【作者】 王卉；

【导师】 王林；

【作者基本信息】 天津医科大学 ， 内科学（专业学位）， 2014， 博士

【摘要】 目的：血脂异常是心血管疾病的主要危险因素已是人们的共识,老年群体是心血管病患病的主要群体,较非老年人在心血管病发病机制、治疗乃至预防策略上既有共性,又有特殊性。为了解老年群体随着年龄增长血脂的变化,我们对一个人员相对固定的老年群体进行动态观察,并分析该老年群体以及健康老年群体血脂的一般水平、分布特征、近3年动态变化及与常见危险因素的关系,进一步探讨老年期的调脂治疗策略及老年心血管疾病防治策略。方法：本研究分析天津医科大学总医院保健医疗部健康体检人群共7303人的体检数据,以掌握该群体老年人以及健康老年人的血脂水平、异常状况及随增龄变化规律,分析血脂水平与性别、年龄、血压(BP)、体质指数(BMI)、尿酸(UA)、空腹血糖(FPG)及糖化血红蛋白(HbAlc)等指标的相关关系；对固定体检人群共3734人自2011-2013年血脂水平进行3年连续的调查研究,以了解该群体血脂动态变化；通过问卷调查的方式,了解老年人群生活习惯、既往病史、服药史等基础资料,分析该人群各项心血管疾病危险因素及常见基础疾病与血脂的关系。结果：1、2013年健康体检老年干部群体共3563人血脂水平：胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)分别为4.97±0.95,1.47±0.89,1.39±0.39,2.94±0.83mmol/L。人群TC.TG及LDL-C随增龄出现先升后降的规律,且存在一致的达峰值年龄,即男性50-59岁,而女性为60-69岁；HDL-C存在随增龄减低,男性50-69岁及女性60-69岁以后升高的趋势。老年组TC.TG.HDL-C及LDL-C总体水平均高于非老年组。女性TC.HDL-C高于男性；TG水平60-岁后,LDL-C水平40-岁后,女性高于男性。女性HDL-C异常升高率50.03%高于男性20.23%。2、本研究健康老年人共786人,占老年人群的22.1%,健康老年人比例随着增龄而减低,且男性比例低于女性。健康老年人血脂水平：TC4.13-6.03mmol/L, TG0.65-2.01mmol/L,HDL-C1.09-1.85mmol/L,LDL-C2.20-3.82mmol/L,均高于一般人群。健康老年组TC、HDL-C及LDL-C水平均高于老年对照组,TG水平低于对照组,HDL-C在所有年龄组均保持较高水平。健康老年女性TC、TG、 HDL-C及LDL-C水平均高于男性。健康老年组TC及LDL-C异常率高于老年对照组,TG、HDL-C异常率低于老年对照组。老年对照组血脂影响因素包括性别、年龄、BMI,血压,UA, FPG及HBAlc等。健康老年组血脂影响因素较老年对照组明显减少。3、2011-2013年干部体检群体(老年组及非老年组)血脂水平及异常率均呈现逐年下降趋势。该群体不良行为包括：吸烟,缺乏运动,打鼾等问题。慢性疾病总患病率高达69.7%,慢性疾病前十位为：高血压51.1%、高脂血症49.5%、冠心病31.1%、慢阻肺23.4%、脑卒中30.6%、骨质疏松21.8%、心律失常21.7%、糖尿病19.1%、脑血管病9.7%、下肢动脉疾病8.3%。人群高血压病史,痛风史,糖代谢异常,糖尿病史,脑血管病史,下肢动脉疾病史,自身免疫性疾病史为冠心病危险因素,HDL-C高水平、进行降甘油三酯治疗和降胆固醇治疗为冠心病保护因素。结论：1、2013年健康体检老年干部群体为常住天津的高知识层次脑力劳动群体。人群超重、肥胖率及血脂的总体异常率略高于以往的研究。TC、TG、HDL-C及LDL-C随增龄出现规律性的变化,平均水平及峰值水平高于以往研究,达峰年龄较以往研究后延10年左右,提示该老年人群冠心病发病风险高。老年女性心血管保护因素与危险因素均处于高水平,预后需进一步随访研究。2、本研究提供了天津市区健康离退休干部群体的血脂水平及一般特征。健康老年人群血脂总体水平较高,HDL-C持续稳定的高水平及TG较低水平可能是健康老年组血脂的重要特征。健康老年群体血脂的影响因素较少,但BMI、UA、FPG、 HBAlc及血压水平在正常范围内波动仍能影响血脂水平。3、该干部群体健康意识逐渐加强,伴随血脂水平及异常率逐年下降,心血管发病风险有逐渐下降的趋势,但体质指数、血压、血尿酸、血脂、血糖异常率等心血管疾病危险因素及慢性疾病总患病率高于国内人群水平。针对上述危险因素制定健康教育计划,倡导良好的行为生活方式,督促老年人定期检测血压、血脂及血糖等控制慢性病,对高危人群进行针对性的调脂治疗,预防心血管疾病的发生。更多还原

