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目的探讨腰围增加与糖尿病患者高血压发病风险的关系,为糖尿病人群高血压的一级预防提供可靠依据。方法从2006年6月至2007年10月在开滦总医院系统共11家医院参加健康体检的101 510名在职及离退休职工中选取研究对象。将第1次健康体检中患糖尿病但未患高血压的体检者纳入研究队列。上述人群于2008年6月至2009年10月进行第2次健康体检,最终23 67例体检者纳入分析。将调查对象按照腰围水平分为肥胖组(男性腰围≥90 cm、女性腰围≥85 cm)和非肥胖组(男性腰围<90 cm、女性腰围<85 cm),依据基线腰围四分位数将研究对象分为4组(第1分位组:腰围<83 cm、第2分位组:83 cm≤腰围<89cm、第3分位组:89 cm≤腰围<94.3 cm、第4分位组:腰围WC≥94.3 cm),比较高血压检出率。用logistic回归模型分析腰围增加与高血压发病的相关性。结果肥胖组高血压检出率(42.50%)高于非肥胖组(33.92%),差异有统计学意义(P<0.01)。随着WC的增加,高血压的检出率逐渐升高,第1分位、第2分位、第3分位和第4分位组的检出率分别为29.85%、35.07%、40.10%和47.80%,组间比较差异有统计学意义(P<0.01)。按性别分层后,男性4组高血压的检出率分别为34.28%、36.38%、40.20%和48.26%,女性分别为18.99%、30.30%、39.64%和44.74%,组间比较差异均有统计学意义(P<0.01)。多因素logistic回归分析结果显示,与基线WC第1分位组比较,女性第2分位组、第3分位组和第4分位组的OR值分别为1.772、2.781和3.516;男性第4分位组OR值1.725;总体第3分位组和第4分位组的OR值分别为1.559和2.094,均有统计学意义(P<0.01)。校正年龄、收缩压等因素后,与基线WC第1分位组比较,仅有女性的第3分位组和第4分位组新发高血压风险增加(OR值分别为2.366和2.709)。结论 WC增长增加糖尿病人群高血压的发病风险,且有性别差异。
Objective To investigate the relationship between the increase of waist circumference and the risk of developing hypertension in patients with diabetes mellitus, and provide a reliable basis for primary prevention of hypertension in diabetic population. Methods From June 2006 to October 2007, 101 510 active and retired staff participating in health examination in 11 hospitals of Kailuan General Hospital were selected for the study. The first physical examination in the diabetic but not suffering from hypertension in the study were included in the cohort. The above population from June 2008 to October 2009 for the second health examination, the final 23 67 cases were included in the analysis. The subjects were divided into the obesity group (waist circumference≥90 cm in men and ≥85 cm in women) and the non-obese group (waist circumference <90 cm in men and <85 cm in waist) according to the waistline. Based on the baseline waist circumference quartiles, Subjects were divided into 4 groups (first sub-group: waist circumference <83 cm, second sub-group: 83 cm≤ waist circumference <89 cm, third sub-group: 89 cm≤ waist circumference <94.3 cm, Waist WC ≥ 94.3 cm), compared with the detection rate of high blood pressure. Logistic regression model was used to analyze the correlation between increased waist circumference and hypertension. Results The detection rate of hypertension (42.50%) in obesity group was higher than that in non-obesity group (33.92%), the difference was statistically significant (P <0.01). With the increase of WC, the detection rate of hypertension increased gradually. The detection rates of the 1st, 2nd, 3rd and 4th quantiles were 29.85%, 35.07% and 40.10% And 47.80%, respectively, there was significant difference between the two groups (P <0.01). According to gender stratification, the detection rate of hypertension in four groups of men were 34.28%, 36.38%, 40.20% and 48.26% respectively, and the differences among the groups were 18.99%, 30.30%, 39.64% and 44.74% Statistical significance (P <0.01). Multivariate logistic regression analysis showed that the ORs of women in the second, third and fourth quartiles were 1.772, 2.781 and 3.516, respectively, compared with those in the first quintile of baseline WC The odds ratio (OR) was 1.725. The odds ratios (ORs) of the third and fourth quartiles were 1.559 and 2.094, respectively (P <0.01). After adjustment for age, systolic blood pressure and other factors, only the risk of new-onset hypertension was increased in women in the third and fourth quintiles (OR = 2.366 and 2.709, respectively) as compared with the baseline WC-1 quintile. Conclusion The increase of WC increases the risk of hypertension in diabetic population, and there is a gender difference.