膳食纤维及常见危险因素对广州社区脑梗死发病的影响
|
摘要
目的探讨膳食纤维(DF)及常见危险因素对广州社区脑梗死发病的影响。方法收集2015年5月至2017年11月本院收治的广州社区(海珠、越秀、荔湾、番禺、白云)本地脑梗死患者及高危人群326例,评估其日均摄入DF,并收集血压、血脂、血糖等临床资料。先根据头颅磁共振弥散成像结果将患者分为脑梗死组(98例)和非脑梗死组(228例),与DF及常见危险因素间行单因素、多因素及ROC曲线分析;再将DF以10 g和25 g为界分三组,分析三组间临床参数的差异。结果脑梗死组收缩压(SBP)、舒张压(DBP)、颈动脉斑块Crouse评分、空腹血糖(FBG),及性别(男)、糖尿病和颈动脉斑块的比率均高于非脑梗死组;而DF、高密度脂蛋白(HDL)低于非脑梗死组,差异均有统计学意义(P<0.05)。Logistic回归分析显示,脑梗死发病主要与Crouse评分(OR=1.125,P=0.026)、SBP(OR=1.029,P=0.021)有关;而DF(OR=0.941,P=0.010)及HDL(OR=0.260,P=0.022)对其有一定保护作用。ROC曲线下面积(AUC)显示,SBP与脑梗死发病相关性较密切(AUC=0.715,P=0.000)。Ordinal回归分析显示,DF三组间脑梗死发病率、年龄、SBP、DBP及糖化血红蛋白(HBA1C)差异均有统计学意义(P<0.05)。结论广州社区患者脑梗死发病主要与其Crouse评分及SBP升高有关,而DF和HDL水平上调对其脑梗死发病有保护作用;DF主要通过调节SBP、DBP及HBA1C的水平而影响脑梗死发病。
Objective To investigate the effects of dietary fiber( DF) and common risk factors on the onset of cerebral infarction in Guangzhou communities. Methods 326 patients were collected from Guangzhou communities. The daily average DF intake was estimated, and the clinical data such as blood pressure, blood lipid and blood glucose were collected. Firstly, the patients were divided into cerebral infarction Group(98 cases) and non-cerebral infarction Group(228 cases) according to the findings on the brain diffusion weighted image; and the univariate and multivariate analysis and ROC curve were used to explore the risk factors affecting the onset of cerebral infarction. Afterward, the data was divided into three groups based on DF<10 g, 10-25 g and ≥25 g, and the differences of clinical parameters were analyzed among the three groups. Results In cerebral infarction group, the levels of systolic pressure( SBP), diastolic pressure(DBP), fasting blood glucose( FBG), carotid plaque Crouse score and as well as the ratios of sex, diabetes and carotid plaque were respectively higher than those in non-cerebral infarction group(all P<0.05); and DF intake and high-density lipoprotein( HDL) level were lower than those in non-cerebral infarction group(both P<0.05). Logistic regression revealed that the onset of cerebral infarction was mainly related to Crouse score( OR=1.125 P=0.026) and SBP level(OR=1.029, P=0.021); and the DF intake(OR=0.941, P=0.010) and HDL level increase(OR=0.260, P=0.022) had certain protective effect on the onset of cerebral infarction. The area under curve(AUC) of ROC also showed that SBP level was closely related to the onset of cerebral infarction(AUC=0.715, P=0.000). Ordinal regression revealed that there were significant differences of the incidence of cerebral infarction, age as well as the levels of SBP, DBP and glycosylated hemoglobin(HBA1C) among the three DF groups(all P<0.05). Conclusions The onset of cerebral infarction in Guangzhou communities was mainly related to increase of Crouse score and SBP; and the enhancement of DF and HDL showed certain protective effect on the onset of cerebral infarction. DF could affect the onset of cerebral infarction mainly through regulating the levels of SBP, DBP and HBA1C.
