握力与心血管疾病的关联及其影响因素的分析

发布时间：2018-03-07 21:45

本文选题：握力　切入点：心血管疾病　出处：《天津医科大学》2017年博士论文　论文类型：学位论文

【摘要】：目的1.以天津慢性炎症与健康队列为基础,分析18岁以上一般成年人握力水平的分布及不同年龄段握力的变化情况,为定义亚洲人群肌肉衰减综合征提供数据基础,为指导预防肌肉衰减综合征提供数据支持。2.以天津慢性炎症与健康队列为基础,分析一般人群中握力与心血管疾病(cardiovascular disease,CVD)以及与CVD相关代谢指标的关联,以及握力预测CVD的最优截断值。3.寻找影响握力的危险因子,为预防肌肉衰减综合征提供指导。方法1.采用握力计进行握力测量。以40岁以下成年人握力的均值作为正常握力参考值。以低于握力均值的2个标准差定义为握力下降。以5岁为一个年龄段,计算握力的第10th、25th、50th、75th、90th分布情况,同时对每个年龄段内握力的平均值(标准差)分布情况进行了计算。2.采用多元logistic回归模型分析握力与CVD及其与CVD相关代谢指标的关联。并通过绘制受试者工作曲线(receiver operating characteristic curves,ROC)曲线对握力和其他人体测量指标预测CVD的能力进行比较。3.采用多元逐步回归分析探索影响握力的危险因素,为预防肌肉力量下降以及肌肉衰减综合征提供指导。结果1.握力分布及握力下降的截断值1.1在纳入的27,241名研究对象中,男性平均握力为42.9kg,女性平均握力为25.7kg。无论在男性还是女性,平均握力在35-40岁左右达到峰值,40-50岁维持在一定水平,而后随着年龄的增加逐渐下降,在60岁之后显著下降。1.2以40岁以下的一般成年人握力为参考标准,男性握力下降的截断值为30.8kg。女性握力下降的截断值为16.8kg。握力低下女性存在率为3.80%,男性为5.16%。握力低下总体存在率为4.51%。2.握力与心血管疾病及其影响因子的关联2.1经体重校正的握力与心血管疾病的关联在调整多种混杂因素后CVD患病率与经体重校正的握力显著负相关。男性CVD患病率在不同握力水平下的OR值(95%CI)分别为1.00,0.87(0.73,1.05),0.74(0.61,0.91)和0.70(0.56,0.88)(趋势性P0.0001)。女性CVD患病率在不同握力水平下的OR值(95%CI)分别为1.00,0.67(0.54,0.84),0.60(0.46,0.78)和0.59(0.43,0.80)(趋势性P0.0001)。2.2握力与心血管疾病影响因素(代谢综合征(metabolic syndrome,MS)及其各组分)间的关联在调整多种混杂因素后,无论在男性人群还是女性人群,握力与MS患病率及其各组成成分(超重和(或)肥胖、甘油三酯(triglycerides,TG)升高、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)降低、血压升高以及血糖升高)的患病率均显著负性相关。2.3握力及一般人体测量指标预测心血管疾病的能力比较男性握力预测CVD的ROC曲线下面积为0.65,最优截断值为39.6kg。灵敏度为0.71,特异度为0.52。女性握力预测CVD的ROC曲线下面积为0.64,最优截断值为23.3kg。灵敏度为0.61,特异度为0.40。3.影响握力的危险因素多元逐步回归分析结果显示,在男性人群中,40-60岁组、60-70岁组、70岁以上组人群的握力低下存在率分别是40岁以下人群组的1.81(1.38,2.37)、4.71(3.63,6.10)、27.6(21.4,35.6)倍。相较于体重正常组,超重组、肥胖组握力低下存在率分别是正常组的1.42(1.06,1.90)、3.34(2.18,5.11)倍。体重每升高1kg,握力下降的存在率为参照组的1.10(1.08,1.12)倍。相较于腰围正常组,腰围升高组握力低下存在率是正常组的1.49(1.11,1.98)倍。在女性人群中,40-60岁组、60-70岁组、70岁以上组人群的握力低下存在率分别是40岁以下人群组的2.57(1.87,3.53)、2.84(1.94,4.17)、10.9(7.46,15.8)倍。相较于体重正常组,超重组、肥胖组握力低下存在率分别是正常组的2.32(1.58,3.40)、6.52(3.60,11.8)倍。体重每升高1kg,握力下降的存在率升高1.13(1.10,1.15)倍。相较于腰围正常组,腰围升高组握力低下存在率是正常组的1.62(1.14,2.31)倍。结论1.我国成年人群中,握力达到峰值的年龄为40岁。男性的握力峰值(均数±标准差)为45.0±6.7 kg,女性握力峰值为27.1±5.0 kg。男性握力下降的截断值为30.8kg。女性握力下降的截断值为16.8kg。握力低下女性存在率为3.80%,男性为5.16%。2.经体重校正的握力是CVD及CVD影响因素的独立危险因素。CVD的存在率随着经体重校正的握力值的升高而降低。在男性人群中,相较于收缩压(systolic blood pressure,SBP)、身体质量指数(body mass index(BMI))和腰围,握力预测CVD的准确性最高。3.无论在男性还是女性,高年龄、超重或肥胖、体重增加及腰围升高均是握力下降的危险因子。
[Abstract]:1. in Tianjin chronic inflammation and Health cohort based distribution analysis over the age of 18 general adults of different ages and levels of grip strength, for the definition of the Asian population of muscle attenuation syndrome provide the data base for guiding prevention of muscle attenuation syndrome to provide data support for.2. based in Tianjin, chronic inflammation and Health Cohort analysis, grip strength and cardiovascular disease in the general population (cardiovascular, disease, CVD and CVD) and the relationship between metabolic index, and grip strength prediction of CVD optimal truncation value.3. for the risk factors of grip strength, to provide guidance for the prevention of muscle decay syndrome. Methods 1. the dynamometer for grip strength measurement. The mean under the age of 40 adults as the normal reference value of the grip grip by 2 lower than the standard average grip strength is defined as the difference of grip strength decreased. In 5 years as an age, grip strength calculation The 10th, 25th, 50th, 75th, 90th and distribution, the average value of each age in the grip (standard deviation) distribution were calculated with.2. correlation multivariate logistic regression model analysis of CVD and CVD and its grip and metabolism. And through the receiveroperating curve (receiver operating characteristic curves, ROC).3. curves were compared using multivariate stepwise regression to explore the influence of grip strength analysis of risk factors for predicting CVD ability to grip and other anthropometric indicators, in order to prevent the decline in muscle strength and muscle attenuation syndrome. The results provide guidance 1. truncated distribution and grip strength decreased grip strength value of 1.1 in the 27241 subjects included. The average male grip strength is 42.9kg, the average woman is 25.7kg. grip both in male and female, average grip strength peaked at about 35-40 years old, 