Article(id=1241023858283696851, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023847537897695, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202409150, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1725811200000, receivedDateStr=2024-09-09, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773812744923, onlineDateStr=2026-03-18, pubDate=1737734400000, pubDateStr=2025-01-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773812744923, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773812744923, creator=13701087609, updateTime=1773812744923, updator=13701087609, issue=Issue{id=1241023847537897695, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='2', pageStart='193', pageEnd='384', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773812742361, creator=13701087609, updateTime=1773812823817, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241024189247845056, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023847537897695, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241024189247845057, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023847537897695, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=376, endPage=380, ext={EN=ArticleExt(id=1241023859235803916, articleId=1241023858283696851, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Prevalence and risk factors of metabolic syndrome among middle-aged and elderly people in Tibet, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To comprehensively understand the incidence of metabolic syndrome (MS) and its potential risk elements in middle-aged and elderly people in Tibet, and to provide a scientific and reliable reference for the development and implementation of precise prevention and control strategies for MS in Tibet.

Methods

Between June 2021 and December 2022, 6 286 middle-aged and elderly people were strictly screened in Tibet by multi-stage stratified cluster random sampling. The data were organized and analyzed by using SPSS27.0 software, and the differences in MS prevalence among different groups were compared by using the chi-square test and the trend chi-square test, and further analyses of the factors affecting the prevalence of MS were conducted using logistics regression.

Results

Among 6 286 middle-aged and elderly participants, a total of 1 409 patients were screened, with an overall prevalence of metabolic syndrome of 22.41%, the older the age, the higher the prevalence of MS (χ2 = 49.694, P < 0.001); the prevalence of MS in men was 27.8%, higher than that in women, which was 18.21%, with a statistically significant difference (P < 0.001). Multifactorial unconditional logistic regression analysis revealed that the main risk factors for the prevalence of MS were advanced age (OR=2.053, 95% CI: 1.545-2.728) for those aged 70 years and above, a family history of hypertension (OR=2.691, 95% CI: 2.293-3.158), a family history of diabetes (OR=4.480, 95% CI: 2.066-9.716) and a body mass index (BMI)≥24.0 kg/m2 (OR=14.148, 95%CI: 11.778-16.995), however, female (OR=0.508, 95%CI: 0.443-0.584) and alcohol consumption (OR=0.628, 95%CI: 0.487-0.812) were protective factors for the development of MS. In addition, among the various combinations of abnormal components of MS, the aggregation pattern of “abnormal glucose + abnormal blood pressure +central obesity” was the most prevalent, involving a total of 340 cases, with a prevalence rate of 5.41%.

Conclusion

The prevalence of MS in middle-aged and elderly people in Tibet is at a high level, in which males, elderly people, people with a family history of hypertension or diabetes, and overweight or obese people should be regarded as the priority targets for MS prevention and control. This study provides a basic reference for the prevention and control of MS in Tibet, so that precise prevention and control measures can be taken according to the high-risk groups.

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目的

了解西藏地区中老年人代谢综合征(MS)的流行状况及其影响因素,为西藏地区制定并实施精准的MS的防控策略提供科学依据。

方法

2021年6月—2022年12月期间在西藏运用多阶段随机抽样的方法抽取6 286名中老年人进行调查, 使用SPSS 27.0软件对数据进行分析,利用χ2检验及趋势性χ2检验进行不同特征群体间的MS患病差异的比较,采用logistics回归模型进行MS患病的影响因素分析。

结果

在6 286名中老年参与者中,筛查出MS患者共计1 409例,总体患病率为22.41%;年龄越大,MS患病率越高(χ2=49.694,P<0.001);男性MS患病率为27.8%,高于女性的18.21%,差异具有统计学意义(P<0.001)。多因素logistic回归分析结果显示,高龄(70岁及以上者OR=2.053,95%CI:1.545~2.728)、高血压家族史(OR=2.691,95%CI:2.293~3.158)、糖尿病家族史(OR=4.480,95%CI:2.066~9.716)以及体质指数(BMI)≥24.0 kg/m2OR=14.148,95%CI:11.778~16.995)为MS患病的危险因素,女性(OR=0.508,95%CI:0.443~0.584)、饮酒(OR=0.628,95%CI:0.487~0.812)为MS患病的保护因素。“血糖异常 + 血压异常 + 中心性肥胖”是MS异常组分组合中最普遍的聚集模式,患病率为5.41%。

