Historic conservation is closely connected with the phenomenon of partial shrinkage in the rapidly developing megacity of Guangzhou. Nine jiedao (subdistricts) including 14 historic conservation areas in old Liwan were selected to observe the shrinkage phenomenon from four aspects, namely, the population growth rate, population aging, economic growth, and vitality of public life. The relationships between old Liwan and changes in the city's development strategy and between conservation policies and urban renewal operations were explored by tracking three stages of shrinkage. Findings show that shrinkage in jiedao with HCAs in growing megacities was not caused by historic conservation but one of the results of complicated relationship. This study played a vital role in clarifying the partial shrinkage in the historic conservation areas in developing Asian megacities at the microscale while providing a reference for urban planning and policy making.

Abstract Health literacy (HL) has become an important public health issue and received growing attention in recent years. However, knowledge about the HL of adolescents and young adults is limited.[1] This study aimed to investigate the awareness rate of HL and its related factors among college freshmen in Jiangsu, China. And the results were used to support the promotion intervention to improve the HL of at-risk groups among this population. A total of 25,272 freshmen were surveyed through multi-stage stratified random sampling from 20 colleges and universities in Jiangsu province between 2016 to 2018. Data were obtained using the “Chinese Citizen Health Literacy Questionnaire” (2013 edition). Multiple logistic regression analysis was conducted to determine the factors influencing HL levels. The awareness rate of HL of college freshmen in Jiangsu province was 26.6% among the 25,272 subjects. The awareness rate of HL tended to increase from 2016 to 2018, which was 17.9%, 21.5%, and 39.6%, respectively (P < 0.001). Specifically, except for chronic diseases, knowledge and attitudes, knowledge and attitudes toward health-related behavior and lifestyle, health-related skill and scientific views of health, infection diseases, safety and first aid, medical care, health information awareness rate all have improved to a certain degree (P < .001). The independent factors associated with HL awareness rate were sex (odds ratio [OR] = 1.099, (1.039 –1.164)), residence (urban: OR = 1.141, (1.056∼1.234)), educational system (OR = 2.133, (1.975–2.305)), only child or not (OR = 1.087, (1.018–1.161)), family structure (OR = 1.192, (1.078–1.319)) and maternal education level (high school: OR = 1.183 (1.067–1.313); university and more: OR = 1.481 (1.324–1.658)). Awareness rate of HL of college freshmen is associated with multi-complex factors, further works are recommended to improve the HL levels of college freshmen, especially for the aspect of chronic diseases.

目的 了解普通变形杆菌的生物特性及其体外利用膳食纤维的能力,为该菌的生理功能研究及肠道菌群与人体健康影响的机制研究提供理论依据.方法 运用梅里埃革兰阴性细菌鉴定卡检测菌株糖类及氨基酸类物质代谢的生化特征;绘制菌株在有氧及无氧环境下膳食纤维培养液中的生长曲线;GC-FID法检测菌株体外发酵产短链脂肪酸的含量.结果 普通变形杆菌含有参与纤维素分解利用的β-葡萄糖苷酶.在有氧条件下,菌株在以纤维素为碳源的培养基中生长较好;在无氧条件下,菌株在以低聚果糖、抗性淀粉为碳源的培养基中生长较好.在体外无氧环境下,菌株能发酵纤维素产乙酸,发酵低聚果糖产乙酸和丙酸,发酵抗性淀粉产乙酸、丁酸、异丁酸和异戊酸.结论 普通变形杆菌含有分解纤维素的酶类,能够利用膳食纤维作为碳源进行生长繁殖,且能在体外无氧条件下发酵膳食纤维产生短链脂肪酸.