【Abstract】 ObjectivesDyslipidemia is a major risk factor of cardiovascular disease. As the primary group of prevalent of cardiovascular disease, elderly population has both commonalities and particularities on pathogenesis, treatment and prevention strategies comparing with non-elderly people. To find out the trend of blood lipid in elderly with aging, we observed a relatively stable elderly population, and analyzed the general level, distribution features, dynamic changes and relationship with some common risk factors, and had further discussion the strategies of blood lipid regulation therapy and prevention and control of cardiovascular disease during senile period.MethodsWe analyzed the data of annual health check from The General Hospital of Tianjin Medical University Health Care Department from2011to2013, followed up the sequence of blood lipid on elderly in order to investigate the general level, abnormality features and dynamic changes of blood lipid in this elderly group and healthy elderly group. We also analyzed the relationship between lipid level and gender, age, blood pressure (BP), body mass index (BMI), uric acid (UA), fasting plasma glucose (FPG), and glycated hemoglobin Ale (HbAlc). By the way of questionnaire, to learn about the basic information of elderly, such as the lifestyle, past medical history, medication history, and analyzed the relationship between lipid level and cardiovascular disease risk factors, and also with some common underlying diseases.Results1. The average blood lipid level of this health screening groups of elderly cadre in2013were total cholesterol (TC)4.97±0.95mmol/L, triglycerides (TG)1.47±0.89mmol/L, high density lipoprotein cholesterol (HDL-C)1.39±0.39mmol/L, low density lipoprotein cholesterol (LDL-C)2.94±0.83mmol/L. The level of BMI, TC, TG and LDL-C increased with aging, and then decreased at the same age pointcut. The pointcut was50-59age group of male and60-69age group of female, was higher than the previous research in China of45-49age group. HDL-C level had a reverse pattern, decreased with aging and then increased at the same pointcut as above. The overall level of TC, TG, HDL-C and LDL-C of elderly group were higher than non-elderly group. In female level of TC, HDL-C were higher than male, TG and LDL-C level were higher than male after60year old and40year old.2. The average blood lipid level of healthy elderly were TC4.13-6.03mmol/L, TG0.65-2.01mmol/L, HDL-C1.09-1.85mmol/L, LDL-C2.20-3.82mmol/L, higher than general population, and all detected blood lipid level were higher in female than in male. Healthy elderly was account for22.1%of elder people and male lower than female, its ratio declined with aging. TC, LDL-C and HDL-C were higher but TG was lower in healthy elderly than in control group. There were some factors which influence the lipid level of elderly control group such as BMI, BP, UA, FPG and HBA1C. Affecting factors were fewer in healthy elderly group.3. The blood lipid level and abnormal ratio appeared declining trend in cadre examination group. The misbehavior in this population included:smoking, lack of physical exercises and snoring. The abnormal ratio of overweight and obesity, hypertension, hyperuricemia, dyslipidemia and hyperglycemia were higher. The total prevalence of chronic diseases was as high as account for69.7%, the top ten chronic diseases in sequence were hypertension, hyperuricemia, coronary heart disease(CHD), chronic obstructive pulmonary disease(COPD), stroke, osteoporosis, arrhythmia, diabetes mellitus, cerebral vascular disease, lower extremity arterial disease. Risk factors of CHD were history of hypertension, gout, abnormal glucose metabolism, diabetes mellitus, cerebrovascular, lower extremity arterial disease, autoimmune disease. Protective factors of CHD were high level of HDL-C, triglyceride and cholesterol lowering therapy.Conclusions1. In2013, this elderly cadres population of health check was a well-educated, professional urban resident population. The overall level of TC, TG, HDL-C and LDL-C of elderly group were higher than non-elderly group. The level of TC, TG, LDL-C and HDL-C changed regularly with aging, and the age pointcut was higher than the previous research in China. The abnormality ratio of overweight, obesity and dyslipidemia were higher than previous research. 2. We investigated the average level and general features of blood lipid in this urban living healthy retired cadres population. The total blood lipid level of healthy elderly was higher than general population, and also higher than the control elderly group except TG. Because HDL-C level in the healthy elderly group was significantly higher than the control group and maintained a high level in all age groups, we considered that sustained and stable high level of HDL-C may be an important feature of blood lipid in healthy elderly group. By comparison and analysis of related factors of blood lipid, we found that the lipid level of healthy elderly may be influenced by the level of BMI, UA, FPG, HBAlc and BP, although these factors were in the normal range of healthy elderly. Health managers should set up a well-focused lipid-lowering therapy for the high-risk groups based on different types of dyslipidemia.3. The blood lipid level and abnormal ratio appeared declining trend in this cadre group, showing people’s health-conscious increased gradually. The unhealthy lifestyle in this population was below the domestic level, but some major risk factors of cardiovascular diseases such as overweight, obesity, hypertension, hyperuricemia, dyslipidemia, hyperglycemia and the total prevalence of chronic diseases were higher than domestic population. We should develop health education programs according to the risk factors, and advocate healthy life-style and regular check-up, in order to control the chronic diseases, prevent the occurrence of cardiovascular disease.更多还原