四川地区代谢综合征的流行病学调查及其与慢性肾脏病的相关性研究
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摘要
目的：调查四川地区(城市和农村)18岁以上人群代谢综合征的流行情况及相关危险因素,分析代谢综合征与慢性肾脏病之间的相关性。方法：在四川地区采用分层多次随机抽样方法,抽取成都市武侯区(代表城市地区),德阳市广汉(代表农村地区)18岁以上常住居民3300人,通过问卷调查包括人口学资料,慢性病史等；体格检查：身高、体重、腰围、臀围、血压和脉搏等；实验室检查：小便常规检查、尿肌酐和尿微量白蛋白,空腹静脉血检查血肌酐、血糖、血尿酸、胆固醇、甘油三酯、高密度脂蛋白和低密度脂蛋白等。采用国际糖尿病联盟(IDF)标准确定代谢综合征诊断,采用K/DOQI有关慢性肾脏病的诊断标准确定慢性肾脏疾病(ACR,血尿、及eGFR降低)。结果：在资料完善的3204名调查对象(应答率为91.6%),经年龄、性别标化后(人口学校正)代谢综合征的患病率为8.6%(95%CI:7.6～9.6%)。男女之间差异有统计学意义(男女分别为6.1%和13.8%,P<0.001),城市与农村之间差异无统计学意义(分别为9.9%和10.0%,P=0.971)。代谢综合征各代谢异常组份：中心性肥胖、血压升高、高甘油三酯(TG)、低高密度脂蛋白胆固醇(HDL-C)和高空腹血糖(FPG)的患病率分别为26.1%、28.5%、64.7%、43.0%和16.8%,标化后的患病率分别为22.4%、22.7%、64.5%、45.4%和13.4%。MS、血压升高、高FPG和中心性肥胖是随着年龄增加而升高,HDL随着年龄增加而下降。在18～49岁之间主要是血脂紊乱为主；50～59岁之间是以血脂紊乱、血压升高、血糖升高为主;60～95岁是以血压升高、血糖升高为主。经logistic多元回归分析提示肾病史、LDL-C、年龄、BMI和女性是代谢综合征的独立危险因素。在MS患病人群中,CKD有79例,患病率为26.2%,与非MS人群的CKD患病率(18.4%)之间差异有统计学意义(P=0.001);白蛋白尿有44例,患病率为14.6%,与非MS人群的CKD患病率(11.1%)之间差异无统计学意义(P=0.068)。在分析单个用于诊断MS的代谢异常组份与ACR增高的关系时：HDL-C降低、高FPG、血压升高、中心性肥胖均有统计学意义(P<0.05)(与无代谢异常组份相比较),OR值(95%CI)分别为0.647(0.511～0.818)、3.285(2.571～4.198)、2.892(2.303～3.633)、1.433(1.126～1.824),其中高FPG对于ACR增高影响最大(OR=3.285)；中心性肥胖+1个代谢异常组份、中心性肥胖+2个代谢异常组份、中心性肥胖+3个代谢异常组份和中心性肥胖+4个代谢异常组份均有统计学意义(P<0.05)(与无代谢异常组份相比较),OR值(95%CI)分别为：1.722(1.031～2.872)、3.075(1.944～4.864)、2.330(1.294～4.194)和2.884(1.78～7.827)。随着代谢异常组份的增加,ACR增加患病风险增加,当中心性肥胖+2个代谢异常组份患病风险最高(OR=3.075)。在分析单个用于诊断MS的代谢异常组份与CKD的关系时：HDL-C降低、高FPG、血压升高、中心性肥胖均有统计学意义(P<0.05),OR值(95%CI)分别为0.524(0.432～0.636)、3.499(2.838～4.312)、2.138(1.771～2.582)、1.502(1.234～1.828);其中高FPG对于CKD影响最大(OR=3.499)。中心性肥胖+1个代谢异常组份、中心性肥胖+2个代谢异常组份、中心性肥胖+3个代谢异常组份和中心性肥胖+4个代谢异常组份差异均有统计学意义(P<0.05),OR值(95%CI)分别为：1.737(1.105～2.731)、2.236(1.542～3.509)、2.093(1.263～3.466)和2.700(1.279～5.698)。随着代谢异常组份的增加,CKD患病风险明显增加,当中心性肥胖+4个代谢异常组份患病风险最高(OR=2.700)。经Logostic多元回归分析,结果提示：年龄、性别、HDL-C降低、高FPG、LDL-C和高尿酸是CKD的独立危险因素。结论：1.四川地区代谢综合征患病率为8.6%,女性高于男性,农村与城市无差异。MS随着年龄增加而升高,在18～49岁之间主要是血脂紊乱为主；50～59岁之间是以血脂紊乱、血压升高、血糖升高为主；60～95岁是以血压升高、血糖升高为主。肾病史、LDL-C、年龄、BMI和女性是代谢综合征的独立危险因素。2.代谢综合征患者CKD的患病率明显高于非代谢综合征人群,代谢综合征患者ACR增加的患病率与非代谢综合征人群无差异。中心性肥胖的基础上随着代谢异常的增多,ACR增加的患病率和CKD的患病率增加；年龄、女性、HDL-C降低、高FPG、LDL-C、血压升高和高尿酸是CKD的独立危险因素。
Objective:To investigate the prevalence of metabolic syndrome and its related risk factors in adults (age≥18 years old) at the urban and rural areas in Sichuan Province, and to analyze the correlationship between metabolic syndrome and chronic kidney disease. Method:Stratified random sampling method was used to select 3300 permanent residents (age≥18 years old) in the Wuhou district in Chengdu city (the urban areas) and the Guanghan district in Deyang city (the rural areas). The risk factors for metabolic syndrome and chronic kidney disease are tested, including:①the medical examinations:height, weight, waist circumference, hip circumference, blood pressure and pulse rate;②the laboratory examination:urine routine examination, serum creatinine and fasting blood examination, blood sugar, uric acid, cholesterol, triglycerides, high density lipid protein and low-density lipoprotein) and questionnaire survey (demographic data, history of chronic diseases, etc.).
