社區老年人代謝症候群相關因素調查研究

Metabolic Syndrome and its Related Factors Among the Elderly in a Community

廖俊正(Chun-Cheng Liao)

指導教授 ： 李孟智

中山醫學大學/醫學院/醫學研究所/碩士(2010年)

https://doi.org/10.6834/CSMU.2010.00100

摘要

前言:代謝症候群是一群與心臟血管疾病相關的危險因子結合，不但會導致糖尿病或心血管疾病的罹病率上升，也會增加全死因之死亡率。目前台灣六十五歲以上老年人的數目也已超過總人口數的10%以上，而此階段族群更是代謝症候群高危險群。而現在國內針對六十五歲以上的老年人代謝症候群的研究雖然慢慢在重視，但針對台中基層里民至今尚未有具代表性的相關研究。
目的:基於上述原因，來探討台中某地區六十五歲以上老年人代謝症候群之盛行率與其相關因素調查，並分析(一)、以國民健康局2007年公告實施修正代謝症候群診斷標準來看此族群的代謝症候群盛行率。(二)、以身體質量指數分三層其代謝症候群的盛行率各為何。(三)、以身體質量指數、急性發炎指標、總膽固醇、低密度膽固醇與總膽固醇與高密度膽固醇之比值等在老年人代謝症候群與非代謝症候群是否有相關性。(四)、用ㄧ些與心血管相關因子來看是否能預測老年人的代謝症候群，並探究其關連性。
方法:本論文為橫斷式研究，主要為台中某地區六十五歲(含)以上里民代謝症候調查(轄下共39里)，統計的資料共1051筆(男性為589筆、女性為462筆資料)。研究中的常態分佈之統計以百分比或平均值±標準差來表示，非常態分佈則是用中位數(IQR)來呈現。而對於連續性變項的比較則採用 Student’s t test 之統計方法來分析，若為非常態變項則用無母數的Mann-Whitney U test來分析。最後使用邏輯斯回歸分析檢定一些與心血管疾病相關的因子，看這些因子是否有預測代謝症候群的能力，而所有統計分析的檢定均以 p < 0.05 當做統計上有意義的參考。
結果:發現此年齡層代謝症候群的盛行率高達約48.1%，比國內外文獻研究都還高。若以身體質量指數分組之分析發現，BMI越大，代謝症候群盛行率就越高，而在六十五歲以上的老年人更是明顯。研究也發現由身體質量指數、總膽固醇與高密度膽固醇比值、CRP、總膽固醇、和低密度膽固醇等五個自變項所建立的邏輯式迴歸模型，對於此族群代謝症候群預測正確率是非常之高。
結論:本研究顯示台中某地區六十五歲以上老年人代謝症候群之盛行率非常高，政府應更加重視此問題對於老年族群健康危害，並將高密度脂蛋白膽固醇優先列入民眾成人健康檢查必檢項目，以早期診斷出代謝症候群。

關鍵字

代謝症候群 ； 盛行率 ； 身體質量指數 ； 急性發炎指標 ； 總膽固醇與高密度膽固醇比值

並列摘要

Introduction: Previous studies indicate that metabolic syndrome (MetS), which represents a combination of risk determinants, has recently been acknowledged as a risk factor for cardiovascular disease, type 2 diabetes mellitus, and hypertension. It is also associated with mortality. Nowadays the number of the group that are greater than 65 years old have exceeded 10% of the number of the general populations. We also know that this group is at the high risk of developing MetS. Although the government have put emphasis on the studies of MetS for those who are greater than 65 years old, no representative studies have yet been conducted in Taichung community
Objectives: Base on above reasons, we will analyze the contributing factors for the prevalence rate of the metabolic syndrome and its related factors among the elderly in a community. This study targets four topics: (1) The prevalence rate of metabolic syndrome among the elderly greater than 65 years old based on 2007 modified MetS Taiwan criteria; (2) The prevalence rate of metabolic syndrome among the groups which were divided by BMI; (3) The relation or difference between MetS group and non-MetS group; (4) Whether some cardiovascular risks would influence MetS or not.
Method: This is a cross-sectional study which involves 1,051
individuals (589 males and 462 females) from a Taichung community (39 units in this community). Data was expressed as the mean with standard deviation and median with inter-quarter range for continuous variables. Student’s t test and Mann-Whitney U test for unpaired data were used for the comparison of mean and median values between metabolic syndrome group and non- metabolic syndrome group. Logistic regression was used for examing the risk factors which are associated with cardiovascular diseases, so as to predict MetS. The goodness of fit in model was also examined.
Results: The prevalence rate of metabolic syndrome in our study was 48.1%. The number of the female patients who suffered from metabolic syndrome was higher than that of the male ones. This figure presented in this result was obviously higher than the studies done overseas or in our country. CRP was significantly different between the metabolic syndrome group and non- metabolic syndrome group. Logistic regression showed that BMI, total cholesterol, low density lipoprotein cholesterol and total-to-HDL cholesterol ratio have strong a relationship with metabolic syndrome.
Conclusion: The prevalence rate of metabolic syndrome is relatively higher among the elderly. So the government should put more emphasis on this problem. To conclude, the examination on the high density of lipoprotein cholesterol should be added to the elders’ health check-up items in order to diagnose the problem sooner.

並列關鍵字

metabolic syndrome ； prevalence ； body mass index ； CRP ； total-to-HDL cholesterol ratio

參考文獻

14.行政院衛生署國民健康局:成人（20 歲以上）代謝症候群之判定標準, 2007。

28.行政院衛生署國民健康局:代謝症候群定義及其臨床診斷準則, 2004。

4.行政院衛生署: 97年度死因統計, 2009。

12. 張明毅、林鉅勝、唐憶淨：某榮民安養機構老年男性代謝症候群之盛行率及其與死亡率的關係。臺灣老年醫學暨老年學雜誌 4(2): 130-42, 2009。

66.王培寧、李明濱：代謝症候群與失智症。台灣醫界雜誌52(12): 11-3, 2009。