职业体力活动和遗传因素与代谢综合征关系的巢式病例对照研究

A nested case-control study on the relationship between occupational physical activity, heredity factors and metabolic syndrome

目的研究职业体力活动和遗传因素与代谢综合征（MS）之间的关系。方法在江苏省MS队列研究基础上，通过对队列人群进行随访调查，采集血液样本，检查生化指标。按照美国国家胆固醇教育计划成人治疗指南Ⅲ（NCEP-ATPⅢ）中的MS诊断标准确定MS新发病例；同时采用1：1配对的方法在队列人群中选取健康对照（匹配条件：地区相同、性别相同、年龄±2岁），共选取389名MS新发病例和389名对照为研究对象。并采用TaqMan荧光探针法检测过氧化物酶体增殖物激活受体a（PPARa）内含子1A／C基因（rs135539）多态性。结果（1）相对于轻体力，重体力职业体力活动者发生MS调整OR值为2．18（95％CI：1．08～4．38）。（2）具有高血压和2型糖尿病家族史的人群发生MS的调整OR值分别为1．44（95％C1：1．02～2．03）和3．25（95％CI：1．28～8．20）。（3）PPARa内含子1A／C基因型（AA、AC、CC）与MS之间无关联；相对于基因型AA，AC、CC型人群发生MS的调整OR值分别为0．98（95％CI：0．70～1．36）和0．75（95％CI：0．44～1．29）。（4）高血压家族史与中体力和重体力之间均存在协同作用，会增加MS发生的危险；暴露于中体力与高血压家族史、重体力与高血压家族史人群发生MS的调整OR值分别为2．47（95％CI：1．00～6．06）和3．82（95％CI：1.31～11．15）。结论职业体力活动、高血压及2型糖尿病家族史与MS发生显著相关，且职业体力活动与高血压家族史之间存在协同作用，可能会增加MS发生的危险性。

Objective To examine the associations between occupational physical activity, heredity factors and metabolic syndrome （MS） in a Chinese population. Methods Based on the MS cohort study in Jiangsu province, subjects were followed-up, and blood samples were collected at the same time for biochemical indicators measurement. Newly confirmed MS patients according to US. National Cholesterol Education Program Adult Treatment Guidelines III （NCEP-ATP III ） were recruited as cases. Controls were 1 ： 1 matched with cases by region, gender and age （ ± 2 years）. In total, 389 MS patients and 389 controls were recruited as study subjects. Nested case-control study was applied for the present analysis. TaqMan fluorescence probe method was used to detect the genetic polymorphism of PPARct intron 1A/C （rs135539）. Results （1）Compared to low physical activity group, the subjects with heavy physical activity were positively associated with MS （0R：2.18, 95% CI： 1.08-4.38）. （2）The subjects, with a family history of hypertension （OR=1.44, 95% CI： 1.02-2.03 ） or type 2 diabetes （ OR = 3.25,95 CI： 1.28-8.20）, were significantly indreased the occurrence of MS. （3） The genotype （AA, AC, CC） of PPARα intron 1A/C was not found to be related to MS. The OR of AC and CC genotype （compared to the genotype AA） were 0.98（95%CI： 0.70-1.36） and 0.75 （95% CI： 0.44-1.29） , respectively. （4） Effect modifications were observed between family history of hypertension and moderate physical activity （OR=2.47, 95% CI： 1.00-6.06 ） or heavy physical activity （0R=3.82, 95%CI： 1.31-11.15） on the development of MS. Conclusion Heavy physical activity, with family history of hypertension or type 2 diabetes, seemed to be positively correlated with the risk of MS. Effect modifications were observed between occupational physical activity and family history of hypertension which might be associated with an increased risk of MS.