以一社區醫院健檢老人驗證國民健康局2006年頒布之代謝症候群定義

Evaluate 2006 Bureau of Health Promotion Definition of Metabolic Syndrome with The Elders Health Examination in a Community Hospital

蕭德武(Te-Wu. Hsiao)

指導教授 ： 許文林

亞洲大學/健康學院/長期照護研究所/碩士(2008年)

摘要

目的：是以 65 歲以上居住在社區老人為對象，探討 (一)、台灣衛生署國民健康局的代謝症候群診斷標準，其與美國國家膽固醇教育計畫和國際糖尿病聯盟三者之間的一致性及各別盛行率。(二)、使用國民健康局的診斷標準，測得代謝症候群之老人，與其組成因素之間的相關性。(三)、傳統心血管疾病的危險因子，用作代謝症候群的預測，探究其間的相關性。
方法：本研究為一橫斷式的調查，以台灣中部某一地區教學醫院參與 2007年高級健康檢查 65 歲以上、居住在社區、自主活動老人作立意取樣，共有 387 位個案 (男性 190 位，女性 197 位) 納入本次研究。所有的受檢者都接受問卷與病史詢問，以及理學檢查，同時採集血液樣本進行生化分析。使用敘述統計法闡明一般數據，採取平均值與標準差描述研究對象之基本資料，並且採用 t 檢定比較兩性間差異；代謝症候群相關因子則用百分比表示，使用卡方檢定來考驗男女性之間的關係， p 值小於 0.05 判定為有統計學上的顯著意義。各種代謝症候群定義之間的一致性則用 Cohen’s kappa (κ) 分析。並且使用邏輯斯迴歸分析 (Logistic regression) 檢定一般特質、生活型態與代謝症候群之間的關聯性。進一步驗證代謝症候群各組成因素的勝算比，並且檢查其適配度，以及探討心血管疾病危險因子用作預測老人代謝症候群的可行性。
結果：台灣衛生署國民健康局的代謝症候群診斷標準，其與美國國家膽固醇教育計畫和國際糖尿病聯盟三者之間的一致性達到幾乎完全吻合的程度；其於老人的盛行率依序為 33.3 %、26.1 %、25.3 %，其中以國民健康局的定義盛行率最高，而且女性罹患的比例高過男性。其次，藉由邏輯斯迴歸模式發現，血壓、血糖、三酸甘油酯及腰圍均具有密切的關係，也都適合用作預測因子。但是，高密度脂蛋白膽固醇在老人家身上卻不盡理想，預測的效力不佳。在傳統心血管疾病的危險因子當中證實性別、總膽固醇和血壓的確與代謝症候群有關，至於低密度脂蛋白膽固醇、高密度脂蛋白膽固醇和抽菸則未達統計上的顯著意義。
結論：高密度脂蛋白膽固醇在老人樣本中，不適合作為代謝症候群的預測因子 (p > .05)，宜調整其切點值，或者採用世界衛生組織的標準。國民健康局代謝症候群定義的各組成因素用以預測老人，其適配度值得商榷，宜再研究更佳的參數，讓診斷工具更精準。可以考慮與老人代謝症候群關聯性較強的總膽固醇和尿酸作為預測因子 (p < .05)。

關鍵字

代謝症候群 ； 胰島素阻抗 ； 心血管疾病

並列摘要

Objective: The study aims to 3 categories: (1) to investigate the correlations of BHP, NCEP and IDF definition of metabolic syndrome and their prevalence respectively. (2) The relation between components of BHP definition and elderly people who suffered from it. (3) Whether traditional cardiovascular risk factors influence metabolic syndrome or not.

Methods: This is a cross sectional study, collected 387 aged individuals of health examination in one year from a community hospital, 197 were female and 190 male. They were all above 65 years old, functional independent and living in community. A complete history, life style questionnaire, physical examination and blood sample for biochemistry were done. The characteristics of study population were demonstrated with descriptive statistics, expressed by mean and standard deviation, distinguished the variation of sex with t-test. Components of metabolic syndrome were seen in percentile and the sex difference compared by chi-square (χ2). Cohen’s kappa coefficient (κ) was applied for agreement of three different kinds of metabolic syndrome definition. Logistic regression was used for factors evaluation for predicting metabolic syndrome. Odds ratio was also applied for comparing each other in the risk factors of cardiovascular disease. The goodness of fit in every model was examined.

Results: In Taiwan, Bureau of Health Promotion in Department of Health established a metabolic syndrome definition, which achieves the agreement with National Cholesterol Education Program and the International Diabetes Federation. The uniformities of them were nearly perfect. The prevalence rate in order is 33.3 %, 26.1 %, 25.3 % respectively. The highest rate was defined by Bureau of Health Promotion. Moreover, the female suffered from metabolic syndrome was higher than the male. Logistic regression appeared to discover that the blood pressure, blood sugar, triglyceride and waist circumference have strong correlation to metabolic syndrome. They served as the predictive operator quite well. But, the high density lipoprotein cholesterol is not actually ideal on the elders, the forecast potency is not so good. In the traditional cardiovascular risk factors, it was confirmed that sex, total cholesterol and blood pressure related with metabolic syndrome. As for the low density lipoprotein cholesterol, high density lipoprotein cholesterol and smoking has not reached in statistical significance.

Conclusion: The high density lipoprotein cholesterol in elderly people is not proper to take metabolic syndrome the predictive operator (p > .05). Adjusts its tangential point value or uses World Health Organization definition might help. If the components of metabolic syndrome definition by Bureau of Health Promotion applied to predict old person, the adaptive is worth discussing. Study a better parameter to get the diagnostic tool more accurate. It might be considered that the strong relativity with metabolic syndrome - total cholesterol and uric acid take the predictive operator with old people (p < .05).

並列關鍵字

metabolic syndrome ； insulin resistance ； cardiovascular disease

參考文獻

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