發(fā)布時間：2018-05-17 18:43

  本文選題：高血壓 + 體重變化��； 參考：《山東大學》2017年碩士論文

【摘要】：高血壓與肥胖均是全球公共衛(wèi)生問題,關(guān)于肥胖與高血壓關(guān)系的研究最早可以追溯到20世紀20年代,隨后Landsberg等人開始用"obesity-related hypertension "對肥胖相關(guān)性高血壓進行描述。盡管肥胖直接引起高血壓的生物學機制尚未完全清楚,但兩者間的關(guān)系已基本確立;然而另一個更具公共衛(wèi)生學意義的危險因素"體重變化"與高血壓的發(fā)生及血壓之間的關(guān)系更值得引起研究者的關(guān)注。目前,大多數(shù)研究僅僅觀察體重變化(定義為基線與高血壓發(fā)病或最后一次隨訪時的體重之差)這一籠統(tǒng)的單一指標,而實際上體重變化有多種涵義,因而該指標無法從多角度闡明體重變化對高血壓影響的模式;還有部分研究只關(guān)注某性別的人群或者研究人群的年齡段非常窄,可能會使研究結(jié)論的推廣存在局限性。此外,有部分研究基于橫斷面設計或自我報告的人體測量學指標,也會存在偏倚。資料與方法:本研究基于"山東多中心縱向健康管理隊列",選取了 2004年～2016年參加體檢且年滿18歲的城市漢族人群,構(gòu)建高血壓隨訪隊列,體檢兩次及以上,排除身高、體重、收縮壓和舒張壓四個變量有缺失值者及首次體檢時有高血壓、心血管疾病者,最終有87296人(其中,男45482人、女41814人)進入隊列。首先定義了五種"體重變化"指標,分別為"絕對體重變化(基線與高血壓發(fā)病或最后一次隨訪時的體重之差)"、"相對體重變化(絕對體重變化除以基線體重)"、"年均體重變化(絕對體重變化除以隨訪時間(年))"、"絕對BMI變化(基線與高血壓發(fā)病或最后一次隨訪時的BMI之差)"和"BMI變化速率(以體檢時間為自變量、BMI為因變量直線回歸的斜率)";每種指標有其不同的流行病學和統(tǒng)計學意義。然后基于中國肥胖標準,采用Cox比例風險回歸模型探索城市漢族人群不同性別五種體重變化指標對高血壓的影響;進而采用廣義估計方程(GEE模型)探究體重變化指標與血壓變化的定量關(guān)系(由于在計算BMI變化速率時已用到多次隨訪的數(shù)據(jù),故構(gòu)建GEE模型時,只納入前四個指標)。最后,求得不同體重變化指標與高血壓和血壓變化關(guān)聯(lián)性的標準化回歸系數(shù),以便為人們科學減肥提供指導依據(jù)。研究結(jié)果如下:1.BMI和五種體重變化指標的高血壓發(fā)病密度及其比較。①無論男女,不同BMI分組(分別為低體重組,正常體重組,超重組和肥胖組)的高血壓發(fā)病密度不同,且發(fā)病密度隨BMI升高而增加;②無論男女,絕對體重變化、相對體重變化、年均體重變化、絕對BMI變化各分組的高血壓發(fā)病密度均不同;除絕對體重變化中增重10kg組未發(fā)現(xiàn)發(fā)病密度間的性別差異外(u=0.384,P=0.701),其余各組均為男性高于女性。2.基線指標分析。所有納入研究的體檢指標均存在性別差異(P0.001);除女性的HDL值高于男性外(P0.001),其它基線指標均為男性高于女性(P0.001)。3.BMI和高血壓關(guān)聯(lián)性的Cox比例風險回歸模型結(jié)果顯示:RR值隨BMI的增加而增大;無論男女,超重和肥胖均是高血壓的危險因素(男性:RR值分別為1.254、1.554;女性:RR值分別為1.245、1.700);低體重是男性高血壓的保護因素(RR=0.780)。4.五種體重變化指標與高血壓關(guān)聯(lián)性的Cox比例風險回歸模型結(jié)果顯示:①絕對體重變化(以絕對體重變化≤5kg作為參照組)。對于男性,減重10kg、5kg減重≤1Okg及5kg增重≤1Okg的男性高血壓發(fā)病風險降低(RR值分別為0.680、0.585和0.943),當增重10kg時高血壓發(fā)病風險增加(RR=1.212);而對于女性,減重是高血壓的保護因素(減重1Okg、5kg減重≤1Okg的RR值分別為0.716、0.652),增重是其危險因素(5kg增重≤10kg、增重10kg的RR值分別為1.124、4.005);②相對體重變化(以相對體重變化≤5%作為參照組)。減重10%、5%減重≤10%均能降低男女高血壓的發(fā)病風險(男性:RR值分別為0.681、0.633;女性:RR值分別0.744、0.694),當增重10%時會增加男女高血壓的發(fā)病風險(男性:RR=1.083;女性:RR=2.100);③年均體重變化(以年均體重變化≤1kg作為參照組)。年均增重或減重1kg時,男女的RR值均大于1;④絕對BMI變化(以BMI變化1kg/m2作為參照組)。無論男女,BMI減小2kg/m2、1kg/m2BMI減小≤2kg/m2均為高血壓的保護因素(男性:RR值分別為0.520、0.703;女性:RR值分別為0.637、0.761);當BMI增大2kg/m2時,女性高血壓的發(fā)病風險升高(RR=1.870);⑤BMI變化速率。無論男女,BMI變化速率是高血壓的危險因素(男性:RR=1.474;女性:RR=1.530);⑥依據(jù)標準化偏回歸系數(shù)結(jié)果,無論男女,對高血壓發(fā)病影響最大的指標均為BMI變化速率(標準化偏回歸系數(shù)分別為 0.393、0.524)。5.四種體重變化指標與血壓變化的相關(guān)分析及其GEE模型結(jié)果顯示:(1)體重變化指標與血壓變化的相關(guān)分析:①無論男女,體重變化指標與SBP變化和DBP變化均存在正相關(guān)關(guān)系;②無論男女,體重變化指標與SBP變化的相關(guān)系數(shù)均大于與DBP變化的相關(guān)系數(shù)。(2)體重變化指標與血壓變化關(guān)聯(lián)性的GEE模型:①對于男性,除絕對BMI變化指標外,其它體重變化指標對SBP變化、DBP變化的影響均較小,絕對體重變化、相對體重變化、年均體重變化每升高一個水平,SBP 平均升高 0.0021mmHg、0.018mmHg、0.0011mmHg,DBP 平均升高 0.0017mmHg、0.014mmHg、0.0007mmHg;絕對 BMI 變化每升高一個單位,SBP平均升高0.0026mmHg,DBP平均升高0.0021mmHg;②對于女性,除絕對BMI變化指標外,其它體重變化指標與DBP變化的關(guān)聯(lián)性均大于其與SBP變化的關(guān)聯(lián)性,絕對體重變化、相對體重變化、年均體重變化每升高一個水平,SBP平均升高 0.0026mmHg、0.0020mmHg、0.0007mmHg,DBP 平均升高 0.4650mmHg、0.3014mmHg、0.1810mmHg;絕對BMI變化每升高一個單位,SBP平均升高0.0022mmHg,DBP平均升高0.3236mmHg。(3)依據(jù)標準化偏回歸系數(shù)結(jié)果,無論男女,對SBP變化、DBP變化影響最重要的指標均為絕對BMI變化。研究結(jié)論:1.體重變化對血壓有影響,但不同體重變化指標與高血壓和血壓變化的關(guān)聯(lián)性均不相同。2.依據(jù)Cox比例風險回歸模型標準化偏回歸系數(shù)結(jié)果:①男性各體重變化指標的重要性依次為:BMI變化速率、年均體重變化、絕對BMI變化、絕對體重變化和相對體重變化;②女性各體重變化指標的重要性依次為:BMI變化速率、年均體重變化、相對體重變化、絕對體重變化和絕對BMI變化。3.依據(jù)GEE模型標準化偏回歸系數(shù)結(jié)果,無論男女,對SBP變化、DBP變化影響最重要的指標均為絕對BMI變化。
