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Article(id=1241522923408773799, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202307077, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1688659200000, receivedDateStr=2023-07-07, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773931731320, onlineDateStr=2026-03-19, pubDate=1710000000000, pubDateStr=2024-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773931731320, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773931731320, creator=13701087609, updateTime=1773931731320, updator=13701087609, issue=Issue{id=1241522919977841545, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='5', pageStart='769', pageEnd='960', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773931730503, creator=13701087609, updateTime=1773931880386, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241523548695622547, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241523548695622548, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=776, endPage=780, ext={EN=ArticleExt(id=1241522923907895977, articleId=1241522923408773799, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis on the prevalence and influencing factors of hyperhomocysteinemia among adult Tibetan residents in the west of Xizang Ali, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the prevalence and influencing factors of hyperhomocysteinemia among Tibetan residents in the west of Xizang Ali.

Methods

By using the method of multi-stage cluster random sampling, Tibetan residents were randomly selected from the western area of Xizang Ali for physical examination and questionnaire survey, and blood routine and biochemical indexes were collected. The prevalence and influencing factors of hyperhomocysteinemia in this area were analyzed by chi-square test and multivariate logistic regression.

Results

A total of 1 362 Tibetan residents in the western region of Xizang Ali were investigated. The results showed that there were 1 044 patients with hyperhomocysteinemia, with a prevalence rate of 76.7%. The prevalence rate of males (84.8%) was higher than that of females (71.5%). Smoking (OR=1.988, 95%CI:1.076-3.675), poor household (OR=1.775, 95%CI: 1.204-2.540), hyperuricemia (OR=3.416, 95%CI: 2.494-4.679), hypercholesterolemia (OR=4.051, 95%CI: 2.811-5.838), and hypertriglyceridemia (OR=2.589, 95%CI: 1.765-3.798) were risk factors of hyperhomocysteinemia. Female (OR=0.538, 95%CI: 0.384-0.752) and agricultural and pastoral areas (OR=0.312, 95%CI:0.156-0.625) were protective factors.

Conclusion

The prevalence rate of hyperhomocysteinemia is high in the western region of Xizang Ali. Sex, residence, smoking, and poor households are the influencing factors of hyperhomocysteinemia. Hyperhomocysteinemia is significantly associated with hyperuricemia, hypercholesterolemia, hypertriglyceridemia, and other diseases.

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目的

了解西藏阿里西部地区藏族居民高同型半胱氨酸血症患病现状及影响因素。

方法

采用多阶段整群随机抽样方法，在西藏阿里西部地区随机抽取藏族居民进行健康体检、问卷调查，收集血常规及生化指标。通过χ2检验和多因素logistic回归分析该地区居民高同型半胱氨酸血症的患病情况及影响因素。

结果

共调查1 362名西藏阿里西部地区藏族居民，研究结果显示高同型半胱氨酸血症患者为1 044名，患病率76.7%，男性患病率为84.8%，高于女性的71.5%。吸烟（OR=1.988，95%CI：1.076～3.675）、贫困户（OR=1.775，95%CI：1.204～2.540）、高尿酸血症（OR=3.416，95%CI：2.494～4.679）、高胆固醇血症（OR=4.051，95%CI：2.811～5.838）、高甘油三酯血症（OR=2.589，95%CI：1.765～3.798）为高同型半胱氨酸血症患病危险因素，女性（OR=0.538，95%CI：0.384～0.752）、农牧区（OR=0.312，95%CI：0.156～0.625）为保护因素。

结论

西藏阿里西部地区高同型半胱氨酸血症患病率较高，性别、居住地、吸烟、贫困户是高同型半胱氨酸血症患病的影响因素。高同型半胱氨酸血症与高尿酸血症、高胆固醇血症、高甘油三酯血症等疾病显著相关。

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熊海，E-mail:；
次仁央宗，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=SL8oT6GrSLwKZCCtY3rQRg==, magXml=T0F+b0xe2pOidkAOFwO3Sw==, pdfUrl=null, pdf=9SqJE//nel2GtJyd7ot6RQ==, pdfFileSize=639881, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=Ezt9eeyCKerOR5Xn1rOnqg==, mapNumber=null, authorCompany=null, fund=null, authors=