Results:In the 3204 investigated adults, response rate was 91.6%after the normalization of the ages and sex(the school population normalization was adopted), The prevalence of metabolic syndrome is 8.6%(95% CI is 7.6%～9.6%). The difference between men and women has statistical significance (the prevalence of the men is 6.1% and the prevalence of the women is 13.8%, P<0.001). However, the difference between urban and rural areas has no statistical significance (the prevalence at the rural area is 10.0% and the prevalence at the urban area is 9.9%, P=0.971). For five components of metabolic syndrome diagnosis; central obesity, high blood pressure, high triglyceride (TG), low high-density lipoprotein cholesterol (HDL-C) and high prevalence rate of PFG, the prevalence's are 26.1%,28.5% 64.7%,43.0% and 16.8% respectively. After normalization, the prevalence are 22.4%, 22.7%,64.5%,45.4% and 13.4% respectively. The MS, high blood pressure, high FPG, and central obesity increased with the increment of the age. HDL decreased with the increment of the age. From 18 to 49 years, the hyperlipemia is the mainly abnormality. From 50 to 59 years old, the hyperlipemia, the high blood pressure, and the high FPG are the mainly abnormality. From 60 to 95 years, the high blood pressure, the high FPG are the mainly abnormality. The logistic regression analysis shows that the renal history, the LDL-C, the age, the BMI and the gender (female) are the independented risk factors for metabolic syndrome. In the 3024 survey patients,579 have CKD and 2445 have not. The prevalence of CKD after the normalization of ages and genders(the school population normalization) is 16.5%. In the 3024 survey patients,346 have albuminuria and 2678 have not. The prevalence of the albuminuria after the normalization of ages and genders (the school population normalization) is 9.5%. In the MS patients,79 are CKD; and the prevalence rate is 26.2%. To be compared with the non-MS patients(the prevalence is 18.4%), the prevalence rate has statistical significance (P=0.001); In the MS patients,44 have white albuminuria and the prevalence rate is 14.6%. To be compared with non-MS patients(the prevalence of CKD is 11.1%), the prevalence rate has no statistical significance(P=0.068). The corelationship analyses between individual components of metabolic abnormalities and elevated ACR, low HDL-C, high FPG, high blood pressure, and central obesity have correlation(P<0.05). the values of OR(95%CI) are 0.647(0.511～0.818),3.285(2.571～4.198),2.892(2.303～3.633),1.433(1.126～1.824). The high-FPG was the greatest effective factor for the elevated ACR (OR=3.285). The central obesity+1 component, the central obesity+2 components, the central obesity+3 components and the central obesity +4 components have significant correlation with the elevated ACR (P<0.05). The factor OR values(95%CI) are 1.722(1.031～2.872),3.075(1.944～4.864),2.330(1.294～4.194)and 2.884(1.78～7.827) respectively. With the increase of metabolic components, the risk of elevated ACR increasing; It was the highest risk (OR=3.075) that the central obesity+2 composition for elevated ACR. The corelationship between individual components of metabolic abnormalities and CKD, low HDL-C, high FPG, high blood pressure, and central obesity have significant correlations(P<0.05). the OR values(95%CI) are0.524(0.432～0.636),3.499(2.838～4.312),2.138(1.771～2.582),1.502(1.234～1.828). The high-FPG is the greatest impact for the CKD (OR=3.499). The central obesity+1 component, the central obesity+2 components, the central obesity+3 components and the central obesity+4 components have significant correlations with the elevated ACR (P <0.05). The factor OR values(95%CI) are 1.737(1.105～2.731),2.236(1.542-3.509), 2.093(1.263～3.466)和2.700(1.279～5.698) respectively. With the increase of metabolic components, the risk of CKD increasing; The highest risk (OR=2.700) for CKD is the central obesity+4 composition. Multiple logistic regression analysis indicates that the age segmentation, the gender, the low HDL-C, the high FPG, the LDL-C, and the high uric acid are independent risk factors of CKD.
