摘要
目的探讨腰围（wc）和BMI在2年随访时间内的动态变化对队列人群高血压发病的影响。方法采用前瞻性研究方法，于2002年1月，对江苏省多代谢异常和代谢综合征（MS）综合防治研究队列人群中随访时间满2年的5888名对象进行第1次随访，完成随访4582名，并于2006年3月对随访时间满5年及参与了第1次随访的对象进行了第2次随访，完成2次随访的对象共3847名，其中满足条件的共2778名基线血压正常对象被纳入分析。基线时WE或BMI正常者在第1次随访时变为非正常者以及基线WC或BMI不正常者存第1次随访时依旧不正常者定义为非控制组；基线WC或BMI非正常者在第1次随访时变为止常以及基线WC或BMI止常者存第1次随访时依旧保持正常者定义为控制组。以第2次随访时是否为高血压作为结局变量（高血压=1，正常血压=0）。运用COX比例风险回归模型分析相互调整的WC和BMI差值与高血压发病的关系，以及按照WC和BMI控制与否分层的高血压发病风险，并计算相应的OR和RR值及95％C1值。结果2778名研究对象巾，新发高血压660例。WC差值和BMI差值以连续型变量进入模型作相互调整时，男女性中高血压发病与WC差值的关联仍具有统计学意义（男性：OR=1．04，95％CI：1．01～1．05；女性：OR=1．04，95％C1：1．02～1．06），而与BMI差值的关联不再具有统计学意义（男性：OR=1．04，95％CI：0．97～1．11；女性：OR=0．98，95％CI：0．93～1．03）。不论基线WC正常与否，非控制组人群的高血压风险高于控制组人群（基线Wc正常组：RR=1．41，95％CI：1．01～2．39；基线WC非正常组：RR=4．41，95％C1：1．66～9．80）。而在基线BMI非正常组中，控制组与非控制组的高血压发病风险差异无统计学意义（RR=1．33，95％CI：0．88—2．02）。当WC得到控制，BMI控制与否对高血压发病风险无明显影响（男性：RR=1．03，95％CI：0．36～2．96；女性：RR=1．02，95％CI：0．70～5．85），WC未得到控制时，即使BMI得到控制，高血压发病风险仍会明显增加（男性：RR=4．03，95％CI：1．61～10．09；女性：RR=1．55，95％CI：1．13～3．60）。结论WE和BMI的控制均可降低高血压发病风险，而相比于控制BMI，控制wc对降低高血压风险的效果更好。
Objective To study the impact of dynamic change of waist circumference （WC） and body mass index （BMI） in two years on hypertension incidence in cohort populations. Methods A perspective cohort study was conducted. The participants （5888 subjects） whose follow-time were 2 years or longer from the program Prevention of multiple metabolic disorders and metabolic syndrome（MS） in Jiangsu province were investigated. Amongst 5888 subjects,4582 participants received the first follow-up investigation in January 2002. Among 4582 subjects who received first follow-up investigation and whose follow-time met 5 years,total 3847 participants received the second follow-up investigation in March 2006. Total 2778 free hypertension subjects were included in this analysis. Subjects with normal WC or BMI at baseline but abnormal WC or BMI at the first follow-up or subjects with abnormal WC or BMI both at baseline and the first follow-up were defined as non-control group. Subjects with abnormal WC or BMI at baseline but normal WC or BMI at the first follow-up or subjects with normal WC or BMI both at baseline and the first follow-up were defined as control group. The incidence of hypertension at second follow-up investigation was defined as the final variable（ hypertension = 1, non-hypertension = 0）. The association between dynamic change of WC or BMI and incident hypertension was analyzed by using Cox proportional hazards regression model. The OR, RR value and 95% CI were calculated through WC and BMI risk stratification. Results Among 2778 participants without hypertension at baseline,660 subjects developed hypertension. When both BMI difference value（D-value） and WC D-value were included in the regression model,WC D-value was associated with hypertension in both genders （ males ： OR = 1.04,95% CI： 1.01 - 1.05 ; females ： OR = 1.04,95% CI： 1.02 -1.06） ,but BMI D-value was not associated with hypertension in both men and women（ males： OR = 1.04,95%CI： 0.97 - 1.11; females： OR= 0.98, 95%CI： 0.93 - 1.03） . Hypertension risk of WC non-control group was higher than that in WC control group in baseline normal and abnormal WC groups （ normal baseline WC group： RR = 1.41,95% CI： 1.01 - 2. 39, abnormal baseline WC group： RR = 4. 41, 95% CI：1. 66 -9.80）. But in baseline abnormal BMI group, there was no significant difference between BMI control and non-control group （ RR = 1.33,95% CI： 0. 88 - 2. 02 ）. Whether BMI was controlled can not influence hypertension risk if WC was controlled （ males： RR = 1.03,95% CI：0. 36 - 2. 96; females： RR = 1.02,95 % CI：0. 70 -5.85 ） , however, control WC could reduce hypertension risk obviously even though BMI was not controlled（ males ： RR = 4. 03,95% CI： 1.61 - 10. 09 ; females ： RR = 1.55,95% CI： 1.13 - 3.60）. Conclusion Both WC and BMI dynamic change were associated with change of hypertension. But reducing WC can decrease hypertension risk more than reducing BMI.
出处
《中华预防医学杂志》
CAS
CSCD
北大核心
2011年第11期1012-1016,共5页
Chinese Journal of Preventive Medicine
基金
基金项目：卫生部科学研究基金资助项目（WKJ2004-2-014）
关键词
人体质量指数
高血压
前瞻性研究
腰围
Body mass index
Hypertension
Prospective study
Waist circumference