丁康致（2000—），男，硕士在读，研究方向：医学遗传学

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丁康致（2000—），男，硕士在读，研究方向：医学遗传学

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丁康致（2000—），男，硕士在读，研究方向：医学遗传学

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Prevalence of hyperhomocysteinaemia among Tibetan residents in the western region of Ali, Tibet

, figureFileSmall=null, figureFileBig=null, tableContent=
基本特征类别人数患病人数患病率（%）χ2值P值
性别男52844884.832.369<0.001
女83459671.5
年龄（岁）18～241028482.425.364<0.001
25～4461043771.6
45～5942532676.7
≥6022519787.6
居住地城镇877282.855.866<0.001
农村46235075.8
牧区62051282.6
农牧区19311057.0
文化程度文盲86866076.00.9730.808
小学26920676.6
初中987778.6
高中及以上12710179.5
婚姻状况未婚16514084.87.1220.028
已婚1 15987675.6
其他382873.7
就业状况在业917481.31.1870.276
未在业1 27197076.3
全家过去一年总收入（元）<12 00022417779.01.5520.670
12 000～19 99953641477.2
20 000～59 99957142975.1
≥60 000312477.4
吸烟是13111575.510.0400.002
否1 23192987.8
饮酒是18314576.30.7880.375
否1 17989979.2
每周锻炼次数从不89568276.20.4480.799
1～220816378.4
≥325919976.8
贫困户是36230274.212.639<0.001
否1 00074283.4
BMI营养不良937277.43.7310.292
正常61045374.3
超重39631078.3
肥胖26320979.5
高尿酸血症是73465989.8153.346<0.001
否62838561.3
高血糖是716084.52.5820.108
否1 29198476.2
高胆固醇血症是55350791.7117.512<0.001
否80953766.4
高甘油三酯血症是28124787.925.030<0.001
否1 08179773.7
高血压是38531481.67.2190.007
否97773074.7
高原红细胞增多症是645789.15.7790.016
否1 29898794.5
), ArticleFig(id=1241678308568518993, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522923408773799, language=CN, label=表1, caption=

西藏阿里西部地区藏族居民HHcy患病情况

, figureFileSmall=null, figureFileBig=null, tableContent=
基本特征类别人数患病人数患病率（%）χ2值P值
性别男52844884.832.369<0.001
女83459671.5
年龄（岁）18～241028482.425.364<0.001
25～4461043771.6
45～5942532676.7
≥6022519787.6
居住地城镇877282.855.866<0.001
农村46235075.8
牧区62051282.6
农牧区19311057.0
文化程度文盲86866076.00.9730.808
小学26920676.6
初中987778.6
高中及以上12710179.5
婚姻状况未婚16514084.87.1220.028
已婚1 15987675.6
其他382873.7
就业状况在业917481.31.1870.276
未在业1 27197076.3
全家过去一年总收入（元）<12 00022417779.01.5520.670
12 000～19 99953641477.2
20 000～59 99957142975.1
≥60 000312477.4
吸烟是13111575.510.0400.002
否1 23192987.8
饮酒是18314576.30.7880.375
否1 17989979.2
每周锻炼次数从不89568276.20.4480.799
1～220816378.4
≥325919976.8
贫困户是36230274.212.639<0.001
否1 00074283.4
BMI营养不良937277.43.7310.292
正常61045374.3
超重39631078.3
肥胖26320979.5
高尿酸血症是73465989.8153.346<0.001
否62838561.3
高血糖是716084.52.5820.108
否1 29198476.2
高胆固醇血症是55350791.7117.512<0.001
否80953766.4
高甘油三酯血症是28124787.925.030<0.001
否1 08179773.7
高血压是38531481.67.2190.007
否97773074.7
高原红细胞增多症是645789.15.7790.016
否1 29898794.5
), ArticleFig(id=1241678310976049502, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522923408773799, language=EN, label=Table 2, caption=