Conclusions:1. In Sichuan province, the prevalence rate of metabolic syndrome is 8.6%; and the prevalence rate of the women is higher than that of the men, but no difference was found between the rural and the urban. The renal history, the LDL-C, the age section, the BMI segmentation and g the ender (female) are the independent risk factors of metabolic syndrome.2. In the metabolic syndrome, the prevalence of CKD is significantly higher than that of the non-metabolic syndrome; the metabolic syndrome prevalence may increase the ACR and non-metabolic syndrome has no difference. With the increase of the central obesity within the metabolic basis the prevalence of CKD and the ACR increases; and the MS metabolic syndrome group is lower HDL-C, higher FPG and blood pressure are independent risk CKD factors.
Objective:To investigate the prevalence of metabolic syndrome and its related risk factors in adults (age≥18 years old) at the urban and rural areas in Sichuan Province, and to analyze the correlationship between metabolic syndrome and chronic kidney disease. Method:Stratified random sampling method was used to select 3300 permanent residents (age≥18 years old) in the Wuhou district in Chengdu city (the urban areas) and the Guanghan district in Deyang city (the rural areas). The risk factors for metabolic syndrome and chronic kidney disease are tested, including:①the medical examinations:height, weight, waist circumference, hip circumference, blood pressure and pulse rate;②the laboratory examination:urine routine examination, serum creatinine and fasting blood examination, blood sugar, uric acid, cholesterol, triglycerides, high density lipid protein and low-density lipoprotein) and questionnaire survey (demographic data, history of chronic diseases, etc.).
Results:In the 3204 investigated adults, response rate was 91.6%after the normalization of the ages and sex(the school population normalization was adopted), The prevalence of metabolic syndrome is 8.6%(95% CI is 7.6%～9.6%). The difference between men and women has statistical significance (the prevalence of the men is 6.1% and the prevalence of the women is 13.8%, P<0.001). However, the difference between urban and rural areas has no statistical significance (the prevalence at the rural area is 10.0% and the prevalence at the urban area is 9.9%, P=0.971). For five components of metabolic syndrome diagnosis; central obesity, high blood pressure, high triglyceride (TG), low high-density lipoprotein cholesterol (HDL-C) and high prevalence rate of PFG, the prevalence's are 26.1%,28.5% 64.7%,43.0% and 16.8% respectively. After normalization, the prevalence are 22.4%, 22.7%,64.5%,45.4% and 13.4% respectively. The MS, high blood pressure, high FPG, and central obesity increased with the increment of the age. HDL decreased with the increment of the age. From 18 to 49 years, the hyperlipemia is the mainly abnormality. From 50 to 59 years old, the hyperlipemia, the high blood pressure, and the high FPG are the mainly abnormality. From 60 to 95 years, the high blood pressure, the high FPG are the mainly abnormality. The logistic regression analysis shows that the renal history, the LDL-C, the age, the BMI and the gender (female) are the independented risk factors for metabolic syndrome. In the 3024 survey patients,579 have CKD and 2445 have not. The prevalence of CKD after the normalization of ages and genders(the school population normalization) is 16.5%. In the 3024 survey patients,346 have albuminuria and 2678 have not. The prevalence of the albuminuria after the normalization of ages and genders (the school population normalization) is 9.5%. In the MS patients,79 are CKD; and the prevalence rate is 26.2%. To be compared with the non-MS patients(the prevalence is 18.4%), the prevalence rate has statistical significance (P=0.001); In the MS patients,44 have white albuminuria and the prevalence rate is 14.6%. To be compared with non-MS