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目的比较美国国家胆固醇教育计划成人治疗指南Ⅲ(NCEP ATPⅢ)代谢综合征定义与心血管病传统危险因素对我国中年男性总死亡率的预测价值。方法本研究在“中国多省市心血管病前瞻性队列研究”上海市人群队列基础上进行。1992年,上海市共有808名35~60岁的中年男性完成了心血管病传统危险因素的基线调查。随访1992-2007年该队列的全死因死亡。利用Cox比例风险模型评估基线NCEP-ATPⅢ代谢综合征定义〔血压升高:收缩压>130 mm Hg或舒张压>85 mm Hg;空腹血糖升高:空腹血糖>6.105 mmol/L(110 mg/d l);甘油三酯(TG)升高:>1.695 mmol/L(150 mg/d l);高密度脂蛋白胆固醇(HDL-C)降低:男性<1.04 mmol/L(40 mg/d l),女性<1.30 mmol/L(50 mg/d l);腰围增大:男性腰围>102 cm;女性>88 cm〕及其5个组成成分对全死因的预测价值。调整的混杂因素包括年龄和吸烟。结果基线808名40~60岁男性中,NCEP ATPⅢ定义代谢综合征的患病率为17.5%。在15年的随访中,共发生各种原因的死亡27例。代谢综合征对总死亡率风险比(HR)及95%可信区间(CI)为1.35(0.57,3.23)。把代谢综合征5个组成成分引入同一模型后,血压升高是总死因死亡的强预测因素,HR与95%CI为3.14(1.29~7.66)。高血糖、高甘油三酯、腰围增大和低HDL水平的HR与95%CI依次为1.48(0.52~4.24),1.51(0.59~3.89),1.59(0.60~4.24)和1.14(0.43~3.04)。结论在我国中年男性中,血压水平升高较NCEP ATPⅢ定义代谢综合征对总死亡率的预测价值更大。
Objective To compare the predictive value of NCEP ATP Ⅲ with the definition of metabolic syndrome and the traditional risk factors of cardiovascular disease in the overall mortality of middle-aged men in China. Methods This study was conducted on the basis of a cohort study of prospective cohort of cardiovascular disease in many provinces in China. In 1992, a total of 808 middle-aged men aged 35-60 in Shanghai completed a baseline survey of traditional risk factors for cardiovascular disease. Follow-up All-cause deaths in this cohort during 1992-2007. Baseline NCEP-ATP III Metabolic Syndrome Assessment Using Cox Proportional Hazard Model (Hypertension: systolic blood pressure> 130 mm Hg or diastolic blood pressure> 85 mm Hg; elevated fasting plasma glucose: 6.105 mmol / L (110 mg / dl ); Triglyceride (TG) increased:> 1.695 mmol / L (150 mg / dl); HDL-C decreased: male <1.04 mmol / L (40 mg / dl) 1.30 mmol / L (50 mg / dl); waist circumference increased:> 102 cm in men and> 88 cm in women] and its five components for all-cause mortality. Confounding factors include age and smoking. Results The prevalence of metabolic syndrome was defined as NCEP ATP III in 808 men aged 40-60 years at baseline of 17.5%. In 15 years of follow-up, a total of 27 cases of deaths of various causes. Metabolic syndrome to total mortality hazard ratio (HR) and 95% confidence interval (CI) was 1.35 (0.57, 3.23). After the five components of metabolic syndrome were introduced into the same model, elevated blood pressure was a strong predictor of overall mortality, with a HR and 95% CI of 3.14 (1.29 to 7.66). HR and 95% CI for hyperglycemia, hypertriglyceridemia, increased waist circumference and low HDL were 1.48 (0.52-4.42), 1.51 (0.59-3.89), 1.59 (0.60-4.44) and 1.14 (0.43-3.04), respectively. Conclusion Among the middle-aged men in our country, the increase of blood pressure level is more valuable than the NCEP ATPⅢ-defined metabolic syndrome in predicting the total mortality.