【摘要】：第一部分:北京市居民脂質(zhì)蓄積指數(shù)與高血壓、糖尿病患病關(guān)系的橫斷面研究背景研究者發(fā)現(xiàn)脂肪組織有復(fù)雜的功能,不同解剖區(qū)域的脂肪功能不同,一些特定區(qū)域的脂肪對(duì)人體是有益的,比如可以?xún)?chǔ)存能量和緩沖壓力,而另一些區(qū)域脂肪的過(guò)度蓄積可能會(huì)造成胰島素抵抗、非酒精性脂肪性肝炎、代謝綜合征等不良后果。為了評(píng)估出這種異常的可能帶來(lái)不良結(jié)局的脂肪積累,研究人員設(shè)計(jì)了基于腰圍和空腹甘油三酯的綜合指標(biāo):脂質(zhì)蓄積指數(shù)(lipid accumulation product,LAP)。本研究探討北京地區(qū)居民脂質(zhì)蓄積指數(shù)適用公式,并進(jìn)一步評(píng)估LAP與高血壓、糖尿病患病的關(guān)系。方法研究對(duì)象來(lái)自2011年“北京市心腦腎及糖尿病慢性病流行病學(xué)綜合調(diào)查研究”,本研究共納入19606名18～79歲北京市常住居民,其中男性8869人,女性10737人。通過(guò)對(duì)18～24歲人群的腰圍進(jìn)行分析,分別計(jì)算北京地區(qū)成年男性和女性的最小腰圍,得到LAP適用公式。使用受試者工作特征曲線(xiàn)(receiver operating characteristic,ROC)比較LAP和BMI兩個(gè)指標(biāo)篩檢高血壓、糖尿病的價(jià)值。采用多因素logistic回歸分析男性和女性不同LAP水平(三分位數(shù)分組)與高血壓、糖尿病患病的關(guān)系;按照身體質(zhì)量指數(shù)(body mass index,BMI)進(jìn)行分組,以低水平LAP合并非超重組(BMI24.0kg/m2)為參照,計(jì)算男性和女性不同LAP和BMI組合下的高血壓和糖尿病患病風(fēng)險(xiǎn)(odds ratio,OR)和95%置信區(qū)間(confidence interval,CI)。結(jié)果北京地區(qū)成人LAP適用公式為:LAP(男)=[腰圍(cm)-61.3 cm]×TG(mmol/L),LAP(女)=[腰圍(cm)-55.6cm]×TG(mmol/L)。LAP對(duì)于男性糖尿病、女性高血壓和糖尿病患病情況的ROC曲線(xiàn)下面積(AUC)均0.59,并且均超過(guò)BMI的AUC,差異有統(tǒng)計(jì)學(xué)意義(P0.001)。男性和女性的高血壓、糖尿病患病風(fēng)險(xiǎn)均隨著LAP水平升高而增加(P趨勢(shì)0.001),以L(fǎng)AP最低水平組為參照,LAP最高水平組的男性和女性高血壓患病風(fēng)險(xiǎn)OR(95%CI)值分別為3.62(3.11,4.22)和5.79(4.84,6.93),其糖尿病患病風(fēng)險(xiǎn)分別為 3.47(2.73,4.41)和 4.10(2.90,5.80);LAP與BMI分組組合后,與低LAP水平和非超重組相比,高LAP水平合并高BMI水平的男性和女性的高血壓和糖尿病患病風(fēng)險(xiǎn)更高;LAP最高水平合并肥胖組的男性和女性高血壓患病風(fēng)險(xiǎn)最高,OR(95%CI)值分別為6.79(5.50,8.37)和9.75(7.76,12.25),其糖尿病患病風(fēng)險(xiǎn)較高OR(95%CI)值分別為3.97(2.87,5.49)和 4.13(2.78,6.14)。結(jié)論北京居民LAP與高血壓和糖尿病患病密切相關(guān),有待開(kāi)展更深入的研究證實(shí)其對(duì)高血壓、糖尿病發(fā)病風(fēng)險(xiǎn)的預(yù)測(cè)價(jià)值。第二部分:中國(guó)成人脂質(zhì)蓄積指數(shù)與動(dòng)脈粥樣硬化性心血管病發(fā)病關(guān)系的前瞻性隊(duì)列研究背景一些前瞻性隊(duì)列研究發(fā)現(xiàn)高LAP水平增加糖尿病、腦卒中的發(fā)病風(fēng)險(xiǎn),然而這些研究均使用Kahn提出的LAP計(jì)算公式,這個(gè)公式是基于美國(guó)人群的數(shù)據(jù),并不一定適用其他人群。