Variable assignments

, figureFileSmall=null, figureFileBig=null, tableContent=
因素赋值
性别1=男性，2=女性
年龄（岁）1=18～24，2=25～44，3=45～59，4=≥60
居住地1=城镇，2=农村，3=牧区，4=农牧区
文化程度1=文盲，2=小学，3=初中，4=高中及以上
婚姻情况1=未婚，2=已婚，3=其他
就业情况1=在业，2=未在业
家庭年收入（元）1=<12 000，2=12 000～19 999，3=20 000～59 999，4=≥60 000
吸烟0=否，1=是
饮酒0=否，1=是
体育锻炼1=从不，2=1～2次，3=3次及以上
贫困户0=否，1=是
BMI1=营养不良，2=正常，3=超重，4=肥胖
高尿酸血症0=否，1=是
高血糖0=否，1=是
高胆固醇血症0=否，1=是
高甘油三酯血症0=否，1=是
高血压0=否，1=是
高原红细胞增多症0=否，1=是
), ArticleFig(id=1241678311873630587, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522923408773799, language=CN, label=表2, caption=

变量赋值情况

, figureFileSmall=null, figureFileBig=null, tableContent=
因素赋值
性别1=男性，2=女性
年龄（岁）1=18～24，2=25～44，3=45～59，4=≥60
居住地1=城镇，2=农村，3=牧区，4=农牧区
文化程度1=文盲，2=小学，3=初中，4=高中及以上
婚姻情况1=未婚，2=已婚，3=其他
就业情况1=在业，2=未在业
家庭年收入（元）1=<12 000，2=12 000～19 999，3=20 000～59 999，4=≥60 000
吸烟0=否，1=是
饮酒0=否，1=是
体育锻炼1=从不，2=1～2次，3=3次及以上
贫困户0=否，1=是
BMI1=营养不良，2=正常，3=超重，4=肥胖
高尿酸血症0=否，1=是
高血糖0=否，1=是
高胆固醇血症0=否，1=是
高甘油三酯血症0=否，1=是
高血压0=否，1=是
高原红细胞增多症0=否，1=是
), ArticleFig(id=1241678315849830790, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522923408773799, language=EN, label=Table 3, caption=

Multivariate logistic regression analysis of HHcy among Tibetan residents in western Ali region of Tibet

, figureFileSmall=null, figureFileBig=null, tableContent=
变量特征B WaldP值OR值（95% CI）
性别女-0.6210.17113.172<0.0010.538（0.384～0.752）
年龄（岁）18～2416.625
25～44-0.4400.3381.6890.1940.644（0.332～1.250）
45～59-0.2620.3530.5500.4580.769（0.385～1.538）
≥600.5860.4042.0970.1481.796（0.813～3.968）
居住地城镇22.801
农村-0.5360.3392.5010.1140.585（0.301～1.137）
牧区-0.2590.3390.5820.4450.772（0.397～1.500）
农牧区-1.1650.35410.8060.0010.312（0.156～0.625）
吸烟是0.6870.3134.8110.0281.988（1.076～3.675）
贫困户是0.5740.1839.8490.0021.775（1.240～2.540）
婚姻状况未婚2.241
已婚-0.3440.2771.5370.2150.709（0.412～1.221）
其他-0.6900.5091.8360.1750.502（0.185～1.361）
高尿酸血症是1.2290.16058.619<0.0013.416（2.494～4.679）
高胆固醇血症是1.3990.18656.298<0.0014.051（2.811～5.838）
高甘油三酯血症是0.9510.19623.660<0.0012.589（1.765～3.798）
高血压是0.1370.1850.5520.4571.147（0.799～1.648）
高原红细胞增多症是0.6350.4412.0680.1501.887（0.794～4.481）
), ArticleFig(id=1241678316797743502, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522923408773799, language=CN, label=表3, caption=