结论

西藏地区中老年人MS患病率相对较高,其中男性、高龄者、具有高血压或糖尿病家族史以及超重肥胖人群应被视为MS防控的优先关注对象。

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杨春霞, E-mail:
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于跃(1989—),女,硕士在读,主管医师,研究方向:慢性非传染性疾病预防与控制

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Preventive Medicine, 2013, 57(6): 867-871., articleTitle=Prevalence of metabolic syndrome and its influencing factors among the Chinese adults: the China Health and Nutrition Survey in 2009, refAbstract=null), Reference(id=1241023872313643419, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023858283696851, doi=null, pmid=null, pmcid=null, year=2021, volume=97, issue=7, pageStart=e695, pageEnd=e705, url=null, language=null, rfNumber=[23], rfOrder=34, authorNames=Zhang FF, Liu LL, Zhang CD, journalName=Neurology, refType=null, unstructuredReference=Zhang FF, Liu LL, Zhang CD, et al. Association of metabolic syndrome andits components with risk of stroke recurrence and mortality: a meta-analysis[J]. Neurology, 2021, 97(7): e695-e705., articleTitle=Association of metabolic syndrome andits components with risk of stroke recurrence and mortality: a meta-analysis, refAbstract=null)], funds=[Fund(id=1241023865497899222, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023858283696851, awardId=2021—2022年, language=CN, fundingSource=中央财政转移支付地方卫生计生项目—心血管病高危人群早期筛查与综合干预项目(2021—2022年), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241023860112413518, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023858283696851, xref=1., ext=[AuthorCompanyExt(id=1241023860133385042, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023858283696851, companyId=1241023860112413518, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1241023860141773653, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023858283696851, companyId=1241023860112413518, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.四川大学华西公共卫生学院/四川大学华西第四医院,四川 成都 610041)]), AuthorCompany(id=1241023860221465435, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023858283696851, xref=2., ext=[AuthorCompanyExt(id=1241023860229854046, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023858283696851, companyId=1241023860221465435, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.西藏自治区疾病预防控制中心)])], figs=[ArticleFig(id=1241023864684204182, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023858283696851, language=EN, label=Table 1, caption=

Prevalence of MS among elderly people with different characteristics in Tibet

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总人数患病数患病率
(%)
χ2P
性别82.072<0.001
2 75076527.81
3 53664418.21
年龄(岁)49.694a<0.001
40~492 11135516.82
50~592 31056924.63
60~691 41235425.07
≥7045313128.92
城乡2.4230.120
城区92922724.44
农牧区5 3571 18222.06
文化程度3.7910.052
初中以下94923624.87
初中及以上5 3371 17321.97
家庭年收入>5万0.9890.320
5 8161 29522.27
47011424.26
吸烟2.1790.103
5 8791 30922.27
40710024.57
饮酒5.0890.024
5 7371 30722.78
54910218.58
高血压家族史247.054<0.001
4 90488418.03
1 38252537.99
糖尿病家族史53.369<0.001
6 2421 37922.09
443068.18
BMI(kg/m21 127.061<0.001
<243 1631544.89
≥243 1231 25540.19
), ArticleFig(id=1241023864776478880, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023858283696851, language=CN, label=表1, caption=

西藏不同特征中老年人MS患病情况

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总人数患病数患病率
(%)
χ2P
性别82.072<0.001
2 75076527.81
3 53664418.21
年龄(岁)49.694a<0.001
40~492 11135516.82
50~592 31056924.63
60~691 41235425.07
≥7045313128.92
城乡2.4230.120
城区92922724.44
农牧区5 3571 18222.06
文化程度3.7910.052
初中以下94923624.87
初中及以上5 3371 17321.97
家庭年收入>5万0.9890.320
5 8161 29522.27
47011424.26
吸烟2.1790.103
5 8791 30922.27
40710024.57
饮酒5.0890.024
5 7371 30722.78
54910218.58
高血压家族史247.054<0.001
4 90488418.03
1 38252537.99
糖尿病家族史53.369<0.001
6 2421 37922.09
443068.18
BMI(kg/m21 127.061<0.001
<243 1631544.89
≥243 1231 25540.19
), ArticleFig(id=1241023864856170661, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023858283696851, language=EN, label=Table 2, caption=