Objective To investigate the effects of dietary fiber( DF) and common risk factors on the onset of cerebral infarction in Guangzhou communities. Methods 326 patients were collected from Guangzhou communities. The daily average DF intake was estimated, and the clinical data such as blood pressure, blood lipid and blood glucose were collected. Firstly, the patients were divided into cerebral infarction Group(98 cases) and non-cerebral infarction Group(228 cases) according to the findings on the brain diffusion weighted image; and the univariate and multivariate analysis and ROC curve were used to explore the risk factors affecting the onset of cerebral infarction. Afterward, the data was divided into three groups based on DF<10 g, 10-25 g and ≥25 g, and the differences of clinical parameters were analyzed among the three groups. Results In cerebral infarction group, the levels of systolic pressure( SBP), diastolic pressure(DBP), fasting blood glucose( FBG), carotid plaque Crouse score and as well as the ratios of sex, diabetes and carotid plaque were respectively higher than those in non-cerebral infarction group(all P<0.05); and DF intake and high-density lipoprotein( HDL) level were lower than those in non-cerebral infarction group(both P<0.05). Logistic regression revealed that the onset of cerebral infarction was mainly related to Crouse score( OR=1.125 P=0.026) and SBP level(OR=1.029, P=0.021); and the DF intake(OR=0.941, P=0.010) and HDL level increase(OR=0.260, P=0.022) had certain protective effect on the onset of cerebral infarction. The area under curve(AUC) of ROC also showed that SBP level was closely related to the onset of cerebral infarction(AUC=0.715, P=0.000). Ordinal regression revealed that there were significant differences of the incidence of cerebral infarction, age as well as the levels of SBP, DBP and glycosylated hemoglobin(HBA1C) among the three DF groups(all P<0.05). Conclusions The onset of cerebral infarction in Guangzhou communities was mainly related to increase of Crouse score and SBP; and the enhancement of DF and HDL showed certain protective effect on the onset of cerebral infarction. DF could affect the onset of cerebral infarction mainly through regulating the levels of SBP, DBP and HBA1C.
引文
[1]朴桂花,金玉,徐英玉.脑梗死与几种不良生活习惯关系的统计分析[J].中国实用医药,2012,7(33):249-250.
[2]Zhang Z,Xu G,Liu D,et al.Dietary fiber consumption and risk of stroke[J].Eur J Epidemiol,2013,28(2):119-130.
[3]Chen GC,Lv DB,Pang Z,et al.Dietary fiber intake and stroke risk:a meta-analysis of prospective cohort studies[J].Eur J Clin Nutr,2013,67(1):96-100.
[4]Threapleton DE,Greenwood DC,Evans CE,et al.Dietary fiber intake and risk of first stroke:a systematic review and metaanalysis[J].Stroke,2013,44(5):1360-1368.
[5]赵秋革,方晓涛,叶凤仪,等.膳食纤维对广州社区脑梗死患者及其高危人群常见危险因素的影响[J].广东医学,2018,39(2):216-220.
[6]Crouse JR,Grobbee DE,O′Leary DH,et al.Carotid intimamedia thickness in low-risk individuals with asymptomatic atherosclerosis:baseline data from the METEOR study[J].Curr Med Res Opin,2007,23(3):641-648.
[7]李飞奉,戚佩谊,庄雅如,等.颈动脉斑块的性质与其社区高危人群常见危险因素的关系[J].国际医药卫生导报,2014,20(23):3513-3516.
[8]Swets JA.Measuring the accuracy of diagnostic systems[J].Science,1988,240(4857):1285-1293.
[9]谭晶,潘生英,徐树平.影响缺血性脑梗急性发作至就诊时间间隔的相关因素[J].热带医学杂志,2017,17(12):1652-1655.
[10]Guan T,Ma J,Li M,et al.Rapid transitions in the epidemiology of stroke and its risk factors in China from 2002 to 2013[J].Neurology,2017,89(1):53-61.
[11]Liu J,Zhu Y,Wu Y,et al.Association of carotid atherosclerosis and recurrent cerebral infarction in the Chinese population:a meta-analysis[J].Neuropsychiatr Dis Treat,2017,13:527-533.
[12]Yan B,Peng L,Han D,et al.Blood Pressure Reverse-Dipping is Associated With Early Formation of Carotid Plaque in Senior Hypertensive Patients[J].Medicine:Baltimore,2015,94(10):e604.
[13]田作军,刘磊,董亚贤,等.影响颈动脉斑块形成因素的临床分析[J].中华神经医学杂志,2008,7(11):1168-1173.