西藏阿里西部地区藏族居民HHcy患病影响因素的多因素logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量特征B WaldP值OR值（95% CI）
性别女-0.6210.17113.172<0.0010.538（0.384～0.752）
年龄（岁）18～2416.625
25～44-0.4400.3381.6890.1940.644（0.332～1.250）
45～59-0.2620.3530.5500.4580.769（0.385～1.538）
≥600.5860.4042.0970.1481.796（0.813～3.968）
居住地城镇22.801
农村-0.5360.3392.5010.1140.585（0.301～1.137）
牧区-0.2590.3390.5820.4450.772（0.397～1.500）
农牧区-1.1650.35410.8060.0010.312（0.156～0.625）
吸烟是0.6870.3134.8110.0281.988（1.076～3.675）
贫困户是0.5740.1839.8490.0021.775（1.240～2.540）
婚姻状况未婚2.241
已婚-0.3440.2771.5370.2150.709（0.412～1.221）
其他-0.6900.5091.8360.1750.502（0.185～1.361）
高尿酸血症是1.2290.16058.619<0.0013.416（2.494～4.679）
高胆固醇血症是1.3990.18656.298<0.0014.051（2.811～5.838）
高甘油三酯血症是0.9510.19623.660<0.0012.589（1.765～3.798）
高血压是0.1370.1850.5520.4571.147（0.799～1.648）
高原红细胞增多症是0.6350.4412.0680.1501.887（0.794～4.481）
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西藏阿里西部地区成年藏族居民高同型半胱氨酸血症患病现况及影响因素分析
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丁康致 , 张玉飞 , 王鹏 , 贾群娣 , 次仁央宗 , 熊海
现代预防医学 | 流行病与统计方法 2024,51(5): 776-780
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现代预防医学 | 流行病与统计方法 2024, 51(5): 776-780
西藏阿里西部地区成年藏族居民高同型半胱氨酸血症患病现况及影响因素分析
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丁康致, 张玉飞, 王鹏, 贾群娣, 次仁央宗 , 熊海
作者信息
  • 西藏大学医学院，西藏 拉萨 850000

    • 丁康致（2000—），男，硕士在读，研究方向：医学遗传学

通讯作者:

熊海，E-mail:；
次仁央宗，E-mail:
Analysis on the prevalence and influencing factors of hyperhomocysteinemia among adult Tibetan residents in the west of Xizang Ali
Kang-zhi DING, Yu-fei ZHANG, Peng WANG, Qun-di JIA, Yang-zong CIREN , Hai XIONG
Affiliations
  • Xizang University School of Medicine, Lhasa, Xizang 850000, China
出版时间: 2024-03-10 doi: 10.20043/j.cnki.MPM.202307077
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摘要
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目的

了解西藏阿里西部地区藏族居民高同型半胱氨酸血症患病现状及影响因素。

方法

采用多阶段整群随机抽样方法，在西藏阿里西部地区随机抽取藏族居民进行健康体检、问卷调查，收集血常规及生化指标。通过χ2检验和多因素logistic回归分析该地区居民高同型半胱氨酸血症的患病情况及影响因素。

结果

共调查1 362名西藏阿里西部地区藏族居民，研究结果显示高同型半胱氨酸血症患者为1 044名，患病率76.7%，男性患病率为84.8%，高于女性的71.5%。吸烟（OR=1.988，95%CI：1.076～3.675）、贫困户（OR=1.775，95%CI：1.204～2.540）、高尿酸血症（OR=3.416，95%CI：2.494～4.679）、高胆固醇血症（OR=4.051，95%CI：2.811～5.838）、高甘油三酯血症（OR=2.589，95%CI：1.765～3.798）为高同型半胱氨酸血症患病危险因素，女性（OR=0.538，95%CI：0.384～0.752）、农牧区（OR=0.312，95%CI：0.156～0.625）为保护因素。

结论

西藏阿里西部地区高同型半胱氨酸血症患病率较高，性别、居住地、吸烟、贫困户是高同型半胱氨酸血症患病的影响因素。高同型半胱氨酸血症与高尿酸血症、高胆固醇血症、高甘油三酯血症等疾病显著相关。

西藏阿里西部地区  /  藏族  /  高同型半胱氨酸血症  /  影响因素
Objective

To investigate the prevalence and influencing factors of hyperhomocysteinemia among Tibetan residents in the west of Xizang Ali.

Methods

By using the method of multi-stage cluster random sampling, Tibetan residents were randomly selected from the western area of Xizang Ali for physical examination and questionnaire survey, and blood routine and biochemical indexes were collected. The prevalence and influencing factors of hyperhomocysteinemia in this area were analyzed by chi-square test and multivariate logistic regression.