BACKGROUND:Gut microbiota is closely related to age. Studies from Europe and the U.S. identified featured microbiota in different age groups for the elderly. Asian studies mainly focused on people living in longevity areas. Featured microbiota for the elderly people of different age groups, especially in the centenarian in the general population, has not been well investigated in China.METHOD:We conducted a comparative study by including 198 subjects of three age groups (65-70, 90-99, and 100+ years) in East China. Information regarding age, sex, height, weight, waist circumference, hip circumference, food preference, smoking status and alcohol consumption were collected by using a structured questionnaire. Fecal samples for each participant were collected as well. 16S rRNA gene sequencing were employed to analyze the gut microbiota composition. Logistic regression with LASSO feature selection was used to identify featured taxa in different age groups and to assess their potential interactions with other factors such as lifestyle.RESULT:The gut microbiota of the 90-99 year and 100+ year age groups showed more diversity, robustness, and richness compared with the 65-70 year age group. PCoA analysis showed a clear separation between the 65-70 and 100+ year age groups. At the species level, Bacteroides fragilis, Parabacteroides merdae, Ruminococcus gnavus, Coprococcus and Clostridium perfringens increased, but Bacteroides vulgatus, Ruminococcus sp.5139BFAA and Clostridium sp.AT5 decreased in the 90-99 year age group. The age differences in gut microbiota were similar across the strata of smoking, alcohol consumption status and food preference.CONCLUSION:Our study demonstrated age differences in many aspects of gut microbiota, such as overall diversity, microbiota structure, and relative abundance of key taxa. Moreover, the gut microbiota of centenarian was significantly different from those of younger age groups of the elderly.

目的 了解上海市不同地区成人血糖测量及血糖知晓情况,为制定糖尿病防治计划提供参考依据.方法 利用2013年上海市慢性病及其危险因素监测数据,以上海市15岁及以上常住居民为目标人群,采用多阶段分层随机抽样方法,抽取25 444名18岁及以上居民,20 587名35岁及以上居民纳入研究,进行问卷调查,对35岁及以上居民进行血糖水平测定.比较不同地区、不同性别及年龄的18岁及以上调查对象的自测血糖时间分布情况以及35岁及以上调查对象自报血糖与实测血糖一致性.为使调查结果能较好地反映总人群的水平,用SPSS 20.0软件对所有统计分析均采用复杂加权进行调整.不同人群间率的比较采用抽样设计校正的Rao-Scott x2检验.结果 上海市18岁及以上成人6个月内测过血糖的比例为30.04％,最近1次血糖测量时间在12个月内、12个月前、记不清楚的比例分别为12.90％、11.79％和6.66％,38.61％的调查对象从未测量过血糖.男性、女性居民从未测过血糖的比例分别为38.89％、38.31％,差异无统计学意义(P＞0.05);18～34岁年龄组从未测过血糖的比例高达50.34％,随着年龄增长从未测过血糖的比例逐渐下降,≥65岁年龄组为17.76％,年龄组别间差异有统计学意义(P＜0.01);农村地区调查对象从未测过血糖的比例最高(47.52％),城乡结合部为44.66％,城市地区为33.41％,地区间差异有统计学意义(P＜0.01).64.68％的35岁及以上的调查对象自报知晓自己的血糖情况,经血糖检测结果对比,59.11％的调查对象自报血糖情况与实测血糖一致.男性、女性居民自报血糖准确率分别为57.99％和60.28％,差异有统计学意义(P＜0.05);35 ～44岁年龄组自报血糖准确率为48.56％,≥65岁年龄组为72.12％,不同年龄组间差异有统计学意义(P＜0.01);小学及以下文化程度居民自报血糖准确率为56.62％,大专及以上文化程度者为66.65％,不同文化程度人群间差异有统计学意义(P＜0.01);农村地区居民自报血糖准确率为50.00％,城乡结合部为51.30％,城市地区为65.12％,地区间差异有统计学意义(P＜0.01).结论 上海市成人测量血糖、关注血糖、掌握实际血糖值的比例不高,应针对特定人群开展有针对性的健康教育,倡导血糖自测,知晓自身血糖情况,及早发现血糖异常.

