中国中老年人群炎性因子分布及与代谢综合征和糖尿病的关系研究
文献类型：学位论文
| 作者 | 叶兴旺 |
| 学位类别 | 博士 |
| 答辩日期 | 2008 |
| 授予单位 | 中国科学院上海生命科学研究院营养科学研究所 |
| 授予地点 | 中国科学院上海生命科学研究院 |
| 导师 | 林旭 |
| 关键词 | 代谢综合征 糖尿病 C反应蛋白 白介素6 肿瘤坏死因子阿尔法受体2 |
| 其他题名 | Distributions of inflammatory factors and their associations with metabolic syndrome and diabetes in middle-aged and old Chinese |
| 学位专业 | 生物化学与分子生物学 |
| 中文摘要 | 研究背景：过去20年，无论是在发达国家还是包括中国在内的发展中国家，代谢相关性疾病如肥胖和2型糖尿病的发病率急剧上升。因此，亟需在人群水平寻找此类疾病发生的危险因子，提出控制和预防此类疾病的措施。近年来研究认为体内低水平慢性炎症可能是2型糖尿病和心脑血管疾病的“共同土壤”。此外，有限的数据还提示慢性炎症可能预示将来患代谢综合征的风险，且代谢综合征又是2型糖尿病和心脑血管疾病的重要危险因素。然而，上述研究结果主要源自于白人。目前在中国人群中，有关炎性因子水平及与代谢综合征和糖尿病的关系研究相对缺乏。 研究目的：本研究旨在探讨炎性因子在中国中老年人群中的分布及与代谢综合征和糖尿病的关系。 研究设计：本研究为基于一般人群的横断面调查，于2005年从北京和上海的城乡共招募了50～70岁的男性1458人，女性1831人。代谢综合征的诊断依据美国2005年修订的针对亚裔的National Cholesterol Education Program Adult Treatment Panel III标准。糖尿病的诊断依据美国糖尿病协会2003年修订后的标准。本研究共测定了C反应蛋白（C-reactive protein，CRP）、白介素6（Interleukin-6，IL-6）和肿瘤坏死因子阿尔法受体2（Tumor necrosis factor α receptor 2，TNFR2）3个炎性因子的浓度。 研究结果： 1．炎性因子的浓度：CRP、IL-6和TNFR2在整个调查人群中的中位数分别为0.68 mg/l、1.04 ng/l和1616.28 ng/l，其中CRP和IL-6的浓度水平无性别差异，而TNFR2的浓度则男性高于女性（P值<0.001）。CRP水平与美国和加拿大多种族研究中华裔的CRP水平相当，低于多种族研究中白人的CRP水平。 2．炎性因子与代谢综合征的相关性：随着CRP浓度的升高，代谢综合征的患病率线性升高（趋势P值<0.001）。在调整年龄、性别、南北、城乡、吸烟、饮酒、体力活动水平、受教育年限以及慢性疾病家族史后，位于CRP最高四分位组的个体（>1.50 mg/l）患代谢综合征的比值比（odds ratio，OR）为最低四分位组（0.33 mg/l）的5.97倍（95%置信区间[confidence interval，CI]：4.75～7.51）。与CRP类似，随着IL-6浓度的增加，患代谢综合征的风险也逐步升高（趋势P值<0.001）。多因素调整以后，与IL-6最低四分位组（≤0.67 ng/l）的个体比较，最高四分位组（>1.59 ng/l）的个体患代谢综合征的OR为2.76（95% CI：2.21～3.43）。此外，无论肥胖还是非肥胖组个体，随着CRP或者IL-6浓度的升高，代谢综合征的患病率均升高。与CRP和IL-6不同，TNFR2与代谢综合征的患病率则无显著相关性。 3．炎性因子与糖尿病的相关性：炎性因子和糖尿病的关系则表现出性别差异。在调整年龄、南北、城乡、吸烟、饮酒、体力活动水平、受教育年限、糖尿病家族史、抗生素、阿司匹林以及降脂药的使用等混杂因素后，与位于CRP四分位最低组个体相比，位于CRP最高四分位组的女性患糖尿病的OR为3.66（95% CI：2.23～6.03），而男性则为1.51（95% CI：0.95～2.41），即CRP与糖尿病患病率的相关性女性强于男性（交互作用P值＝0.004）。调整上述混杂因素后，IL-6与糖尿病的关系女性亦强于男性（交互作用P值＝0.045）：与IL-6最低四分位组比较，最高四分位组的女性患糖尿病的OR为2.95（95% CI：1.78～4.90），而男性则为2.23（95% CI：1.39～3.59）。与CRP和IL-6不同，TNFR2与糖尿病患病率则无显著相关性。 结论：尽管中国中老年人群的CRP水平较白人低，但CRP和IL-6与代谢综合征以及糖尿病的患病率密切相关，并且CRP和IL-6与糖尿病的相关性女性强于男性。大规模前瞻性研究将有助于进一步确定中国人群中炎症因子在代谢综合征以及糖尿病发生发展过程中的作用。 |
| 索取号 | D2008-023 |
| 英文摘要 | Backgrounds: During the past two decades, the prevalence of metabolic diseases including obesity and type 2 diabetes increased dramatically not only in western countries, but also in developing countries, such as in China. Therefore, it is urgent to identify major risk factors and develop effective strategies to prevent the epidemic of these diseases at population levels. Recently, low-grade chronic inflammation is considered as the “common soil” for type 2 diabetes and cardiovascular diseases. Furthermore, existing data, mainly from the studies in Caucasian populations, suggest that inflammation could predict metabolic syndrome (MetS), a strong risk factor for type 2 diabetes and cardiovascular diseases. However, little is known about the distributions of inflammatory factors and their associations with metabolic disorders such as MetS and diabetes in Chinese population. Objectives: This study evaluated the distributions of inflammatory factors and their associations with MetS and diabetes in a middle-aged and old Chinese population. Study design: A population-based cross-sectional survey was conducted in 2005 and a total of 1,458 men and 1,831 women aged 50 to 70 years were recruited from urban and rural area in Beijing and Shanghai. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria for Asian Americans revised in 2005. Diabetes was defined according to the American Diabetes Association’s criteria revised in 2003. C-reactive protein (CRP), interleukin-6 (IL-6) and Tumor necrosis factor α receptor 2 (TNFR2) were assayed. Results: 1. Concentrations of inflammatory factors: The medians of CRP, IL-6 and TNFR2 were 0.68 mg/l, 1.04 ng/l and 1616.28 ng/l among the study population, respectively. No gender differences in CRP and IL-6 levels were observed whereas higher levels of TNFR2 were noted in men than in women (P <0.001). The CRP levels observed in our study were comparable with those of Chinese reported in multiethnic studies from United States and Canada. In those studies, the CRP levels of Chinese were lower than that of white population. 2. Associations between inflammatory factors and MetS: The prevalence of MetS progressively increased with elevated CRP (P <0.001 for trend). In the highest quartile of CRP levels (>1.50 mg/l), the odds ratio (OR) for MetS was 5.97（95% confidence interval [CI] 4.75-7.51) compared to that in the lowest quartile of CRP levels (0.33 mg/l) after adjustment for age, gender, region, residence, smoking, alcohol drinking, physical activity, educational attainment and family history of chronic diseases. Similarly, with elevated IL-6 levels, the prevalence of MetS increased gradually (P <0.001 for trend). Compared with the 1st quartile of IL-6 (≤0.67 ng/l)，the OR for the 4th quartile (>1.59 ng/l) was 2.76 (95% CI 2.21-3.43) after multiple adjustments. In addition, increased risks for MetS were observed with either elevated CRP or IL-6 levels in both obese and non-obese participants. In contrast, no significant associations between TNFR2 and MetS were found. 3. Associations between inflammatory factors and diabetes: Gender specific associations were observed between inflammatory factors and diabetes. Comparing the highest with the lowest quartile of CRP, the OR of diabetes was significantly higher in women (3.66 [95% CI 2.23–6.03]) than in men (1.51 [0.95–2.41]) (P for interaction = 0.004) after adjustment for age, region, residence, smoking, alcohol drinking, physical activity, education, family history of diabetes, and use of antibiotics, aspirin and lipid-lowering drugs. The multiple-adjusted OR of IL-6 for diabetes was also higher in women (2.95 [1.78–4.90]) than in men (2.23 [1.39–3.59]) (P for interaction = 0.045). In contrast, no significant associtions between TNFR2 and diabetes was observed. Conclusions: Compared with the white population, the overall plasma level of CRP is low but CRP and IL-6 are closely associated with MetS and diabetes in middle-aged and old Chinese people. Prospective studies are needed to verify the role of inflammatory factors in the development of MetS and diabetes in Chinese. |
| 语种 | 中文 |
| 公开日期 | 2015-12-24 |
| 源URL | [http://202.127.25.144/handle/331004/254]  |
| 专题 | 中国科学院上海生命科学研究院营养科学研究所_人类营养与疾病研究组 |
| 推荐引用方式 GB/T 7714 | 叶兴旺. 中国中老年人群炎性因子分布及与代谢综合征和糖尿病的关系研究[D]. 中国科学院上海生命科学研究院. 中国科学院上海生命科学研究院营养科学研究所. 2008. |
入库方式： OAI收割
来源：上海营养与健康研究所
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