糖脂代谢紊乱流行病学及糖脂代谢病分期诊治
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摘要
糖脂代谢性疾病的危害在于长期糖、脂、血压水平异常对全身脏器的损害进而导致其功能逐渐减退,是造成患者致残、致死的重要原因,已成为严重威胁健康的重大公共卫生问题。基于长期临床实践和研究,本团队率先提出"糖脂代谢病"创新理论,将糖代谢异常、脂代谢异常、高血压及非酒精性脂肪性肝病(NAFLD)等疾病进行整体认识和一体化防控。最新的流行病学研究显示,糖尿病、血脂异常、NAFLD等患病率增长迅速。近10年来,此类疾病合病/并病的危害逐渐引起重视。2008—2009年本团队调查首先发现,高脂血症患者合并糖尿病、高血压的占84.2%。2012年的3B研究显示,2型糖尿病患者合并血脂异常、高血压的占72%。依据共同存在的病理机制、疾病进程,我们将糖脂代谢病分为3期诊治,对指导临床诊疗和提高防控效果意义重大。
Glucolipid metabolism disorder with chronic abnormal levels of glucose,lipid and blood pressure leading to the gradual decline of whole body function,which is a crucial cause of morbidity and mortality and has become a major public health threaten. Based on long-term research and clinical practice,our team for the first time proposed the novel theory of "Glucolipid Metabolic Disorders(GLMD)" and took the lead in the overall understanding,integrated prevention and control of glycolipid metabolism disorders including glucose metabolism disorder,lipid metabolism disorder,hypertension,non-alcoholic fatty liver disease,overweight and so on. The latest epidemiological research shows that the prevalence rate of patients suffering from diabetes mellitus,dyslipidemia,non-alcoholic fatty liver disease and so on,is increasing rapidly. During the past 10 years,the harm of glucolipid metabolism disorder with complications or concomitant diseases has gradually attracted great interests and attention. A survey from our team conducted from 2008 to 2009 reported that 84.2% of patients with hyperlipidemia had diabetes,hypertension and other diseases. Moreover,the "3 B" study conducted from 2010 to 2012 found that 72% of T2 DM patients were associated with hypertension and/or dyslipidemia. Here we proposed the clinical staging of GLMD with three diagnosis stages and the according treatment strategies,which will provide clinical guidance and significantly contribute to the improvement on the prevention and treatment of GLMD.
Glucolipid metabolism disorder with chronic abnormal levels of glucose,lipid and blood pressure leading to the gradual decline of whole body function,which is a crucial cause of morbidity and mortality and has become a major public health threaten. Based on long-term research and clinical practice,our team for the first time proposed the novel theory of "Glucolipid Metabolic Disorders(GLMD)" and took the lead in the overall understanding,integrated prevention and control of glycolipid metabolism disorders including glucose metabolism disorder,lipid metabolism disorder,hypertension,non-alcoholic fatty liver disease,overweight and so on. The latest epidemiological research shows that the prevalence rate of patients suffering from diabetes mellitus,dyslipidemia,non-alcoholic fatty liver disease and so on,is increasing rapidly. During the past 10 years,the harm of glucolipid metabolism disorder with complications or concomitant diseases has gradually attracted great interests and attention. A survey from our team conducted from 2008 to 2009 reported that 84.2% of patients with hyperlipidemia had diabetes,hypertension and other diseases. Moreover,the "3 B" study conducted from 2010 to 2012 found that 72% of T2 DM patients were associated with hypertension and/or dyslipidemia. Here we proposed the clinical staging of GLMD with three diagnosis stages and the according treatment strategies,which will provide clinical guidance and significantly contribute to the improvement on the prevention and treatment of GLMD.
引文
[1] YE Dewei,RONG Xianglu,XU Aimin,et al.Liver-adipose tissue crosstalk:a key player in the,pathogenesis of Glucolipid Metabolic Disease[J].Chn J Integr Med,2017,23(6):410-414.
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[4] WANG Limin,GAO Pei,ZHANG Mei,et al.Prevalence and ethnic pattern of diabetes and prediabetes in china in 2013[J].JAMA,2017,317(24):2515-2523.
[5] 国家卫生和计划生育委员会疾病预防控制局.中国居民营养与慢性病状况报告(2015年)[R].北京:人民卫生出版社,2015:80-100.
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[8] ZHAI Hualing,WANG Ningjian,HAN Bing,et al.Low vitamin D levels and non-alcoholic fatty liver disease,evidence for their independent association in men in East China:a cross-sectional study (survey on prevalence in East China for metabolic diseases and risk factors (SPECT-China))[J].Brit J Nutr,2016,115(8):1352-1359.
[9] ADAMS L A,LYMP J F,SAUVER J S,et al.The natural history of nonalcoholic fatty liver disease:a population-based cohort study[J].Gastroenterology,2005,129(1):113-121.