Objective To investigate the levels of literacy and numeracy in type 2 diabetes patients with poor glycemic status in communities of Shanghai,China,and to evaluate their associations with blood glucose level.Methods A total of 800 type 2 diabetes patients with recent HbA1c≥7.5％ or fasting plasma glucose level ≥10 mmol/L were recruited from 8 communities in Minhang district and Changning district of Shanghai,China,and were interviewed using a structured questionnaire during February 2015 and March 2016.Literacy and numeracy levels of all patients were evaluated using the validated Health Literacy Management Scale (HeLMS) and the 5-item version Diabetes Numeracy Test (DNT-5),respectively.Results The patients included in this study were observed to have higher levels of health literacy,with a median score of HeLMS being 116 [interquartile range (IQR),108-120] and a median correct rate of DNT-5 of 80％ (IQR,60％-100％).Age,educational level and occupation were significantly related with health literacy levels and numeracy.Sex and income were closely related with health literacy levels.HeLMS score was not significantly associated with HbA1c level (P =0.383),while the lower correct rate of DNT-5 was linked with a higher level of HbA1c.The median HbA1c level was 8.3％ (IQR 7.7％-9.4％) in the patients with the lowest tertile of DNT-5 correct rate,significantly higher than 8.2％ (IQR:7.5％-9.2％) in the medium and 8.0％ (IQR:7.5 ％-8.8 ％) in the highest tertile group (P =0.009).Conclusions Diabetes patients with poor glycemic status in communities of Shanghai have high levels of health literacy,which was significantly related with age,sex,educational level,occupation and income.Ability in numeracy may be a more important influence factor than health literacy for glycemic status of diabetes patients.

Objective To evaluate the correlation between anthropometric indices and diabetes and dyslipidemia in Chinese adults. Methods A total of 14336 participants with complete data from Shanghai Adults Diabetes Epidemiology Study during 2002 to 2003 were recruited. The correlation between body mass index(BMI), waist circumference, waist-hip ratio (WHR) and waist-height ratio (WHtR) and blood glucose and lipids were analyzed; receiver operating characteristic (ROC) curve analysis and the best cut-off point of the four indicators for diabetes and hyperlipidemia were compared; multi-variable logistic regression analysis was also conducted. Results All anthropometric (BMI, waist circumference, WHR and WHtR) indices were closely correlated with blood glucose and lipid levels(partial correlation coefficient 0.034-0.261, P<0.01), which were not affected by gender and age. Compared with other anthropometric indicators, WHtR was found to have the largest area under the ROC curve (0.712 for diabetes and 0.642 for hyperlipidemia), and the best cut-off points of diabetes and hyperlipidemia were 0.51 and 0.49, respectively. Multi-variable logistic regression analysis showed WHtR had the highest degree of association with diabetes, hypertriglyceridemia and hypercholesterolemia (OR=1.67, 2.0 and 1.53). Conclusion There is a close relationship between anthropometric indices and diabetes and lipid metabolic disorder in adult population of Shanghai. WHtR can serve as an important indicator of screening assessment.

目的 研究冲洗马桶的两种不同方式对卫生间空气中的细菌多样性以及种群结构等特征的影响,倡导良好的居家生活卫生习惯.方法 采集卫生间空气本底(SB)、以及加盖冲洗(SC)和敞开冲洗(SO)马桶时卫生间的空气样品,提取样品基因组DNA,扩增细菌16S rRNA基因V3区,对扩增产物进行Illumina Miseq宏基因组测序,并对测序结果进行生物信息学分析和处理.结果 SB、SC,和SO分别得到优质序列43 183、55 372,和64 187条.除Shannon指数以外,其余反映物种丰富度的Chao1和ACE指数,冲洗马桶时无论加盖与否,均较未冲洗马桶时的空气微生物本底要高,表现出SO＞SC＞SB的趋势.在门分类阶元上,共鉴定出卫生间空气相关细菌16个门,SO与SC的优势菌顺位一致,均与SB不同.结论 冲洗马桶可触发卫生间空气微生物在数量和种类上的增加,且敞开冲洗比加盖冲洗有着更高的物种丰富度,无论加盖与否,抽水动作所造成的气旋都会干扰卫生间空气细菌的群落特征.