[14]刘彦伯,王一丹,任凤学,等.原发性高血压患者脉搏波传导速度的研究[J].热带医学杂志,2017,17(7):940-944.
[15]Mauriello A,Servadei F,Sangiorgi G,et al.Asymptomatic carotid plaque rupture with unexpected thrombosis over a non-canonical vulnerable lesion[J].Atherosclerosis,2011,218(2):356-362.
[16]田作军,黎宣谷,陆亚琴,等.高血压患者前循环脑梗死发作与颈动脉斑块的性质之间的关系[J].实用医学杂志,2012,28(14):2336-2339.
[17]Connelly MA,Shalaurova I,Otvos JD.High-density lipoprotein and inflammation in cardiovascular disease[J].Transl Res,2016,173:7-18.
[18]单婉莹,汪玲,徐格林.膳食纤维与卒中[J].国际脑血管病杂志,2017,25(1):84-90.
[19]Tighe P,Duthie G,Vaughan N,et al.Effect of increased consumption of whole-grain foods on blood pressure and other cardiovascular risk markers in healthy middle-aged persons:a randomized controlled trial[J].Am J Clin Nutr,2010,92(4):733-740.
[20]崔军,高志敏.高血压、高血糖、高血脂与膳食关系相关性分析[J].中国医刊,2012,47(2):57-58.
[21]何凤怡,陈超刚,林刁珠,等.膳食纤维和血糖负荷与糖代谢异常风险的相关性[J].中华内分泌代谢杂志,2016,32(1):38-41.
[22]Aleixandre A,Miguel M.Dietary fiber and blood pressure control[J].Food&Function,2016,7(4):1864-1871.
[23]Jayalath VH,de Souza RJ,Sievenpiper JL,et al.Effect of dietary pulses on blood pressure:a systematic review and metaanalysis of controlled feeding trials[J].Am J Hypertens,2014,27(1):56-64.
[24]胡家庭,胡杨,石云鹤,等.膳食纤维与降压药治疗高血压患者的临床观察及干预措施[J].饮食保健,2017,4(6):10-11.
[25]Ismaiel M,Min C.Dietary fiber role in type 2 diabetes prevention[J].Brit Food J,2016,118(4):961-975.
[26]Mcrae MP.Dietary Fiber Intake and Type 2 Diabetes Mellitus:An Umbrella Review of Meta-analyses[J].J Chiropr Med,2018,17(1):44-53.
[27]Weickert MO,Pfeiffer AFH.Impact of Dietary Fiber Consumption on Insulin Resistance and the Prevention of Type 2 Diabetes[J].JNutr,2018,148(1):7-12.
[28]徐谷根,杨茵,肖毅,等.膳食纤维对2型糖尿病的临床疗效[J].中国医药导报,2016,13(33):80-83.
[29]Surampudi P,Enkhmaa B,Anuurad E,et al.Lipid Lowering with Soluble Dietary Fiber[J].Curr Atheroscler Rep,2016,18(12):75.
[30]邹莉芳,沈以红,黄先智,等.食品功能性成分降血脂作用机理研究进展[J].食品科学,2016,37(5):239-244.
[2]Zhang Z,Xu G,Liu D,et al.Dietary fiber consumption and risk of stroke[J].Eur J Epidemiol,2013,28(2):119-130.
[3]Chen GC,Lv DB,Pang Z,et al.Dietary fiber intake and stroke risk:a meta-analysis of prospective cohort studies[J].Eur J Clin Nutr,2013,67(1):96-100.
[4]Threapleton DE,Greenwood DC,Evans CE,et al.Dietary fiber intake and risk of first stroke:a systematic review and metaanalysis[J].Stroke,2013,44(5):1360-1368.
[5]赵秋革,方晓涛,叶凤仪,等.膳食纤维对广州社区脑梗死患者及其高危人群常见危险因素的影响[J].广东医学,2018,39(2):216-220.
[6]Crouse JR,Grobbee DE,O′Leary DH,et al.Carotid intimamedia thickness in low-risk individuals with asymptomatic atherosclerosis:baseline data from the METEOR study[J].Curr Med Res Opin,2007,23(3):641-648.
[7]李飞奉,戚佩谊,庄雅如,等.颈动脉斑块的性质与其社区高危人群常见危险因素的关系[J].国际医药卫生导报,2014,20(23):3513-3516.