Assignment of variables in logistic regression analysis

, figureFileSmall=null, figureFileBig=null, tableContent=
变量变量名称赋值方式
YMS否=0;是=1
X1性别男=0;女=1
X2年龄(岁)40~49=0;50~59=1;60~69=2;70~=3
X3饮酒否=0;是=1
X4高血压否=0;是=1
X5糖尿病否=0;是=1
X6血脂异常否=0;是=1
X7中心性肥胖否=0;是=1
X8BMI≥24 kg/m2否=0;是=1
), ArticleFig(id=1241023864940056749, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023858283696851, language=CN, label=表2, caption=

logistic回归分析变量赋值情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量变量名称赋值方式
YMS否=0;是=1
X1性别男=0;女=1
X2年龄(岁)40~49=0;50~59=1;60~69=2;70~=3
X3饮酒否=0;是=1
X4高血压否=0;是=1
X5糖尿病否=0;是=1
X6血脂异常否=0;是=1
X7中心性肥胖否=0;是=1
X8BMI≥24 kg/m2否=0;是=1
), ArticleFig(id=1241023865044914356, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023858283696851, language=EN, label=Table 3, caption=

Multifactorial unconditional logistic regression analysis of MS in middle-aged and elderly Tibetans

, figureFileSmall=null, figureFileBig=null, tableContent=
因素参照组βSEWald χ2POR值(95%CI
性别-0.6760.07191.485<0.0010.508(0.443~0.584)
年龄(岁)50~5940~490.3590.08617.360<0.0011.432(1.209~1.695)
60~690.3480.10012.1070.0011.416(1.164~1.723)
≥700.7190.14524.583<0.0012.053(1.545~2.728)
文化程度初中及以上初中以下0.1700.0963.1340.0771.185(0.982~1.430)
饮酒-0.4640.13012.628<0.0010.628(0.487~0.812)
高血压家族史0.9900.082147.047<0.0012.691(2.293~3.158)
糖尿病家族史1.5000.39514.419<0.0014.480(2.066~9.716)
BMI≥24 kg/m22.6500.094802.185<0.00114.148(11.778~16.995)
), ArticleFig(id=1241023865141383358, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023858283696851, language=CN, label=表3, caption=

西藏中老年人MS的多因素非条件logistic回归分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
因素参照组βSEWald χ2POR值(95%CI
性别-0.6760.07191.485<0.0010.508(0.443~0.584)
年龄(岁)50~5940~490.3590.08617.360<0.0011.432(1.209~1.695)
60~690.3480.10012.1070.0011.416(1.164~1.723)
≥700.7190.14524.583<0.0012.053(1.545~2.728)
文化程度初中及以上初中以下0.1700.0963.1340.0771.185(0.982~1.430)
饮酒-0.4640.13012.628<0.0010.628(0.487~0.812)
高血压家族史0.9900.082147.047<0.0012.691(2.293~3.158)
糖尿病家族史1.5000.39514.419<0.0014.480(2.066~9.716)
BMI≥24 kg/m22.6500.094802.185<0.00114.148(11.778~16.995)
), ArticleFig(id=1241023865263018181, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023858283696851, language=EN, label=Table 4, caption=

Aggregation patterns of different abnormal components of MS in middle-aged and elderly Tibetans

, figureFileSmall=null, figureFileBig=null, tableContent=
MS组合类(种)血糖异常血压异常中心性肥胖高TG低HDL-C患病数患病率(%)
3+++--3405.41
3++-+-1001.59
3++--+420.67
3+-++-831.32
3+-+-+490.78
3+--++50.08
3-+++-1061.69
3-++-+1582.51
3-+-++1041.65
4++++-1832.91
4+++-+1342.13
4++-++70.11
4+-+++150.24
4-++++400.64
5+++++430.68
), ArticleFig(id=1241023865384653009, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023858283696851, language=CN, label=表4, caption=