[目的]了解上海市社区管理2型糖尿病患者治疗和血糖控制状况及其变化趋势. [方法]于2009和2013年,分别从上海市社区糖尿病患者管理系统中随机抽样1710名和2800名2型糖尿病患者,对其进行问卷调查、体格检查和实验室检查,收集患者人口学信息、治疗方案、血糖控制情况. [结果]两次调查分别回收有效问卷1 629、2741份.2009年到2013年间,社区管理2型糖尿病患者血糖控制达标率由43.7％上升到46.8％;用药依从率由88.1％提升到94.8％.2013年使用最广泛的口服降糖药依次为磺脲类(53.3％)、双胍类药物(40.1％)和糖苷酶抑制剂类(15.8％),磺脲类药物使用率较2009年(59.4％)显著下降(P＜0.05),双胍类药物和糖苷酶抑制剂类无明显变化,胰岛素的使用比例也无变化.仅口服降糖药的患者血糖达标率高于使用胰岛素的患者,单纯一种药物治疗的患者达标率优于联合多种药物治疗的患者(P＜0.05). [结论]社区管理可明显提高2型糖尿病患者药物依从性和血糖控制达标率,但社区医生对降糖药物的使用与国内、外防治指南还存有差距,应及时制定政策加强对社区糖尿病防治的技术支持.

虽然国内、外大量的研究显示,强化2型糖尿病患者血糖控制可以降低微血管并发症的发生和死亡的风险,但大多数国家的糖尿病患者血糖总体控制水平不尽人意.本文通过系统归纳现行的血糖监测指标、血糖控制标准的种类及特征,旨在为2型糖尿病患者的个体化血糖控制评估提供依据;通过对比国内、外糖尿病血糖控制现况,总结影响血糖控制率的地区差异和变化因素,为我国各级政府及相关预防机构制定糖尿病血糖控制率群体目标和具体措施,提高糖尿病防治能力提供借鉴.

健康素养是指个体获取、处理、理解基础保健知识和服务,运用其做出适宜健康决策的能力.了解糖尿病患者的健康素养,采取有针对性的措施,对降低糖尿病并发症的发生、改善患者的健康结局具有重要意义.本文从糖尿病患者健康素养评估工具、健康素养与疾病结局的关联、健康素养影响因素以及健康素养干预研究等几个方面,对糖尿病患者的健康素养研究进展进行综述,以期为糖尿病的防控提供依据.

Objective To investigate and compare the optimal screening tool for impaired fasting glucose(IFG) subjects, impaired glucose tolerance(IGT) subjects and undiagnosed diabetes, using waist circumstance(WC) and waist-to-height ratio(WHtR) in Shanghai. Methods A total of 18 062 participants (aged ≥35 years) were enrolled from the Shanghai Chronic Disease and Risk Factor Surveillance in 2013. Correlational analyses of WC and WHtR with IFG and IGT were conducted using Pearson correlation method. The receiver operating characteristic (ROC) analysis was used to compare their predictive ability for IFG, IGT and undiagnosed diabetes. According to the recommended cut-off value, screening of the three abnormal glucose status was performed using WC, WHtR and/or body mass index (BMI). Results Both WC and WHtR were positively correlated with FPG (r=0.161, 0.153, P<0.05 all above) and 2 hPG (r=0.182, 0.225, P<0.05 all above). The AUCs of WC and WHtR in screening IGT, IFG and undiagnosed diabetes were 0.620(95%CI:0.611-0.629),0.636 (95%CI:0.628-0.645, Z=2.549,P<0.05), respectively. The same result was obtained among female patients in screening IGT (0.663 vs 0.636, Z=-2.386, P<0.05). The AUC of WC in screening IGT (0.617, 95%CI:0.605-0.629) was significantly lower than that of WHtR(0.646, 95%CI:0.635-0.658, Z=-3.418, P<0.01). However, no difference between WC and WHtR in screening IFG and undiagnosed diabetes was shown (P>0.05). The difference of the best cut-off value of WC and WHtR between male and female subjects was 3-5 cm and 0.01, respectively. Among 4 screening algorithms by combining BMI in parallel or in serial, the specificity of WC combing BMI in serial was the highest for the screening of IFG, IGT, undiagnosed diabetes, and abnormal glucose subject (67.61%, 69.17%, 68.94%, and 72.46%, respectively). The sensitivity of WHtR combing BMI in parallel was the highest (76.10%, 82.79%, 83.89%, and 81.63%). Conclusion WHtR is a better option than WC in screening IGT for females. There is almost no gender difference in the optimal cut off values of WHtR for screening of IGT, IFG and undiagnosed diabetes.