[10] REILLY J J.Health effects of overweight and obesity in 195 countries[J].N Engl J Med,2017,377(15):1495-1496.
[11] World Health Organization.A global brief on hypertension[R].2013.
[12] WANG Zengwu,CHEN Zuo,ZHANG Linfeng,et al.Status of hypertension in China:results from the China hypertension survey,2012--2015[J].Circulation,2018,137:2344-2356.
[13] YU Xiaohu,TIAN Xinxin,WANG Shengguang.Age-specific relevance of usual blood pressure to vascular mortality:a meta-analysis of individual data for one million adults in 61 propective studies[J].J Lepid Soc,2002,52(26):141-147.
[14] 朴胜华,郭姣,胡竹平.高脂血症住院患者中医证候临床研究[J].中国中西医结合杂志,2012,32(10):1322-1325.
[15] JI Linong,HU Dayi,PAN Changyu,et al.Primacy of the 3B approach to control risk factors for cardiovascular disease in type 2 diabetes patients[J].Am J Med,2013,126(10):925.e11-925.e22.
[16] 中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪性肝病专家委员会.非酒精性脂肪性肝病防治指南(2018年更新版)[J].实用肝脏病杂志,2018,21(2):177-186.
[17] PORTILLOSANCHEZ P,BRIL F,MAXIMOS M,et al.High prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus and normal plasma aminotransferase levels[J].J Clin Endocr Metab,2015,100(6):2231-2238.
[18] LEITE N C,VILLELA-NOGUEIRA C A,PANNAIN V L,et al.Histopathological stages of nonalcoholic fatty liver disease in type 2 diabetes:prevalences and correlated factors[J].Liver Int,2011,31(5):700-706.
[19] TARGHER G,BERTOLINI L,RODELLA S,et al.Non- alcoholic fatty liver disease is independently associated with an increased prevalence of chronic kidney disease and proliferative/laser-treated retinopathy in type 2 diabetic patients[J].Diabetologia,2008,51:444-450.
[20] ZHAO Yang,SUN Haohang,WANG Bingyuan,et al.Impaired fasting glucose predicts the development of hypertension over 6 years in female adults:results from the rural Chinese cohort study[J].J Diabet Complic,2017,31:1090-1095.
[21] EMDIN C A,ANDERSON S G,WOODWARD M,et al.Usual blood pressure and risk of new-onset diabetes[J].J Am Coll Cardiol,2015,66:1552-1562.
[22] ZHANG Yuqing,JIANG Xueli,Bo Jian,et al.Risk of stroke and coronary heart disease among various levels of blood pressure in diabetic and nondiabetic Chinese patients[J].J Hypertens,2018,36:93-100.
[23] PAN Ling,YANG Zhenhua,Wu Yue,et al.The prevalence,awareness,treatment and control of dyslipidemia among adults in China[J].Atherosclerosis,2016,248:2-9.
[24] GUO Jiao.Research progress on prevention and treatment of Glucolipid Metabolic Disease with integrated traditional Chinese and Western medicine[J].Chin J Integr Med,2017,23(6):403-409.
[25] 郭姣,肖雪,荣向路,等.糖脂代谢病与精准医学[J].世界科学技术-中医药现代化,2017,19(1):50-54.
[26] BEI WeiJian,GUO Jiao,WU Haiyun,et al.Lipid-regulating effect of traditional Chinese medicine:mechanisms of actions[J].Evid-Based Compl Alt,2012,2012:1-10.
[27] 黄婧文,朴胜华,郭姣.糖脂代谢病人群中医体质类型及舌脉特点分析[J].中华中医药杂志,2018,33(3):1082-1084.
[28] 黄婧文,郭姣.糖脂代谢病中医证候分布规律的现代文献研究[J].世界中医药,2019,14(1):1-5.
[29] 李硕,郭姣.糖脂代谢病患者报告结局量表的初步研制[J].世界中医药,2019,14(1):12-17.
[30] 余雪,李敏谦,郭姣.内脏脂肪指数与糖脂代谢病的相关性研究[J].世界中医药,2019,14(1):29-38.
[2] 孔令东,郝海平,郭淑贞,等.中西医结合防治代谢性疾病的关键科学问题[J].中国科学基金,2018(4):434-441.
[3] International Diabetes Federation.IDF Diabetes Atlas.8th ed [R].2017.
[4] WANG Limin,GAO Pei,ZHANG Mei,et al.Prevalence and ethnic pattern of diabetes and prediabetes in china in 2013[J].JAMA,2017,317(24):2515-2523.
[5] 国家卫生和计划生育委员会疾病预防控制局.中国居民营养与慢性病状况报告(2015年)[R].北京:人民卫生出版社,2015:80-100.
[6] ANDREW M,GU Dongfeng,ZHAO Dong,et al.Future cardio-vascular disease in china:markov model and risk factor scenario projections from the coronary heart disease policy Model-China[J].Circ Cardiovasc Qual Outcom,2010,3(3):243-252.