西藏中老年人MS不同异常组分聚集模式

, figureFileSmall=null, figureFileBig=null, tableContent=
MS组合类(种)血糖异常血压异常中心性肥胖高TG低HDL-C患病数患病率(%)
3+++--3405.41
3++-+-1001.59
3++--+420.67
3+-++-831.32
3+-+-+490.78
3+--++50.08
3-+++-1061.69
3-++-+1582.51
3-+-++1041.65
4++++-1832.91
4+++-+1342.13
4++-++70.11
4+-+++150.24
4-++++400.64
5+++++430.68
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西藏中老年人代谢综合征患病现状及危险因素分析
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于跃 1, 2 , 白国霞 2 , 扎西宗吉 2 , 史恒 2 , 彭介入 1 , 杨春霞 1
现代预防医学 | 临床与预防 2025,52(2): 376-380
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现代预防医学 | 临床与预防 2025, 52(2): 376-380
西藏中老年人代谢综合征患病现状及危险因素分析
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于跃1, 2, 白国霞2, 扎西宗吉2, 史恒2, 彭介入1, 杨春霞1
作者信息
  • 1.四川大学华西公共卫生学院/四川大学华西第四医院,四川 成都 610041
  • 2.西藏自治区疾病预防控制中心
  • 于跃(1989—),女,硕士在读,主管医师,研究方向:慢性非传染性疾病预防与控制

通讯作者:

杨春霞, E-mail:
Prevalence and risk factors of metabolic syndrome among middle-aged and elderly people in Tibet
Yue YU1, 2, Guo-xia BAI2, Zong-ji ZHAXI2, Heng SHI2, Jie-ru PENG1, Chun-xia YANG1
Affiliations
  • West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2025-01-25 doi: 10.20043/j.cnki.MPM.202409150
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目的

了解西藏地区中老年人代谢综合征(MS)的流行状况及其影响因素,为西藏地区制定并实施精准的MS的防控策略提供科学依据。

方法

2021年6月—2022年12月期间在西藏运用多阶段随机抽样的方法抽取6 286名中老年人进行调查, 使用SPSS 27.0软件对数据进行分析,利用χ2检验及趋势性χ2检验进行不同特征群体间的MS患病差异的比较,采用logistics回归模型进行MS患病的影响因素分析。

结果

在6 286名中老年参与者中,筛查出MS患者共计1 409例,总体患病率为22.41%;年龄越大,MS患病率越高(χ2=49.694,P<0.001);男性MS患病率为27.8%,高于女性的18.21%,差异具有统计学意义(P<0.001)。多因素logistic回归分析结果显示,高龄(70岁及以上者OR=2.053,95%CI:1.545~2.728)、高血压家族史(OR=2.691,95%CI:2.293~3.158)、糖尿病家族史(OR=4.480,95%CI:2.066~9.716)以及体质指数(BMI)≥24.0 kg/m2OR=14.148,95%CI:11.778~16.995)为MS患病的危险因素,女性(OR=0.508,95%CI:0.443~0.584)、饮酒(OR=0.628,95%CI:0.487~0.812)为MS患病的保护因素。“血糖异常 + 血压异常 + 中心性肥胖”是MS异常组分组合中最普遍的聚集模式,患病率为5.41%。

结论

西藏地区中老年人MS患病率相对较高,其中男性、高龄者、具有高血压或糖尿病家族史以及超重肥胖人群应被视为MS防控的优先关注对象。

代谢综合征  /  患病现状  /  影响因素  /  中老年人  /  西藏
Objective

To comprehensively understand the incidence of metabolic syndrome (MS) and its potential risk elements in middle-aged and elderly people in Tibet, and to provide a scientific and reliable reference for the development and implementation of precise prevention and control strategies for MS in Tibet.

Methods

Between June 2021 and December 2022, 6 286 middle-aged and elderly people were strictly screened in Tibet by multi-stage stratified cluster random sampling. The data were organized and analyzed by using SPSS27.0 software, and the differences in MS prevalence among different groups were compared by using the chi-square test and the trend chi-square test, and further analyses of the factors affecting the prevalence of MS were conducted using logistics regression.