Objective This study aimed to investigate the epidemiology of diabetes in adults from Shanghai, aged 35 and older, in 2013. Methods We estimated the diabetes prevalence in a representative sample of 18,736 adults who were selected through a multistage stratified cluster sampling process. A standard questionnaire containing questions about demographic characteristics and lifestyle factors was distributed. After an overnight fast of at least 10 hours, a venous blood sample was collected from each participant. For each patient without a history of diabetes, another blood sample was drawn 120 min after an oral glucose tolerance test to identify undiagnosed diabetes and prediabetic condition. Results Among Shanghai residents aged 35 and above, the overall weighted prevalence of diabetes was 17.6% [95% confidence interval(CI): 16.4%-18.8%]. The prevalences were 19.3% in men and 15.8% in women as well as 19.1%, 15.4%, and 16.1% in urban, suburban, and rural residents, respectively. In addition, the weighted prevalence of prediabetes was 16.5%(95% CI: 15.3%-17.8%), with the prevalences of 16.5% in men, 16.6% in women, 15.2% in urban residents, 18.0% in suburban residents, and 18.5% in rural residents. Among all patients with diabetes, 68.1%(95% CI: 64.3%-71.6%) were aware of their status, 63.5%(95% CI: 60.0%-66.9%) received diabetes treatment, but only 35.1%(95% CI: 32.4%-37.8%) had adequate glycemic control. Conclusion In Shanghai, diabetes and prediabetes are highly prevalent. However, 1/3rd of diabetes cases are undiagnosed, and the rate of glycemic control is low.

目的:调查社区2型糖尿病患者自我效能情况并探讨其影响因素.方法:采用一般情况调查表、糖尿病知识调查表和自我效能量表,以方便抽样方法对2014年9-10月在社区进行糖尿病随访管理的250例2型糖尿病患者进行调查.比较不同人口学特征患者的自我效能得分情况.采用多元逐步回归和多元Logistic回归方法分析影响患者自我效能水平的因素.结果:参加调查的250例糖尿病患者中男85例(34.0％),女165例(66.0％),平均年龄(68.0±8.9)岁.患者的自我效能总分为(82.2±20.1)分,自我效能良好、中等和差的患者分别为15.6％、38.8％和45.6％.文化程度、是否在婚、月均收入、付费方式、治疗方式和既往是否参加过糖尿病自我管理与2型糖尿病患者总自我效能或某些组得分有关(均P＜0.05).多元逐步回归分析和多元Logistic回归分析结果显示,糖尿病知识知晓率、家庭人均月收入和既往是否参加过糖尿病自我管理是影响糖尿病患者总自我效能的重要因素(均P＜0.05).结论:社区2型糖尿病患者自我效能水平较低,影响因素是多方面的,应对2型糖尿病患者进行有针对性的干预,加强知识宣教、社会支持和健康教育等,提高患者的自我效能、自我管理水平和生活质量.