Results

A total of 1 362 Tibetan residents in the western region of Xizang Ali were investigated. The results showed that there were 1 044 patients with hyperhomocysteinemia, with a prevalence rate of 76.7%. The prevalence rate of males (84.8%) was higher than that of females (71.5%). Smoking (OR=1.988, 95%CI:1.076-3.675), poor household (OR=1.775, 95%CI: 1.204-2.540), hyperuricemia (OR=3.416, 95%CI: 2.494-4.679), hypercholesterolemia (OR=4.051, 95%CI: 2.811-5.838), and hypertriglyceridemia (OR=2.589, 95%CI: 1.765-3.798) were risk factors of hyperhomocysteinemia. Female (OR=0.538, 95%CI: 0.384-0.752) and agricultural and pastoral areas (OR=0.312, 95%CI:0.156-0.625) were protective factors.

Conclusion

The prevalence rate of hyperhomocysteinemia is high in the western region of Xizang Ali. Sex, residence, smoking, and poor households are the influencing factors of hyperhomocysteinemia. Hyperhomocysteinemia is significantly associated with hyperuricemia, hypercholesterolemia, hypertriglyceridemia, and other diseases.

Xizang Ali western region  /  Tibetan  /  Hyperhomocysteinemia  /  Influencing factors
丁康致, 张玉飞, 王鹏, 贾群娣, 次仁央宗, 熊海. 西藏阿里西部地区成年藏族居民高同型半胱氨酸血症患病现况及影响因素分析. 现代预防医学, 2024 , 51 (5) : 776 -780 . DOI: 10.20043/j.cnki.MPM.202307077
Kang-zhi DING, Yu-fei ZHANG, Peng WANG, Qun-di JIA, Yang-zong CIREN, Hai XIONG. Analysis on the prevalence and influencing factors of hyperhomocysteinemia among adult Tibetan residents in the west of Xizang Ali[J]. Modern Preventive Medicine, 2024 , 51 (5) : 776 -780 . DOI: 10.20043/j.cnki.MPM.202307077
正文
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同型半胱氨酸（homocysteine，Hcy）是一种含硫氨基酸，为蛋氨酸在人体内分解代谢的中间产物[1]。当空腹血浆中Hcy≥15 μmol/L时称为高同型半胱氨酸血症（hyperhomocysteinemia，HHcy）[2]。据已有的研究表明，血浆中Hcy水平升高是心脑血管疾病发病的危险因素。有研究结果显示，血浆同型半胱氨酸每增加5 μmol/L中风发病风险增加59%，缺血性心脏病风险增加33%[3-4]。HHcy是多种心脑血管疾病的独立危险因素，它与骨质疏松相关骨折、阿尔兹海默症、帕金森病等疾病的关系密切[5]。近期的研究表明，HHcy是血管内皮细胞、神经细胞受损的生物标志物之一，同时与癌症的发生密切相关[6-7]。持续的HHcy会导致神经、心脑血管、肾脏、骨骼等系统损伤，临床上表现为致残、致死率较高[8]。根据血浆总Hcy水平，可将HHcy分为轻型（15～30 μmol/L）、中间型（31～100 μmol/L）和重型（>100 μmol/L）。