Results

Among 6 286 middle-aged and elderly participants, a total of 1 409 patients were screened, with an overall prevalence of metabolic syndrome of 22.41%, the older the age, the higher the prevalence of MS (χ2 = 49.694, P < 0.001); the prevalence of MS in men was 27.8%, higher than that in women, which was 18.21%, with a statistically significant difference (P < 0.001). Multifactorial unconditional logistic regression analysis revealed that the main risk factors for the prevalence of MS were advanced age (OR=2.053, 95% CI: 1.545-2.728) for those aged 70 years and above, a family history of hypertension (OR=2.691, 95% CI: 2.293-3.158), a family history of diabetes (OR=4.480, 95% CI: 2.066-9.716) and a body mass index (BMI)≥24.0 kg/m2 (OR=14.148, 95%CI: 11.778-16.995), however, female (OR=0.508, 95%CI: 0.443-0.584) and alcohol consumption (OR=0.628, 95%CI: 0.487-0.812) were protective factors for the development of MS. In addition, among the various combinations of abnormal components of MS, the aggregation pattern of “abnormal glucose + abnormal blood pressure +central obesity” was the most prevalent, involving a total of 340 cases, with a prevalence rate of 5.41%.

Conclusion

The prevalence of MS in middle-aged and elderly people in Tibet is at a high level, in which males, elderly people, people with a family history of hypertension or diabetes, and overweight or obese people should be regarded as the priority targets for MS prevention and control. This study provides a basic reference for the prevention and control of MS in Tibet, so that precise prevention and control measures can be taken according to the high-risk groups.