[7] YOUNOSSI Z M,KOENIG A B,ABDELATIF D,et al.Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence,incidence,and outcomes[J].Hepatology,2016,64(1):73-84.
[8] ZHAI Hualing,WANG Ningjian,HAN Bing,et al.Low vitamin D levels and non-alcoholic fatty liver disease,evidence for their independent association in men in East China:a cross-sectional study (survey on prevalence in East China for metabolic diseases and risk factors (SPECT-China))[J].Brit J Nutr,2016,115(8):1352-1359.
[9] ADAMS L A,LYMP J F,SAUVER J S,et al.The natural history of nonalcoholic fatty liver disease:a population-based cohort study[J].Gastroenterology,2005,129(1):113-121.
[10] REILLY J J.Health effects of overweight and obesity in 195 countries[J].N Engl J Med,2017,377(15):1495-1496.
[11] World Health Organization.A global brief on hypertension[R].2013.
[12] WANG Zengwu,CHEN Zuo,ZHANG Linfeng,et al.Status of hypertension in China:results from the China hypertension survey,2012--2015[J].Circulation,2018,137:2344-2356.
[13] YU Xiaohu,TIAN Xinxin,WANG Shengguang.Age-specific relevance of usual blood pressure to vascular mortality:a meta-analysis of individual data for one million adults in 61 propective studies[J].J Lepid Soc,2002,52(26):141-147.
[14] 朴胜华,郭姣,胡竹平.高脂血症住院患者中医证候临床研究[J].中国中西医结合杂志,2012,32(10):1322-1325.
[15] JI Linong,HU Dayi,PAN Changyu,et al.Primacy of the 3B approach to control risk factors for cardiovascular disease in type 2 diabetes patients[J].Am J Med,2013,126(10):925.e11-925.e22.
[16] 中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪性肝病专家委员会.非酒精性脂肪性肝病防治指南(2018年更新版)[J].实用肝脏病杂志,2018,21(2):177-186.
[17] PORTILLOSANCHEZ P,BRIL F,MAXIMOS M,et al.High prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus and normal plasma aminotransferase levels[J].J Clin Endocr Metab,2015,100(6):2231-2238.
[18] LEITE N C,VILLELA-NOGUEIRA C A,PANNAIN V L,et al.Histopathological stages of nonalcoholic fatty liver disease in type 2 diabetes:prevalences and correlated factors[J].Liver Int,2011,31(5):700-706.
[19] TARGHER G,BERTOLINI L,RODELLA S,et al.Non- alcoholic fatty liver disease is independently associated with an increased prevalence of chronic kidney disease and proliferative/laser-treated retinopathy in type 2 diabetic patients[J].Diabetologia,2008,51:444-450.
[20] ZHAO Yang,SUN Haohang,WANG Bingyuan,et al.Impaired fasting glucose predicts the development of hypertension over 6 years in female adults:results from the rural Chinese cohort study[J].J Diabet Complic,2017,31:1090-1095.
[21] EMDIN C A,ANDERSON S G,WOODWARD M,et al.Usual blood pressure and risk of new-onset diabetes[J].J Am Coll Cardiol,2015,66:1552-1562.
[22] ZHANG Yuqing,JIANG Xueli,Bo Jian,et al.Risk of stroke and coronary heart disease among various levels of blood pressure in diabetic and nondiabetic Chinese patients[J].J Hypertens,2018,36:93-100.
[23] PAN Ling,YANG Zhenhua,Wu Yue,et al.The prevalence,awareness,treatment and control of dyslipidemia among adults in China[J].Atherosclerosis,2016,248:2-9.
[24] GUO Jiao.Research progress on prevention and treatment of Glucolipid Metabolic Disease with integrated traditional Chinese and Western medicine[J].Chin J Integr Med,2017,23(6):403-409.
[25] 郭姣,肖雪,荣向路,等.糖脂代谢病与精准医学[J].世界科学技术-中医药现代化,2017,19(1):50-54.
[26] BEI WeiJian,GUO Jiao,WU Haiyun,et al.Lipid-regulating effect of traditional Chinese medicine:mechanisms of actions[J].Evid-Based Compl Alt,2012,2012:1-10.
[27] 黄婧文,朴胜华,郭姣.糖脂代谢病人群中医体质类型及舌脉特点分析[J].中华中医药杂志,2018,33(3):1082-1084.
[28] 黄婧文,郭姣.糖脂代谢病中医证候分布规律的现代文献研究[J].世界中医药,2019,14(1):1-5.
[29] 李硕,郭姣.糖脂代谢病患者报告结局量表的初步研制[J].世界中医药,2019,14(1):12-17.
[30] 余雪,李敏谦,郭姣.内脏脂肪指数与糖脂代谢病的相关性研究[J].世界中医药,2019,14(1):29-38.