本研究旨在通過(guò)2000年中國(guó)健康與營(yíng)養(yǎng)調(diào)查的數(shù)據(jù),提出適用于我國(guó)成人的LAP公式,并通過(guò)前瞻性隊(duì)列隨訪(fǎng),探討我國(guó)成人LAP水平與動(dòng)脈粥樣硬化性心血管病(atherosclerotic cardiovascular disease,ASCVD)發(fā)病風(fēng)險(xiǎn)的關(guān)系。方法本研究首先利用2000年中國(guó)健康與營(yíng)養(yǎng)調(diào)查(China Health and Nutrition Survey,CHNS)的研究數(shù)據(jù)得出LAP計(jì)算公式。然后選取中國(guó)心血管病流行病學(xué)多中心協(xié)作研究(China Multicenter Collaborative Study of Cardiovascular Epidemiology,ChinaMUCA)和中國(guó)心血管健康多中心合作研究(International Collaborative Study of Cardiovascular Disease in Asia,InterAsia)的調(diào)查對(duì)象,該兩項(xiàng)研究分別于1998年和2000-2001年開(kāi)展基線(xiàn)調(diào)查,共納入年齡在35～74歲之間的研究對(duì)象共27020人,于2007-2008年和2013～2015年開(kāi)展兩次隨訪(fǎng)調(diào)查。本研究最終分析納入23227名研究對(duì)象,其中男性11112人,女性12115人。將研究對(duì)象分性別按照LAP四分位數(shù)分組,以L(fǎng)AP第一分位組為參照,使用Cox比例風(fēng)險(xiǎn)回歸模型分析男性和女性不同LAP水平組的動(dòng)脈粥樣硬化性心血管病發(fā)病風(fēng)險(xiǎn)比。結(jié)果中國(guó)成人LAP 適用公式為:LAP(男)=[WC(cm)-59.1 cm]×TG(mmol/L),LAP(女)=[WC(cm)-56.4cm]×TG(mmol/L)。本研究隊(duì)列平均隨訪(fǎng) 12.3 年,有1081例研究對(duì)象發(fā)生ASCVD,其中男性657人,女性424人。男性第一分位LAP水平組至第四分位LAP水平組動(dòng)脈粥樣硬化性心血管病發(fā)病率分別為3.74/1000人年、4.18/1000人年、5.71/1000人年和5.98/1000人年,女性分別為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水平組為參照,經(jīng)過(guò)調(diào)整協(xié)變量包括年齡、城鄉(xiāng)、南北方、高中及以上教育水平、心血管病家族史、工作相關(guān)中-重度體力活動(dòng)水平、吸煙、飲酒、空腹血糖和基線(xiàn)收縮壓水平,男性人群第二分位、第三分位以及第四分位LAP水平組發(fā)生ASCVD的HR 值(95%CI)分別為 0.97(0.76,1.25)、1.17(0.92,1.49)和 1.10(0.85,1.41),線(xiàn)性趨勢(shì)檢驗(yàn) P=0.407;女性分別為 1.42(0.98,2.06)、1.30(0.90,1.87)和 1.72(1.21,2.44),線(xiàn)性趨勢(shì)檢驗(yàn)P=0.003。將對(duì)數(shù)轉(zhuǎn)換后的LAP值作為連續(xù)性變量代入模型,結(jié)果顯示LnLap每增加一個(gè)單位,女性動(dòng)脈粥樣硬化性心血管病的發(fā)病風(fēng)險(xiǎn)增加24%(95%CI:8.9%,41.2%),男性的發(fā)病風(fēng)險(xiǎn)增加5.3%,但未達(dá)到統(tǒng)計(jì)學(xué)顯著水平。結(jié)論女性動(dòng)脈粥樣硬化性心血管病發(fā)病風(fēng)險(xiǎn)隨LAP水平增加呈逐漸增加的趨勢(shì),LAP是女性動(dòng)脈粥樣硬化性心血管病發(fā)病的危險(xiǎn)因素,LAP對(duì)于女性ASCVD發(fā)病具有預(yù)測(cè)價(jià)值。動(dòng)脈粥樣硬化性心血管病在男性中未呈現(xiàn)此趨勢(shì),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.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R181.3

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