Metabolic syndrome  /  Disease status  /  Influencing factors  /  Middle-aged and elderly people  /  Xizang
于跃, 白国霞, 扎西宗吉, 史恒, 彭介入, 杨春霞. 西藏中老年人代谢综合征患病现状及危险因素分析. 现代预防医学, 2025 , 52 (2) : 376 -380 . DOI: 10.20043/j.cnki.MPM.202409150
Yue YU, Guo-xia BAI, Zong-ji ZHAXI, Heng SHI, Jie-ru PENG, Chun-xia YANG. Prevalence and risk factors of metabolic syndrome among middle-aged and elderly people in Tibet[J]. Modern Preventive Medicine, 2025 , 52 (2) : 376 -380 . DOI: 10.20043/j.cnki.MPM.202409150
代谢综合征(metabolic syndrome MS)是一组常见的临床综合征,主要涉及腹型肥胖、糖代谢异常、脂类代谢紊乱和高血压,胰岛素抵抗是其最重要的病理机制,内脏型肥胖是其最常见的临床表现。相关研究表明,MS被视为导致多种心脑血管疾病及恶性肿瘤的关键诱因,涉及冠心病、脑卒中、糖尿病、胰腺癌,还有与性激素水平相关联的前列腺癌、乳腺癌等癌症,对人类身体健康及生活质量等带来了巨大威胁[1-3]。全球目前有超过10亿人受到 MS的影响[3]。西藏坐落于青藏高原之上,其区域内绝大部分地区海拔超过4 000米,因此被誉为“世界屋脊”及“地球第三极”。目前有关海拔较高西藏地区MS患病现况分析的相关研究较少,本研究旨在通过分析西藏中老年人群MS的流行状况及其潜在风险因素,为当地制定更加精准有效的预防与控制策略提供科学依据。
来源于2021年6月—2022年12月在西藏自治区开展的“心血管病高危人群早期筛查与综合干预项目”的调查人群。使用多阶段随机抽样的方法,在西藏7市(地)中各随机抽取1个区/县,然后在被抽中的区/县中法再各自随机抽取4个街道/乡,抽中街道/乡中连续居住六个月及以上、年龄≥40岁常住居民作为调查对象。本研究实施前已取得阜外医院伦理委员会审批通过(2014-574),每位研究对象在正式参与调查研究前,均由调查人员向其解释研究方案、数据保密措施、自愿参与原则及随时退出的权力等相关信息,研究对象在充分了解并自愿签署知情同意书后,才会被正式纳入调查。
由国家项目办统一制定的调查问卷,由接受过国家及省级两级培训的调查员进行面对面调查,问卷内容涉及基本信息(性别、年龄等)、疾病史、生活行为习惯、腰围、血压测量等。吸烟指每天至少吸1支,且持续吸烟时间≥6个月[4];饮酒指有每周至少有1次饮酒行为[5]。采用身高体重仪测量身高及体重,测量时要求被测者脱鞋帽及厚外套,并清空裤子口袋中的物品。血压测量前中老年被调查者要在安静环境中休息至少五分钟,需要测量两次右上臂血压,测量值相差<10 mmHg,取两次平均值作为最终血压值。
采集调查对象空腹外周静脉血用于检测空腹血糖(FBG)、总胆固醇(TC)、高密度脂蛋白(HDL–C)、低密度脂蛋白(LDL- C)、甘油三酯(TG)等指标。所有检测仪器及试剂均按照国家心血管病中心的要求进行采购,其中血糖检测采用PD-G001-2型血糖仪,血脂检测则使用Cardiocheck PA干式血脂检测仪。
高血压指收缩压(SBP)≥140 mmHg和/或舒张压(DBP)≥90 mmHg,或自报服用降血压药物[6]。糖尿病指空腹血糖(FPG)≥7.0 mmol/L,或自报服用降血糖药物[7];超重指24.0 kg/m2≤身体质量指数(BMI)<28.0 kg/m2,肥胖指BMI≥28.0 kg/m2[8]。代谢综合征(MS)判定标准采用中华医学会糖尿病分会的诊断标准[7]具有以下三项及以上特征者即为MS患者:①中心性肥胖:腰围男性≥90 cm、女性≥85 cm;②血压异常:收缩压(SBP)≥130 mmHg和(或)舒张压(DBP)≥85 mmHg,或已确诊为高血压并治疗者;③血糖异常:FPG≥6.1 mmol/L和(或)已确诊为糖尿病并治疗者;④高TG:TG≥1.70 mmol/L;⑤低HDL-C:HDL-C<1.04 mmol/L。
使用SPSS 27.0软件对数据进行整理并分析,利用χ2检验及趋势性χ2检验进行不同特征群体间MS患病差异的比较,采用logistic回归模型探讨MS患病的危险因素,检验水准α=0.05。
本次调查共收集到6 542名对象的信息,剔除不完整及异常数据后,最终对6 286名年龄≥40岁的中老年人的信息进行分析,数据有效率为96.1%。对象中男性2 750人(43.75%),女性3 536人(56.25%);年龄40~49岁2 111人(33.58%),50~59岁2 310人(36.75%),60~69岁1 412人(22.46%),70岁及以上453人(7.21%);城区929人(14.78%),农牧区5 357人(85.22%);文化程度在初中及以上者949人(15.10%),初中以下5 337人(84.90%);不吸烟者5 879人(93.50%),吸烟者407人(6.47%);不饮酒者5 737人(91.27%),饮酒者549人(8.73%);体质指数(BMI)≥24.0 kg/m2者有3 123人(49.68%);有高血压家族史1 382人(21.99%);有糖尿病家族史者44人(0.70%)。
6 286名对象中,共筛出MS患者1 409人,患病率为 22.41%。随着年龄增加MS患病率增高,女性MS患病率(18.21%)低于男性(27.81%),饮酒者MS的患病率(18.58%)低于不饮酒者(22.78%),有高血压(37.99%)及糖尿病家族史者(68.18%)MS患病率高于无高血压(18.03%)及糖尿病家族史者(22.09%),BMI≥24.0 kg/m2者MS患病率(40.19%)高于BMI<24.0 kg/m2者,差异均有统计学意义(P<0.05),见表1