[8]Swets JA.Measuring the accuracy of diagnostic systems[J].Science,1988,240(4857):1285-1293.
[9]谭晶,潘生英,徐树平.影响缺血性脑梗急性发作至就诊时间间隔的相关因素[J].热带医学杂志,2017,17(12):1652-1655.
[10]Guan T,Ma J,Li M,et al.Rapid transitions in the epidemiology of stroke and its risk factors in China from 2002 to 2013[J].Neurology,2017,89(1):53-61.
[11]Liu J,Zhu Y,Wu Y,et al.Association of carotid atherosclerosis and recurrent cerebral infarction in the Chinese population:a meta-analysis[J].Neuropsychiatr Dis Treat,2017,13:527-533.
[12]Yan B,Peng L,Han D,et al.Blood Pressure Reverse-Dipping is Associated With Early Formation of Carotid Plaque in Senior Hypertensive Patients[J].Medicine:Baltimore,2015,94(10):e604.
[13]田作军,刘磊,董亚贤,等.影响颈动脉斑块形成因素的临床分析[J].中华神经医学杂志,2008,7(11):1168-1173.
[14]刘彦伯,王一丹,任凤学,等.原发性高血压患者脉搏波传导速度的研究[J].热带医学杂志,2017,17(7):940-944.
[15]Mauriello A,Servadei F,Sangiorgi G,et al.Asymptomatic carotid plaque rupture with unexpected thrombosis over a non-canonical vulnerable lesion[J].Atherosclerosis,2011,218(2):356-362.
[16]田作军,黎宣谷,陆亚琴,等.高血压患者前循环脑梗死发作与颈动脉斑块的性质之间的关系[J].实用医学杂志,2012,28(14):2336-2339.
[17]Connelly MA,Shalaurova I,Otvos JD.High-density lipoprotein and inflammation in cardiovascular disease[J].Transl Res,2016,173:7-18.
[18]单婉莹,汪玲,徐格林.膳食纤维与卒中[J].国际脑血管病杂志,2017,25(1):84-90.
[19]Tighe P,Duthie G,Vaughan N,et al.Effect of increased consumption of whole-grain foods on blood pressure and other cardiovascular risk markers in healthy middle-aged persons:a randomized controlled trial[J].Am J Clin Nutr,2010,92(4):733-740.
[20]崔军,高志敏.高血压、高血糖、高血脂与膳食关系相关性分析[J].中国医刊,2012,47(2):57-58.
[21]何凤怡,陈超刚,林刁珠,等.膳食纤维和血糖负荷与糖代谢异常风险的相关性[J].中华内分泌代谢杂志,2016,32(1):38-41.
[22]Aleixandre A,Miguel M.Dietary fiber and blood pressure control[J].Food&Function,2016,7(4):1864-1871.
[23]Jayalath VH,de Souza RJ,Sievenpiper JL,et al.Effect of dietary pulses on blood pressure:a systematic review and metaanalysis of controlled feeding trials[J].Am J Hypertens,2014,27(1):56-64.
[24]胡家庭,胡杨,石云鹤,等.膳食纤维与降压药治疗高血压患者的临床观察及干预措施[J].饮食保健,2017,4(6):10-11.
[25]Ismaiel M,Min C.Dietary fiber role in type 2 diabetes prevention[J].Brit Food J,2016,118(4):961-975.
[26]Mcrae MP.Dietary Fiber Intake and Type 2 Diabetes Mellitus:An Umbrella Review of Meta-analyses[J].J Chiropr Med,2018,17(1):44-53.
[27]Weickert MO,Pfeiffer AFH.Impact of Dietary Fiber Consumption on Insulin Resistance and the Prevention of Type 2 Diabetes[J].JNutr,2018,148(1):7-12.
[28]徐谷根,杨茵,肖毅,等.膳食纤维对2型糖尿病的临床疗效[J].中国医药导报,2016,13(33):80-83.
[29]Surampudi P,Enkhmaa B,Anuurad E,et al.Lipid Lowering with Soluble Dietary Fiber[J].Curr Atheroscler Rep,2016,18(12):75.
[30]邹莉芳,沈以红,黄先智,等.食品功能性成分降血脂作用机理研究进展[J].食品科学,2016,37(5):239-244.