40-50 years old to maintain at a certain level With the increase of age, and then decreased gradually after the age of 60 was significantly decreased by.1.2 with 40 years old of the following general adult grip as the reference standard, cut-off value of 16.8kg. decreased male grip grip low female existence rate of 3.80% truncated decreased 30.8kg. values for male female grip, grip 5.16%. overall low existence rate of grip and 4.51%.2. cardiovascular disease and its influencing factors associated with 2.1 correction by the association grip weight and cardiovascular disease in a variety of confounding factors adjusted prevalence of CVD and the weight correction grip is negatively correlated. The prevalence rate of male CVD in different grip levels of OR values (95%CI) were 1.00,0.87 (0.73,1.05), 0.74 (0.61,0.91) and 0.70 (0.56,0.88) (trend P0.0001). Female CVD prevalence in different levels of grip strength of the OR value (95%CI) were 1.00,0.67 (0.54,0.84), 0.60 (0.46,0.78) and 0.59 (0.43,0.80) (trend The potential of P0.0001) factors affecting.2.2 grip strength and cardiovascular disease (metabolic syndrome (metabolic, syndrome, MS) and its components) the relationship between the adjustment in the various confounding factors, either in males or females, grip strength and the prevalence of MS and its components (super heavy and (or) obesity, triglyceride (triglycerides TG), elevated high density lipoprotein cholesterol (high density lipoprotein cholesterol, HDL-C) decreased, blood pressure and blood glucose) the prevalence rates were significantly negative correlated.2.3 grip and general body measurement index prediction ability of cardiovascular disease in men grip forecast area under the CVD curve of ROC was 0.65, the optimal cut-off value the sensitivity of 39.6kg. was 0.71, the specificity was 0.52. female grip under the CVD curve of ROC forecast area is 0.64, the optimal cut-off value of 23.3kg. sensitivity was 0.61, specificity for dangerous grip 0.40.3. Multivariate stepwise regression analysis showed that in men, 40-60 years old group, 60-70 years old group, 70 years old groups have low grip strength were people under the age of 40 was 1.81 (1.38,2.37), 4.71 (3.63,6.10), 27.6 (21.4,35.6) times. Compared with the normal body weight group, overweight the obesity group, there were low grip strength in normal group 1.42 (1.06,1.90), 3.34 (2.18,5.11) times. Each weight increased 1kg, decreased strength the existence rate of the control group (1.08,1.12) 1.10 times. Compared with the normal group increased waist circumference waist, low rate of group grip strength is the normal group 1.49 (1.11,1.98) times. In women, 40-60 years old group, 60-70 years old group, 70 years old groups have low grip strength were people under the age of 40 was 2.57 (1.87,3.53), 2.84 (1.94,4.17), 10.9 (7.46,15.8) times. Compared with normal weight group, overweight group, obesity rate has low grip strength respectively. The 2.32 is the normal group (1.58,3.40), 6.52 (3.60,11.8) times. Each weight increased 1kg, decreased strength existence rate increased by 1.13 (1.10,1.15) times. Compared with the normal group increased waist circumference, waist group low grip strength existence rate is the normal group 1.62 (1.14,2.31) times. Conclusion 1. of China's adult population, grip the peak age of 40 years. The peak grip men (mean SD) was 45 + 6.7 kg, peak 27.1 female grip truncated + 5 kg. male decreased strength value of 16.8kg. for the female low grip strength existence rate of 3.80% truncated decreased to 30.8kg. women grip strength value, the male is 5.16%.2. by weight correction CVD and CVD of the.CVD grip is independent risk factor factors exist rate decreased with increasing weight after correction value. The grip in the male population, compared with the systolic blood pressure (systolic blood, pressure, SBP), body mass index (body, mass and index (BMI)) Waist circumference and grip strength predict the highest accuracy of CVD..3., whether in men or women, is a risk factor for grip strength decline in high age, overweight or obesity, body weight gain and waist circumference.

【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R54;R181.3

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