长江三峡地区的故事：根据 ATPIII、WHO 和 IDF 标准比较代谢综合征的患病率，以及与中国现代化进程中血管健康的关系。

A Tale of Three Gorges in the Yangtze River: Comparing the Prevalence of Metabolic Syndrome According to ATPIII, WHO, and IDF Criteria and the Association with Vascular Health in Modernizing China.

机构信息

1 Institute of Future Cities, The Chinese University of Hong Kong, Hong Kong SAR, China.

2 Department of Anesthesia, Ninth Peoples Hospital of Chongqing, Chongqing, China.

出版信息

Metab Syndr Relat Disord. 2019 Apr;17(3):137-142. doi: 10.1089/met.2018.0091. Epub 2019 Mar 5.

DOI:10.1089/met.2018.0091

PMID:30835162

Abstract

BACKGROUND

Metabolic syndrome (MS) is associated with atherosclerotic diseases. The prevalence of MS according to the Adult Treatment Panel III (ATPIII), World Health Organization (WHO), and International Diabetes Federation (IDF) criteria are variable but increasing in western countries and modernizing China. This study aimed to evaluate the prevalence of MS according to these three criteria, in farmers or ex-farming residents in three-gorges territories undergoing rapid lifestyle changes.

METHODS

We compared 95 residents (ex-farmers) in Wu Shan (WS) (28.4% men, aged 49.7 ± 9 years) resettled uphill for 3-5 years, and 87 age- and gender-matched farmers in Da Chang (DC) (27.6% men, aged 48.8 ± 10 years) before migration. MS and other traditional risk factors were assessed and carotid intima-media thickness (IMT) measured.

RESULTS

Ninety-nine percent of WS residents were retired or adopted nonfarming jobs. Compared with DC farmers, WS ex-farmers had higher waist circumference, low density lipoprotein-cholesterol, and triglycerides (P < 0.0001), but their blood pressures, HDL-cholesterol, and fasting glucose were similar. MS were identified in 43.2% (IDF), 36.8% (WHO), and 29.5% (ATPIII) respectively in WS ex-farmers, compared with 17.2%, 13.8%, and 11.5% respectively in DC farmers. Carotid IMT was significantly higher in WS ex-farmers (0.74 ± 0.16 mm) than in DC farmers (0.64 ± 0.11 mm) (P < 0.0001). On multivariate regression analysis, prevalence of MS was correlated with job nature (beta = 0.425, P < 0.0001). Carotid IMT was better correlated with IDF MS criteria (beta = 0.208, P = 0.021), independent of age and WS location (regression adjusted R = 0.444, F-value 12.0, P < 0.0001), but not with the ATPIII or WHO criteria.

CONCLUSIONS

IDF MS criteria is more sensitive, better correlates with atherosclerosis surrogate, and accordingly is more readily applicable to modernizing China.

摘要

背景

代谢综合征（MS）与动脉粥样硬化性疾病有关。根据成人治疗小组 III（ATPIII）、世界卫生组织（WHO）和国际糖尿病联合会（IDF）标准，MS 的患病率各不相同，但在西方国家和现代化的中国呈上升趋势。本研究旨在评估这三种标准在中国三峡地区快速生活方式改变过程中从事农业或原务农居民的 MS 患病率。

方法

我们比较了 95 名（原）居民（WS）（28.4%男性，年龄 49.7±9 岁），他们已搬迁到山上居住 3-5 年，以及 87 名年龄和性别匹配的农民（DC）（27.6%男性，年龄 48.8±10 岁）。评估了 MS 和其他传统危险因素，并测量了颈动脉内膜中层厚度（IMT）。

结果

WS 居民 99%已退休或从事非农业工作。与 DC 农民相比，WS 原居民的腰围、低密度脂蛋白胆固醇和甘油三酯更高（P<0.0001），但血压、高密度脂蛋白胆固醇和空腹血糖相似。WS 原居民的 MS 分别按 IDF（43.2%）、WHO（36.8%）和 ATPIII（29.5%）标准检出，而 DC 农民的 MS 分别为 17.2%、13.8%和 11.5%。WS 原居民的颈动脉 IMT 明显高于 DC 农民（0.74±0.16 mm 比 0.64±0.11 mm）（P<0.0001）。多变量回归分析显示，MS 患病率与工作性质有关（β=0.425，P<0.0001）。颈动脉 IMT 与 IDF MS 标准相关性更好（β=0.208，P=0.021），独立于年龄和 WS 位置（回归调整后的 R=0.444，F 值 12.0，P<0.0001），而与 ATPIII 或 WHO 标准无关。