;ApoAⅠ、膳食维生素A是ηb升高的保护因素。3.低水碘可通过升高ApoA Ⅰ或(和)增加红细胞变形性来降低血液黏度。水碘过量可降低红细胞变形性,升高血液粘度。
[Abstract]:Objective: To investigate the distribution of blood rheology index in Shandong Province, to describe the distribution of blood rheology index, and to analyze the influencing factors of abnormal blood rheology. It has important guiding significance for developing the prevention and control strategy of cardiovascular disease, and the effect of different water iodide level on blood flow degeneration, and the damage and movement of high iodine induced blood vessel. A scientific basis for the mechanism study of atheromatous atherosclerosis. Methods: 4 survey sites with different iodine concentrations in the Shandong Province survey site: iodine concentration in low iodine group (LI): water iodine concentration is less than 10 mu; iodine concentration in iodine group (NI): iodine concentration 50~150 mu g/L; high iodine group (HI): iodine concentration 150~300 u g/L; iodine excess group (EI): iodine concentration greater than 300 u g/L. using stratified pumping The sample method, each survey site randomly selected 3~5 investigation villages, selected adults as the subject of inclusion criteria. The survey included questionnaire survey, physical examination, and laboratory examination in three parts. The questionnaire included individual baseline survey and 3 day 24 hour diet questionnaire survey; physical examination included height, weight, blood. The 24 hour dietary survey questionnaire, including urinary iodine, blood lipid and blood rheology, was recorded by "V2.65> software" for.3 days, using Epidata3.1 to establish database and SPSS20.0 software for data analysis. Results: 1. general cases were completed in 1984 cases, of which 409 in group LI, 325 in NI group, 478 in HI group, E In group I, 772 people were 37.30% and 62.70% of the total number of men and women. There was no significant difference in sex and age distribution among all groups. The age of each group was negatively biased. The cultural level of each group, the distribution of occupations were different (P0.05), the occupations were the highest among the farmers. There was no significant difference in the distribution of drinking among the groups. The distribution of smoking among groups was not distributed. (P0.05), group LI had the highest smoking ratio among groups in the past, the highest among the NI group never smoked, the lowest among the smoking proportions, the lowest in the HI group, and the highest among those in the proportion of smoking, and the lowest dietary intake of the EI in the past group of smoking in different water and iodine areas. Nutrients intake and standard rate (80% of RNI or AI, less than UL) were evaluated. Energy, protein, vitamin A, vitamin E, thiamine, nicotinic acid, vitamin C, calcium, phosphorus, potassium, magnesium, iron, zinc, selenium, copper, manganese, carbohydrate supply ratio, fat supply ratio, and fat supply ratio in each group. There was no significant difference (P0.05). There was no significant difference between groups of riboflavin, vitamin B6, vitamin B12, folic acid, sodium, and iodine. There was no significant difference in height, weight and BMI distribution between each group. The distribution of systolic pressure in each group was not significant. The distribution of diastolic pressure in each group was different (P0.05), LI, HI, E. There was no significant difference in diastolic pressure distribution in I group and lower than group NI (P0.05).4. laboratory to detect the distribution of urine iodine in 4.1 different iodine areas, NI, HI, and EI group, the median of urine iodine was 93.10 u g/L, 235.60 mu g/L, 291.50 mu g/L and 807.25 micron. The epidemiological evaluation standard of iodine nutrition level in the median concentration monitoring group, the group LI group was in iodine deficiency state; the iodine intake of group NI and HI group was higher than that of iodine need, but the EI group was in the iodine excess state, and the distribution of blood lipid in different iodine areas of.4.2 was TG, high density lipoprotein (HDL) There was no significant difference in the distribution of cholesterol and apolipoprotein B. The total cholesterol (TC), low density lipoprotein cholesterol (LDL-CH), apolipoprotein A I (ApoA I), and ApoA I /ApoB distribution were different (P0.05) in.LI group and NI group. A I was higher than group LI and HI (P0.05), and the lowest (P0.05).EI group Apoa I /ApoB group between group ApoA I group (P0.05), LI group, group, and group, there was no significant difference between groups of blood flow and distribution in different water iodine areas. The distribution of other indexes in each group was different (P0.05). The total blood viscosity of group HI and EI group was higher than that of group LI and NI group (P0.05), the apparent viscosity of plasma was higher than that of group NI, and the erythrocyte rigidity index of HI and EI group (P0.05) was lower than that in the group of HI and EI group (P0.05). The index of cell electrophoresis was lower than that of LI group, NI and HI group (P0.05).5. blood rheology index abnormal Logistic regression analysis. The multiple classification logistic regression analysis showed that sex, age, diastolic pressure (DBP), water iodine, TG, TC, ApoA I, ApoB, dietary vitamin and iron intake were all the factors affecting the abnormal distribution of whole blood viscosity. The risk of low ETA b-H gamma is significantly lower than that of women. The risk of high ETA b-L gamma, high ETA b-M gamma and high ETA b-H gamma is significantly higher than that of women. Age shows an increase in the trend of ETA b-M gamma, which is a protective factor for low ETA b-M gamma. The risk of high ETA b-L gamma, high ETA b-M gamma and high ETA b-H gamma increases with the increase of DBP level. The higher ETA b-M gamma appears with the increase of TG level. The risk of high ETA b-H gamma increased significantly. With the increase of TC level, the risk of low ETA b-H gamma was significantly reduced,.ApoA I was high ETA b-L gamma, and the protective factor of high ETA b-M y.ApoB was low ETA b-L gamma, and the protection factor of low ETA b-M gamma was the risk factor of high ETA b-L gamma and high ETA b-MY. Low; with the increase of dietary iron intake, the risk of high ETA b-L gamma increased significantly. The risk of low ETA b-L gamma, low ETA b-M gamma and low ETA b-H gamma in low iodine areas was significantly higher than those in the iodide region; the risk of low b-H gamma in iodine excess areas was significantly lower than that of the population in the iodide area. Conclusion: 1. There was no significant difference in the distribution of whole blood viscosity and whole blood viscosity, and the distribution of other indexes in all groups was different. The total blood viscosity of group HI and EI group was higher than that of group LI and group NI, and the plasma apparent viscosity level of group HI and group NI was higher than that of group NI, and the erythrocyte rigidity index and erythrocyte deformability index in group.LI and EI group were lower than that of NI group, HI group and EI group. Erythrocyte aggregation index and erythrocyte electrophoresis index were lower than that of LI group, and.2.. And HI group.2.. Affected the abnormal distribution of ETA B, including sex, age, DBP, water iodine, TG, TC, ApoA I, ApoB, dietary vitamin A and iron intake. A is a protective factor for the increase of ETA B,.3. low water iodine can reduce blood viscosity by increasing ApoA I or (and) to increase erythrocyte deformability. Excess iodine can reduce erythrocyte deformability and increase blood viscosity.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R54

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