[目的]评价上海市社区管理的2型糖尿病患者的生存质量,探索其影响因素. [方法]采用分层多阶段等概率抽样方法,抽取2741例上海市社区管理的2型糖尿病患者,对其基本情况、疾病情况和生存质量进行问卷调查,利用多因素非条件logistic逐步回归对生存质量影响因素进行分析. [结果]女性1596例(占58.23％),男性1 145例(占41.77％);年龄(67.70±9.30)岁;病程中位数为8年,10年以上患者占36.61％;患者自报发生糖尿病慢性并发症占13.06％;患有高血压、冠心病、脑卒中相关慢性病的比例分别为63.99％、17.22％和11.57％.社区糖尿病患者生存质量的躯体功能、躯体角色、躯体疼痛、总体健康感、活力、社会功能、情绪角色和精神健康8个维度的得分分别为85、100、90、62、75、89、100、80分.生存质量的促进因素主要包括体育锻炼,对上述8个维度均有促进作用,OR值范围1.21～1.91.生存质量的负面因素主要包括:女性(对8个维度均有影响,OR值范围0.50～0.81)、患有慢性并发症/冠心病(均对6个维度有影响,OR值范围分别为0.53～0.75,0.62～0.77)及脑卒中相关慢性病(对5个维度有影响,OR值范围0.57～0.75);其他负面因素包括高龄、低文化程度、低收入. [结论]提高糖尿病患者的生活质量需要采取综合措施,重点包括开展适当的体育锻炼、积极治疗相关合并症或并发症.

目的 探讨个体化和量化营养干预对2型糖尿病患者代谢及饮食结构的影响.方法 采用随机抽样法,按入选条件选取上海市曹杨社区卫生服务中心55～75岁在册管理的106例2型糖尿病患者为调查对象,其中有94例完成研究,失访12例,失访率为11.3％,以居委会为基础分为对照组45例,干预组49例.干预组进行为期3月的个体化和量化营养干预和教育指导,制定个体化营养治疗方案,能量按照统一原则供给.教育手段包括一对一教育、分阶段集体教育及资料发放等.干预开始前后分别对受检者进行膳食调查、体格检查及实验室相关指标检测.结果 经个体化和量化营养干预后,干预组体质指数[(23.65±3.23) kg/m2]较对照组[(25.19±2.68) kg/m2]有所下降,差异有统计学意义(P＜0.05);空腹血糖[(6.39±2.89) mmol/L]、餐后2h血糖[(9.89±6.42) mmol/L]、糖化血红蛋白[7.0(5.9～9.0) mmol/L]均较对照组[分别为(7.09±3.43)、(11.34±4.62)、7.2(6.5～9.0) mmol/L]明显下降,差异均有统计学意义(P＜0.05);干预组健康饮食评分(health eating index,HEI)[(65.96±5.89)分]较对照组[(61.31±3.49)分]显著上升,差异有统计学意义(P＜0.05).结论 在社区糖尿病管理工作中,个体化和定量化营养干预可有效控制患者的血糖水平,改善患者膳食结构.

[目的] 评价上海市社区2型糖尿病患者自我管理项目实施效果,为在社区推广、开展该项目提供依据.[方法]于2014年8-9月,在上海市徐汇、闵行、松江及金山区的8个社区招募250名确诊2型糖尿病患者参加自我管理活动.对活动前后糖尿病防治知识、健康行为、健康状况和自我效能进行问卷调查,并检测空腹血糖和血压.比较自我管理活动前后的知识、行为和自我效能的变化采用两配对样本McNemar检验,比较活动前后血糖、血压的变化采用配对t检验.[结果]所有参加自我管理的患者中男性85人(34.0％),女性165人(66.0％);平均年龄为(68.04±8.91)岁;糖尿病肾病、视网膜病变、神经病变、下肢血管病变和糖尿病足5种糖尿病慢性并发症的患病率分别为1.6％、11.2％、7.2％、3.6％和1.2％,冠心病、脑卒中、高血压、高血脂和慢性阻塞性肺疾病5种慢性病的患病率分别为25.6％、12.4％、75.2％、26.0％和0.8％.活动前后患者糖尿病相关知识知晓率分别为46.7％和70.3％,差异有统计学意义(P＜0.05).活动结束时患者平均每周有3d以上进行自我血糖监测、平均每周有5d以上遵循糖尿病健康饮食要求、平均每周有5d以上进行30 min或以上的有氧运动和按时服药的比例较活动前明显升高(均P＜0.05).活动结束时患者自我效能得分较活动前升高,差异有统计学意义(P＜0.05).活动结束时患者空腹血糖平均水平较活动开始前下降了0.93 mmol/L;过去30d内由于疾病和紧张、压抑等不良情绪造成的健康状况不良的天数比活动前分别下降了0.77和0.51 d(均P＜0.05). [结论]自我管理可以有效地提高患者对糖尿病认知水平、自我管理能力及自我效能,改善患者的血糖水平和健康状况.