[Abstract]:Hypertension and obesity are all global public health problems. Studies on the relationship between obesity and hypertension can be traced back to 1920s. Then Landsberg and others began to describe obesity related hypertension with "obesity-related hypertension". Although the biological mechanism of obesity directly causes hypertension, the biological mechanism is not completely clear, But the relationship between the two has been basically established; however, another more public health risk factor, "weight change", is more worthy of the attention of the researchers. Most studies are currently only observing body weight changes (defined as the baseline and the body of hypertension or the last follow-up. In fact, there are many meanings of this general single indicator, but in fact, there are many meanings of body weight change, so the index can not explain the model of weight change impact on hypertension from multiple angles. Some studies are based on cross-sectional design or self reporting of anthropometric indicators, and there will be bias. Data and methods: Based on the "Shandong multi center longitudinal health management queue", the study selected the urban Han population aged 18 years old from 2004 to 2016. The follow-up cohort of hypertension was constructed, and two times and above were excluded. The four variables of height, weight, systolic and diastolic pressure were missing, and there were 87296 people (of them, 45482 men and 41814 women) with hypertension and cardiovascular disease at the first physical examination. First, five "body weight changes" were defined, respectively, "the body weight change (the baseline and hypertension or the last follow-up body). Relative weight change (absolute weight change divided by baseline weight) "," annual average weight change (absolute weight change divided by follow-up time (year)) "," "absolute BMI change (baseline and hypertension or the last follow-up of the BMI difference)" and "BMI change rate (with the time of physical examination as the independent variable, BMI as the slope of the variable linear regression) "Each index has its different epidemiological and statistical significance. Then based on the Chinese obesity standard, the Cox proportional risk regression model is used to explore the effect of five kinds of body weight changes on the hypertension in the urban Han population, and then the generalized estimation equation (GEE model) is used to explore the quantitative correlation between the index of body weight change and the change of blood pressure. In order to provide guidance for people to lose weight, the results are as follows: 1.BMI and five kinds of weight. The results are as follows: the results are as follows: 1.BMI and five kinds of weight. (1) the density of hypertension in different BMI groups (low body recombination, normal weight group, super recombinant and obesity group) was different, and the density of the disease was increased with the increase of BMI; and the change of absolute weight, relative weight, annual weight, absolute BMI change The incidence of high blood pressure in each group was different, except the sex difference between the weight gain 10kg group and the weight gain group (u=0.384, P=0.701), and the other groups were all higher than the female.2. baseline analysis. All the examination indexes in the study had sex difference (P0.001), and the HDL value of women was higher than that of the male (P0.0). 01) the Cox proportional risk regression model of other baseline indicators that were male higher than women (P0.001).3.BMI and hypertension showed that the RR value increased with the increase of BMI; both male and female, overweight and obesity were risk factors for hypertension (male: RR, 1.254,1.554, RR value, respectively 1.245,1.700); low weight was male. The Cox proportional risk regression model of the five weight change indices of hypertension (RR=0.780).4. and the association of hypertension showed: (1) the absolute weight change (with the absolute weight change < 5kg as the reference group). For men, the risk of hypertension in men with weight loss 10kg, 5kg weight less than 1Okg and 5kg weight gain less than 1Okg (RR values, respectively) For 0.680,0.585 and 0.943), the risk of hypertension increased when weight gain was 10kg (RR=1.212); for women, weight loss was a protective factor for hypertension (weight loss 1Okg, RR