以是否患MS作为因变量,纳入性别、年龄、文化程度、饮酒情况、高血压、糖尿家族史及BMI等因素构建MS患病的多因素非条件logistic回归模型,赋值情况见表2。结果发现,年龄增长会增加MS的患病风险;高血压家族史(OR=2.691,95%CI:2.293~3.158)、糖尿病家族史(OR=4.480,95%CI:2.066~9.716)、BMI≥24.0 kg/m2OR=14.148,95%CI:11.778~16.995)是西藏中老年人MS患病的危险因素;饮酒(OR=0.628,95%CI:0.487~0.812)、女性(OR=0.508,95%CI:0.443~0.584)为MS患病的保护因素,见表3
调查对象MS不同组分中最普遍的组合为“血糖异常+血压异常 + 中心性肥胖”的聚集模式,有340例,患病率为5.41%,其次为血糖异常+血压异常+中心性肥胖+高TG”的组成模式,有183例,患病率为2.91%;不同代谢异常组分聚集模式情况。见表4
代谢综合征与脑卒中[9]、心肌梗死[10] 等严重影响健康的慢性疾病发展紧密相关,而代谢综合征确切起因至今尚未明确[11],因此,深入分析不同人群特征MS的流行状况及其影响因素,对于制定有效的疾病防控策略,维护公众健康,具有深远的公共卫生意义。本研究首次调查西藏中老年人MS的患病现状及其相关影响因素。
西藏中老年人MS患病率为22.41%,低于成都市27.00%[11],高于云南省16.40%[12]和河北省的16.51%[13],也远高2009—2011年西藏拉萨地区成年藏族的MS患病率(8.1%)[14],提示西藏成年居民MS患病率较高并且呈现大幅度上升趋势,值得高度重视。西藏地处高原地区,缺氧和独特生活习俗是MS的重要诱因。一方面缺氧导致机体代偿性改变,如心率加快、红细胞增多,同时干扰代谢,导致脂肪酸摄取下降而葡萄糖摄取上升等[14];此外,当地居民偏好高热量饮食如甜茶、奶渣等,与代谢紊乱疾病风险紧密相连[14-16]。随着经济与生活的城市化进程加速,居民生活方式也发生了变化,除了饮食因素,运动不足也可能导致能量消耗不达标,进而增加肥胖和代谢综合征的风险[16-17]
女性MS患病率低于男性,这可能与人体内的炎症状况密切相关[18],男性MS患者往往表现出过量的促炎细胞因子产生,相比之下,女性患者则通常伴有抗炎脂肪因子—脂联素水平的下降。另外年龄是MS患病的危险因素,随年龄增加,MS患病率升高,这可能与随年龄增加,机体各器官功能的逐渐减弱,个体更容易受到疾病的侵扰,从而引发多种代谢异常状况。本次研究得出存在高血压或糖尿病家族史,以及身体质量指数(BMI)达到或超过24 kg/m2是MS患病的危险因素,与其他相关研究结论基本一致。MS是一种多基因遗传病,发病具有家族聚集性,具有高血压或糖尿病家族史的人因可能拥有相关易感基因,而面临更高的MS患病风险[19]。BMI是衡量个体肥胖程度的关键指标,BMI达到或超过24 kg/m2,通常意味着个体存在肥胖问题,肥胖者体内脂肪含量偏高,易引发胰岛素抵抗加剧,而胰岛素抵抗作为MS的关键特征。相关研究表明,吸烟与饮酒可能与较高的MS患病率存在关联[20-21],但也有研究未能发现这两者与MS之间的明确联系[22],本次研究发现饮酒为MS的保护因素,可能与饮酒的定义有关,饮酒定义为每周至少有1次,而不是根据饮酒量大小来定义饮酒行为。
西藏地区中老年人最为普遍的代谢异常组合表现为“血糖异常 + 血压异常 + 中心性肥胖“,其次是“血糖异常 + 血压异常 + 中心性肥胖+高TG”,这意味着在西藏,许多人同时面临着血糖水平不正常、血压偏高、腹部脂肪过多以及血脂异常的问题,这些因素共同作用显著增加了代谢综合征的风险。一项meta分析的结果揭示,个体中代谢综合征异常组分数量越多,其罹患心血管疾病的风险便相应增大[23] ,因此,针对代谢综合征的防控工作,关键在于强化对高危人群的早期筛查与及时干预措施。
本研究也存在一些局限性,一方面MS影响因素较多,本次研究未将饮食行为习惯等因素纳入分析,另一方面本研究采用现况研究设计,因果论证强度比较有限。今后要进一步深入研究,为MS精准防治提供相关循证依据。
综上所述,西藏中老年人MS患病率较高,应采取综合措施提升中老年人群高血压与糖尿病知识的认知普及度,维持正常的血压、血脂、血糖水平,从而降低MS患病风险,尤其针对超重肥胖者、具有高血压及糖尿病家族史、高年龄组及男性等重点人群。
  • 中央财政转移支付地方卫生计生项目—心血管病高危人群早期筛查与综合干预项目(2021—2022年)
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2025年第52卷第2期
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doi: 10.20043/j.cnki.MPM.202409150
  • 接收时间:2024-09-09
  • 首发时间:2026-03-18
  • 出版时间:2025-01-25
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  • 收稿日期:2024-09-09
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中央财政转移支付地方卫生计生项目—心血管病高危人群早期筛查与综合干预项目(2021—2022年)
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    1.四川大学华西公共卫生学院/四川大学华西第四医院,四川 成都 610041
    2.西藏自治区疾病预防控制中心

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
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