- 學位論文
偏遠居民高血壓前期和糖尿病前期之盛行率及影响因子
Prevalence and associated factors of prehypertension and prediabetes mellitus in a rural Taiwanese population
摘要
背景 高血壓和糖尿病長期會造成患者多重器官的損傷。此外，此二者在台灣的死亡率排行榜中亦佔有舉足輕重的地位，前十名當中至少有五項和其有關。然而，臨床上沒有症狀的國人是否有不正常的血壓值和血糖濃度似乎是一個很重要的議題。特別是住在偏遠地區的居民，我們很少去了解其高血壓前期和糖尿病前期的盛行率和危險因子。本研究就是要探討偏遠地區居民其高血壓前期和糖尿病前期的盛行率及影响危險因子，並嘗試提供適當的介入方式來減緩其步入高血壓和糖尿病。 方法 我們從2001年到2007年，在南台灣的旗山地區收集了6204名參加中華民國衛生福利部中央健康保險署所提供的檢查。其中2650名是男性，3554名是女性。我們分析不同血壓組和血糖組人口統計學、代謝和行為學上的特徵。最後並用多變項邏輯回歸方法來分析資料。 結果 在我們收集的6204名參加者當中，有1792名(28.9%)為高血壓前期。相對於正常血壓組，高血壓前期組有較高的血糖、膽固醇、三酸甘油脂和身體質量指數(body mass index, BMI)。經由多變項邏輯回歸方法分析發現肥胖(BMI≧30 kg/m2)是高血壓前期最強的預測因子，危險對比值(OR)是3.172。若分別就男性和女性而言，肥胖亦是高血壓前期最強的預測因子，危險對比值分別是3.465和3.203。 就血糖方面而言，有1084名(17.5%)為糖尿病前期。相對於正常血糖組，糖尿病前期組有較高的膽固醇、三酸甘油脂、尿酸和身體質量指數。經由多變項邏輯回歸方法分析發現肥胖是糖尿病前期最強的預測因子，危險對比值(OR)是2.005。若分別就男性和女性而言，肥胖亦是糖尿病前期最強的預測因子，危險對比值分別是2.325和1.819。 結論 台灣偏遠地區居民其高血壓前期和糖尿病前期的盛行率高。對於臨床上沒有症狀的高血壓前期和糖尿病前期居民，其日後非常容易發展成高血壓和糖尿病。此二者都是心血管疾病重要的危險因子，甚至造成將來極高的致死率。我們應該提供偏遠地區居民足夠之健康促進的資訊。早期生活型態的調整，例如適當的控制體重，是一個值得推薦的介入模式。
並列摘要
Background Hypertension and diabetes mellitus are well-known associated with long-term multiple organ damage. Besides, both of them are leading causes of mortality in Taiwan. However, it seems more important to identify abnormal blood pressure and glucose level of asymptomatic people. Little is known about the prevalence of prehypertension and prediabetes mellitus and their associated risk factors in a rural Taiwanese population. Thus, we design this study to answer this inquiry. Method Community based cross-sectional data were collected in the Chi-Shan district in Southern Taiwan between 2001 and 2007. A total of 6204 adults (2650 men and 3554 women) were analyzed for their demographic, metabolic and behavior characteristics. These characteristics were compared between the different blood pressure and blood glucose groups. Multiple logistic regression methods were used to carry out the analysis of the data. Results Within the study population, 1792 (28.9%) out of 6204 were prehypertensive subjects. The prehypertensive group had higher levels of blood glucose, total cholesterol, triglycerides and body mass index (BMI) than did the normotensive group. Multivariate logistic regression analysis revealed that obese (BMI≧30 kg/m2) was the strongest predictor of prehypertension (OR = 3.172, 95% CI = 1.938-5.192, P < 0.001). Obese was also the strongest predictor of prehypertension for both males and females (OR = 3.465, 95% CI = 1.017-11.805, P =0.047; and OR = 3.203, 95% CI = 1.856-5.527, P < 0.001, respectively). Meanwhile, 1084 (17.5%) out of 6204 were prediabetic subjects. The prediabetic group had higher levels of total cholesterol, triglycerides, uric acid and body mass index (BMI) than did the normosugar group. Multivariate logistic regression analysis revealed that obese was the strongest predictor of prediabetes (OR = 2.005, 95% CI = 1.576-2.552, P < 0.001). Obese was also the strongest predictor of prediabetes for both males and females (OR = 2.325, 95% CI = 1.525-3.547, P < 0.001; and OR = 1.819, 95% CI = 1.351-2.450, P < 0.001, respectively). Conclusion The prevalence of prehypertension and prediabetes are high in a rural Taiwanese population. Higher risk factors for cardiovascular disease occur among those of poor blood pressure control. Besides, prediabetes are known to be at increased risk for progression to DM, which is associated with many risk factors for further cardiovascular disease. We should give enough information for health promotion in a rural area. Early lifestyle modifications, such as optimal weight control is a recommended intervention.
參考文獻
延伸閱讀
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