目的 评估上海市社区管理的2型糖尿病患者血糖、血压及血脂控制情况,为优化社区糖尿病管理提供依据.方法 对上海市社区管理的1 624例2型糖尿病患者进行调查,根据中华医学会糖尿病防治指南的综合控制目标,评估血糖、血压和血脂的达标情况.结果 1 624例被调查者的糖化血红蛋白(HbA1C)平均值为7.5％±1.7％.患者HbA1C达到控制目标(HbA1C＜7.0％)的比例为43.6％,血压达标率(＜130/80 mmHg)为14.3％,血脂3项[甘油三酯(TG)＜1.7 mmol/L,高密度脂蛋白胆固醇(HDL-C)男性＞1.0 mmol/L,女性＞1.3 mmol/L,低密度脂蛋白胆固醇(LDL-C)＜2.6 mmol/L]达标率为13.2％,HbA1c、血压和LDL-C同时达标的患者仅占2.6％.多因素logistic回归分析结果显示,影响血糖达标的因素为郊区、年龄小、病程长、不控制饮食及中心性肥胖;影响血压达标的因素为郊区、年龄大及超重;影响血脂达标的因素为女性、超重及中心性肥胖.结论 目前上海市社区管理的2型糖尿病患者血糖、血压和血脂控制达标率不够理想,尤其需关注郊区、超重或中心性肥胖的患者.

It is not known which obesity index best explains variations in cardiovascular disease risk across populations. The objective of this study was to differentiate the associations of waist circumference (WC) and body mass index (BMI) with cardiovascular disease risk in a Chinese population. Cardiovascular risk factors, WC, and BMI were measured in 13 817 adults aged more than 18 years in Shanghai. Higher WC tertiles were associated with higher blood pressure and higher cholesterol, triacylglycerol, and glucose concentrations within each tertile of BMI and vice versa. The odds ratios (ORs) of hypertension, dyslipidemia, and metabolic syndrome increased with successive WC (or BMI) tertiles after adjustment for BMI (or WC) and several covariates. However, BMI tertiles were not associated with the ORs of diabetes after adjustment for WC. WC may be better than BMI as an alternative measure of body fatness or fat distribution for predicting diabetic risks in Chinese adults.

[目的]分析TRB3基因+251A/G多态性分布,并探讨该多态性与糖耐量减低(IGT)及胰岛素抵抗的相关性.[方法]在112例IGT者和209例对照者中,采用Taqman探针方法对TRB3基因+251A/G位点进行基因分型;同时进行问卷调查、体格检查及血糖、血脂、胰岛素等生化指标的检测,并计算稳态模型法β细胞功能指数(HOMA-B)、早期相胰岛素分泌指数(△I30/△G30)、稳态模型法胰岛素抵抗指数(HOMA-IR)、Cederholm胰岛素敏感指数(ISIc)等评价胰岛素分泌及胰岛素敏感性. [结果]在IGT组与对照组中,性别、年龄差异无统计学意义;两组临床指标比较:BMI、血糖(空腹及糖后2h)、糖化血红蛋白、游离脂肪酸、胰岛素(空腹及糖后2h)、△I30/△G30、HOMA-IR、ISIc等10项差异有统计学意义.TRB3基因+251A/G位点存在多态性.AA、AG、GG 3种基因型的频率分布在IGT组、对照组分别为64.29％、64.11％,28.57％、32.54％,7.14％、3.35％,其分布差异无统计学意义(x2=0.006,P=0.938).两组不同基因型的临床指标比较:在IGT组中,AG/GG基因型者空腹胰岛素、HOMA-IR高于AA基因型者(P＜0.05);对照组+251A/G不同基因型者血糖、血脂、胰岛素、HOMA-B、HOMA-IR等各指标差异均无统计学意义. [结论]TRB3基因+251A/G多态性与研究人群IGT的发生无关,但可能与IGT者肝脏胰岛素抵抗存在相关性.