河南省高血压病和糖尿病人群血脂现况调查

Current status of blood lipids in people with hypertension and diabetes in Henan province

目的了解河南省高血压病和糖尿病人群的血脂水平和血脂异常情况。方法2016年4月至2017年4月,在河南省郑州市中牟县、新乡市获嘉县、濮阳市华龙区、鹤壁市淇县、洛阳市西工区和平顶山市舞钢市6个区县采用多阶段整群抽样方法,对71 285名年龄35~75岁的当地户籍居民进行调查,并采集血液样本。根据是否符合高血压病和/或糖尿病诊断标准,将调查对象分为非高血压非糖尿病组(29 427例)、高血压非糖尿病组(21 965例)、糖尿病非高血压组(8 009例)和高血压糖尿病组(11 884例),比较各组间的血脂水平和血脂异常情况。结果调查对象的总体血清总胆固醇(TC)水平为4.37(3.78,5.05)mmol/L,甘油三酯(TG)水平为1.27(0.97,1.80)mmol/L,低密度脂蛋白胆固醇(LDL-C)水平为2.34(1.88,2.88)mmol/L,高密度脂蛋白胆固醇(HDL-C)水平为1.31(1.08,1.59)mmol/L。除65~75岁女性TC水平、55~64岁和65~75岁女性LDL-C水平外,非高血压非糖尿病组、高血压非糖尿病组、糖尿病非高血压组和高血压糖尿病组不同年龄段(包括35~44、45~54、55~64和65~75岁)和不同性别调查对象的TC、TG、LDL-C和HDL-C水平差异均有统计学意义(P均<0.01)。除35~44岁男性LDL-C和HDL-C水平及65~75岁女性LDL-C水平外,非高血压非糖尿病组、高血压非糖尿病组、糖尿病非高血压组和高血压糖尿病组不同年龄段和不同性别调查对象的TC、TG、LDL-C和HDL-C异常的检出率差异均有统计学意义(P<0.01或0.05)。校正年龄、性别、吸烟、饮酒、打鼾、地域和体重指数后,多因素logistic回归分析显示,高血压(OR=1.221,95%CI 1.113~1.339,P<0.01)、糖尿病(OR=1.636,95%CI 1.461~1.833,P<0.01)和高血压合并糖尿病(OR=1.832,95%CI 1.658~2.023,P<0.01)是TC异常的危险因素;高血压(OR=1.566,95%CI 1.478~1.659,P<0.01)、糖尿病(OR=2.182,95%CI 2.031~2.342,P<0.01)和高血压合并糖尿病(OR=2.655,95%CI 2.492~2.829,P<0.01)是TG异常的危险因素;糖尿病(OR=1.510,95%CI 1.309~1.742,P<0.01)和高血压合并糖尿病(OR=1.461,95%CI 1.285~1.661,P<0.01)是LDL-C异常的危险因素;糖尿病(OR=1.261,95%CI 1.180~1.346,P<0.01)和高血压合并糖尿病(OR=1.195,95%CI 1.126~1.268,P<0.01)是HDL-C异常的危险因素。结论河南省高血压病和糖尿病人群血脂异常患病率较高,应尽早采取血脂教育和控制工作。

Objective To investigate the blood lipid levels and prevalence of dyslipidemia in people with hypertension and diabetes in Henan province. Methods From April 2016 to April 2017, multi-stage cluster sampling was adopted to investigate 71 285 local residents aged between 35 and 75 from 6 districts and counties in Henan province including Zhongmu county of Zhengzhou city, Huojia county of Xinxiang city, Hualong district of Puyang city, Qi county of Hebi city, Xigong district of Luoyang city, and Wugang city of Pingdingshan city. Blood samples were collected. According to the diagnostic criteria of hypertension and diabetes, the study population was divided into control group (n=29 427), hypertension group (n=21 965), diabetes group (n=8 009) and hypertension-diabetes group (n=11 884). Comparisons on blood lipid levels and dyslipidemia between 4 groups were performed. Results The total cholesterol (TC) level of all subjects was 4.37 (3.78, 5.05) mmol/L. The triglyceride (TG) level was 1.27 (0.97, 1.80) mmol/L, the low-density lipoprotein cholesterol (LDL-C) level was 2.34 (1.88, 2.88) mmol/L and the high-density lipoprotein cholesterol (HDL-C) level was 1.31 (1.08, 1.59) mmol/L. Except for the TC level in women aged 65-75 years and LDL-C levels in women aged 55-64 and 65-75 years, there were significant differences in TC, TG, LDL-C and HDL-C levels between subjects of control group, hypertension group, diabetes group, and hypertension-diabetes group in different age ranges (including 35-44, 45-54, 55-64,and 65-75 years) and genders(all P<0.01).Except for the LDL-C and HDL-C in men aged 35-44 years and LDL-C in women aged 65-75 years, there were significant differences in the dyslipidemia rates of TC, TG, LDL-C and HDL-C between subjects of control group, hypertension group, diabetes group and hypertension-diabetes group in different age ranges and genders(P<0.01 or <0.05). After adjusting for age, gender, smoking, drinking, snoring, region, and body mass index, multivariate logistic regression analysis showed that hypertension (OR=1.221, 95%CI 1.113-1.339, P<0.01), diabetes (OR=1.636, 95%CI 1.461-1.833, P<0.01) and hypertension-diabetes (OR=1.832, 95%CI 1.658-2.023, P<0.01) were independent risk factors for TC abnormality. Hypertension (OR=1.566, 95%CI 1.478-1.659, P<0.01), diabetes (OR=2.182, 95%CI 2.031-2.342, P<0.01) and hypertension-diabetes (OR=2.655, 95%CI 2.492-2.829, P<0.01) were also independent risk factors for TG abnormality. Diabetes (OR=1.510, 95%CI 1.309-1.742, P<0.01) and hypertension-diabetes (OR=1.461, 95%CI 1.285-1.661, P<0.01) were independent risk factors for LDL-C abnormality. Diabetes (OR=1.261, 95%CI 1.180-1.346, P<0.01) and hypertension-diabetes (OR=1.195, 95%CI 1.126-1.268, P<0.01) were independent risk factors for HDL-C abnormality. Conclusion The prevalence of dyslipidemia in patients with hypertension and diabetes is high in Henan province, so adequate blood lipid education and control should be applied to people with risk factors as soon as possible.