西藏自治区（简称西藏）平均海拔在4 000 m以上。在高原环境下，HHcy是脑梗死的独立危险因素，藏族HHcy患者比例远高于汉族患者[9]。阿里地区位于西藏西部，平均海拔4 500 m以上，寒冷干燥，气压低，空气稀薄。在这一区域，高血压、心脑血管病、骨质疏松等高发，其病因除与藏族居民特有的饮食习惯和环境因素有关外，还与HHcy等多种危险因素密切相关。查阅文献，鲜有系统性、规范化的流行病学研究。为了全面了解和掌握西藏阿里西部地区HHcy的患病情况及其影响因素，本研究对西藏阿里西部地区的藏族人群进行流行病学调查和健康体检，并分析了影响HHcy的相关危险因素，为西藏高海拔地区HHcy和相关疾病的防治提供参考依据。
1　对象与方法
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1.1　研究对象
于2020年7—8月，研究团队采用多阶段整群随机抽样的方法，选取了西藏阿里西部地区居住6个月以上、年龄≥18岁的世居藏族居民。根据人口总数的比例，分别从普兰县、扎达县、日土县随机选取2个样本乡镇，从噶尔县随机选取3个样本乡镇，每个样本乡镇中抽取3个自然村，与当地政府对接并设立医疗点，提前通知抽到村的村民进行问卷调查和体格检查，通过核对身份证信息排除非藏族居民，共纳入1 362名居民作为调查对象。研究的纳入标准为：年龄≥18岁、6个月以上常住藏族居民。研究的排除标准包括：有重要数据信息缺失的对象、有精神疾病者、严重心脑血管疾病者、肝肾功能障碍者、孕妇和哺乳女性。研究对象签署知情同意书，该项目已获西藏大学伦理委员会批准（批准号：2021-011）。
1.2　调查方法
1.2.1　问卷调查
本研究采用“青藏高原慢性病防治”项目自行编制的问卷，由经过统一专业培训的藏汉双语调查员开展面对面的藏语询问。问卷内容主要包括一般人口学特征、生活方式和慢性病情况等。
1.2.2　体格检查
由专门培训的医学生进行身高、体重和血压检测，并计算体质指数（body mass index，BMI）=体重（kg）/身高的二次方（m）2；由训练有素的医学生，按照规定操作标准，使用HBP-1300型血压计（中国欧姆龙公司）测量受试对象右上臂，连续测量三次后，计算平均收缩压和舒张压。
1.2.3　血样采集和检测
采集调查对象清晨空腹静脉血5 ml进行血常规和生化检测，包括Hcy、血清总胆固醇（TC）、甘油三脂（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖、血尿酸、肌酐、血尿酸等。根据血浆中Hcy浓度升高程度进行分类[10]：正常（5～15 μmol/L）、轻度升高（15～30 μmol/L）、中度（30～100 μmol/L）、重度（>100 μmol/L）。
1.2.4　诊断标准
（1）体质指数（body mass index，BMI）：<18.5 kg/m2为营养不良，18.5～23.9 kg/m2为正常，24.0～27.9 kg/m2为超重，≥28.0 kg/m2为肥胖[11]。（2）高尿酸血症：在正常嘌呤饮食状态下，非同日两次空腹状态下血清中尿酸含量男性超过416 μmol/L，女性超过357 μmol/L[12]。（3）高血糖：空腹血糖≥6.1 mmol/L或餐后2 h血糖≥7.8 mmol/L[13]。（4）高胆固醇血症:总胆固醇≥6.22 mmol/L或低密度脂蛋白胆固醇LDL-C≥4.14 mmol/L[14]。（5）高甘油三脂血症：血液中甘油三脂水平高于1.7 mmol/L[15]。（6）高血压：收缩压≥140 mm Hg和/或舒张压≥90 mm Hg[16]。（7）高原红细胞增多症：男性血红蛋白浓度≥210 g/L，女性血红蛋白浓度≥190 g/L[17]。（8）HHcy：空腹血浆Hcy≥15 μmol/L[2]。
1.3　统计学方法
应用SPSS 24.0软件分析处理数据。计数资料用频数和构成比表示。单因素分析用χ2检验。多因素logistic回归分析各影响因素的优势比（OR）和95%可信区间（CI）。均采用双侧检验，检验水准α=0.05。
2　结果
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2.1　调查对象基本情况
本次研究共纳入1 362名居民。女性占61.2%（834人），高于男性的38.8%（528人）；平均年龄43（33～55）岁，25～44岁年龄组构成比最高，占44.8%；牧区居民占多数，为45.5%（620人）；文化程度以文盲者居多，占63.7%（868人），婚姻情况以已婚为主，占85.1%（1 159人）。见表1。
2.2　不同特征居民HHcy患病情况
1 362名居民中有1 044例HHcy患者，患病率为76.6%，其中男性患病率为84.8%，高于女性的71.5%。年龄≥60岁居民患病率高。城镇和牧区居民患病率明显高于农村和农牧区。单因素结果显示性别、年龄、居住地、婚姻状况、吸烟、贫困户等因素具有统计学意义（P<0.05）。见表1。
2.3　HHcy患病影响因素多因素logistic回归分析
以单因素分析结果中有意义的变量为自变量，以是否患HHcy为因变量，使用logistic回归进一步分析该地区HHcy影响因素，赋值为0=否、1=是，以影响因素中第一个作为参考变量，见表2。