value of 5kg weight less than 1Okg respectively 0.716,0.652), and weight gain was a risk factor (5kg increase weight < < 10kg, 10kg RR value); and relative weight change (relative weight) Weight change less than 5% as a reference group. Weight loss 10%, 5% weight loss less than 10% can reduce the risk of hypertension in men and women (male: RR value is 0.681,0.633, female: RR respectively 0.744,0.694), when the weight gain 10% will increase the risk of hypertension in men and women (male: RR=1.083; female: RR=2.100); and (3) annual weight change (average annual weight change is less than) 1kg as a reference group). When the average annual weight gain or weight loss 1kg, the RR value of both men and women is greater than 1; (4) the absolute BMI change (BMI change 1kg/m2 as the reference group). Regardless of the male and female, BMI decreases 2kg/m2,1kg/m2BMI less than 2kg/m2 is the protective factor of hypertension (male: RR value is 0.520,0.703; female: RR values respectively); when enlargement The risk of hypertension in women (RR=1.870); (5) the rate of change in BMI. The rate of change in BMI is a risk factor for hypertension (male: RR=1.474; female: RR=1.530). (6) according to the standardized partial regression coefficient, both male and female, the most influential index of hypertension is the rate of BMI change (standardized partial regression coefficient) The correlation analysis of four kinds of weight change indexes and blood pressure changes in.5. and the results of GEE model showed that: (1) the correlation analysis between the index of weight change and the change of blood pressure: (1) there is a positive correlation between the index of body weight change and the change of SBP and the changes of DBP in both men and women; (2) the relationship between the index of body weight change and the change of SBP in both men and women The correlation coefficient was greater than that of DBP. (2) the GEE model of the correlation between the weight change index and the blood pressure change: (1) for the male, except for the absolute BMI change index, the influence of the other weight change indexes on the change of SBP, the change of DBP, the change of absolute weight, the average annual weight change of one level, the average of SBP rise High 0.0021mmHg, 0.018mmHg, 0.0011mmHg, DBP increase 0.0017mmHg, 0.014mmHg, 0.0007mmHg, and the absolute BMI changes each unit, SBP increase averagely 0.0026mmHg, DBP average increase 0.0021mmHg. Association, absolute weight change, relative weight change, average annual weight change per level, SBP average increase 0.0026mmHg, 0.0020mmHg, 0.0007mmHg, DBP increase 0.4650mmHg, 0.3014mmHg, 0.1810mmHg; absolute BMI change per unit, SBP average increase 0.0022mmHg, DBP average rise (3) according to standardized partial return The result of return coefficient, the most important index of SBP change and DBP change for both men and women is absolute BMI change. Conclusion: 1. body weight changes have influence on blood pressure, but the correlation of different weight changes and hypertension and blood pressure change is different.2. according to the Cox proportional risk regression model standardized partial regression coefficient results: (1) male The importance of the index of body weight change was BMI change rate, annual weight change, absolute BMI change, absolute weight change and relative weight change, and the importance of female body weight change indexes were BMI change rate, annual weight change, relative weight change, absolute weight change and absolute BMI change.3. based on GEE model standard. The results of the normalized partial regression coefficient showed that the most important indicators of SBP change and DBP change were absolute BMI changes, both male and female.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R544.1

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