结果显示，性别、居住地、吸烟、贫困户、高尿酸血症、高胆固醇血症和高甘油三酯血症与HHcy的患病相关。女性患病风险是男性0.538倍，吸烟居民的患病风险是非吸烟的1.988倍，贫困居民的患病风险是非贫困的1.775倍。见表3。
3　讨论
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本研究发现，西藏阿里西部地区藏族人群HHcy患病率为76.7%，远高于中国人群HHcy患病率37.2%。分层分析显示，HHcy患病率男性为34.8%，女性为18.7%；北方为34.3%，中部地区为21.0%，南方为16.0%；其中男性HHcy患病率高于女性，与本研究结果一致[18]。
本研究结果所示，性别、居住地、吸烟及贫困户均为Hcy的危险因素。相比于女性来说，男性更容易患上HHcy，造成该结果的原因可能与西藏阿里西部地区居民男、女性的激素调节以及生活习惯相关，女性所分泌的雌激素可以降低血液中Hcy水平，由于男性吸烟、饮酒等不良生活习惯也会导致体内Hcy水平出现升高[19]。本研究结果显示，西藏阿里西部地区贫困户居民HHcy患病风险较高，其可能原因为由于居民收入水平低，蔬菜膳食和水果的摄入量低，从而导致叶酸和维生素D摄入不足[20]。吸烟也与Hcy的升高相关，Haj等[21]研究发现吸烟人群Hcy水平明显高于非吸烟人群，并且吸烟量与血浆中Hcy浓度显著相关。其发生机制可能是吸烟会使胃肠道消化与吸收发生障碍，导致维生素B6、维生素B12及叶酸吸收减少，并且烟雾中氰化物可能使身体中维生素B6、维生素B12活性下降，导致血浆中Hcy浓度升高[22]。
研究结果还发现，西藏阿里西部地区居民高尿酸血症、高胆固醇血症和高甘油三酯血症与HHcy的升高有关。冯胜强等人[23]对北京社区1 680名居民进行横断面研究发现，Hcy水平与高尿酸血症具有相关性，尿酸能够激活前炎性因子，从而使肾脏中的Hcy相关代谢酶失活，使Hcy水平升高，与本研究结果一致。较低的HDL和较高的TG、VLDL会使Hcy升高，同时发现合并血脂异常的冠心病患者Hcy水平明显高于对照组[24]。高原红细胞增多症是一种常见的慢性高原病，由于高原环境人体红细胞处于缺血缺氧，AMP/ATP比值发生改变，延缓甲硫氨酸循环进行，减缓了tHcy在机体中的代谢，从而使体内Hcy水平升高[25]，与本研究结果存在差异，原因可能为既往研究的人群为移居汉族，本研究研究对象为世居藏族，高原红细胞增多症患病率较低，故存在差异。本研究也存在局限性：（1）本研究是一项横断面研究，无法阐明上述因素HHcy的因果关系；（2）本研究采用的抽样方法是整群随机抽样，随机抽取市区以及乡镇，但由于西藏地广人稀，交通不便，所以只能将前来参与问卷和体格检查的实际人群作为研究对象；（3）由于当地特殊的地理环境，道路交通不便，村民往返路途较远，只能单日测量三次血压，取平均值。
综上所述，在西藏阿里西部地区的藏族人群中，性别、居住地、吸烟、贫困户对于HHcy的关系具有显著修饰作用，重点关注血浆Hcy水平，通过补充维生素B12和叶酸能够降低血浆Hcy水平，减少HHcy发病率。因此，建议当地医务部门加强相关知识普及，提醒人们注重饮食并加强锻炼，特别是农牧区人群，养成良好生活习惯，并定期进行体检。
基金
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  • 中央财政支持地方高校改革发展专项资金(00060585; 00060695/051)
  • 阿里科技计划项目(ALKJ-BJCZ-2019-02)
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2024年第51卷第5期
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doi: 10.20043/j.cnki.MPM.202307077
  • 接收时间：2023-07-07
  • 首发时间：2026-03-19
  • 出版时间：2024-03-10
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  • 收稿日期：2023-07-07
基金
中央财政支持地方高校改革发展专项资金(00060585; 00060695/051)
阿里科技计划项目(ALKJ-BJCZ-2019-02)
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    西藏大学医学院，西藏 拉萨 850000

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
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
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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