patients(the prevalence of CKD is 11.1%), the prevalence rate has no statistical significance(P=0.068). The corelationship analyses between individual components of metabolic abnormalities and elevated ACR, low HDL-C, high FPG, high blood pressure, and central obesity have correlation(P<0.05). the values of OR(95%CI) are 0.647(0.511～0.818),3.285(2.571～4.198),2.892(2.303～3.633),1.433(1.126～1.824). The high-FPG was the greatest effective factor for the elevated ACR (OR=3.285). The central obesity+1 component, the central obesity+2 components, the central obesity+3 components and the central obesity +4 components have significant correlation with the elevated ACR (P<0.05). The factor OR values(95%CI) are 1.722(1.031～2.872),3.075(1.944～4.864),2.330(1.294～4.194)and 2.884(1.78～7.827) respectively. With the increase of metabolic components, the risk of elevated ACR increasing; It was the highest risk (OR=3.075) that the central obesity+2 composition for elevated ACR. The corelationship between individual components of metabolic abnormalities and CKD, low HDL-C, high FPG, high blood pressure, and central obesity have significant correlations(P<0.05). the OR values(95%CI) are0.524(0.432～0.636),3.499(2.838～4.312),2.138(1.771～2.582),1.502(1.234～1.828). The high-FPG is the greatest impact for the CKD (OR=3.499). The central obesity+1 component, the central obesity+2 components, the central obesity+3 components and the central obesity+4 components have significant correlations with the elevated ACR (P <0.05). The factor OR values(95%CI) are 1.737(1.105～2.731),2.236(1.542-3.509), 2.093(1.263～3.466)和2.700(1.279～5.698) respectively. With the increase of metabolic components, the risk of CKD increasing; The highest risk (OR=2.700) for CKD is the central obesity+4 composition. Multiple logistic regression analysis indicates that the age segmentation, the gender, the low HDL-C, the high FPG, the LDL-C, and the high uric acid are independent risk factors of CKD.
Conclusions:1. In Sichuan province, the prevalence rate of metabolic syndrome is 8.6%; and the prevalence rate of the women is higher than that of the men, but no difference was found between the rural and the urban. The renal history, the LDL-C, the age section, the BMI segmentation and g the ender (female) are the independent risk factors of metabolic syndrome.2. In the metabolic syndrome, the prevalence of CKD is significantly higher than that of the non-metabolic syndrome; the metabolic syndrome prevalence may increase the ACR and non-metabolic syndrome has no difference. With the increase of the central obesity within the metabolic basis the prevalence of CKD and the ACR increases; and the MS metabolic syndrome group is lower HDL-C, higher FPG and blood pressure are independent risk CKD factors.
引文
[1]Lim HS, Patel JV, Lip GY. Metabolic syndrome:a definition progress. Circulation. 2004; 110(4):e35.
[2]Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults:findings from the third National Health and Nutrition Examination Survey. JAMA.2002; 287(3):356-359.
[3]Hu G, Qiao Q, Tuomilehto J, Balkau B, Borch-Johnsen K, Pyorala K; DECODE Study Group. Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women. Arch Intern Med. 2004; 164(10):1066-1076.
[4]顾东风,Reynolds K,杨文杰,等.中国成年人代谢综合征的患病率。中华糖尿病杂志,2005,13(3)：181～186.
[5]脑卒中、冠心病发病危险因素进一步研究协作组.11省市队列人群代谢综合征的流行病学研究.中华预防医学杂志,2002,36(5):298～300.
[6]Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease:a position statement from Kidney Disease:Improving Global Outcomes (KDIGO). Kidney Int.2005; 67(6):2089-2100.
[7]Levey AS, Coresh J, Balk E, et al. National Kidney Foundation. National Kidney Foundation practice guidelines for chronic kidney disease:evaluation, classification, and stratification. Ann Intern Med.2003; 139(2):137-147.
[8]Garg AX, Kiberd BA, Clark WF, et al. Albuminuria and renal insufficiency prevalence guides population screening:results from the NHANES III. Kidney Int.2002; 61(6): 2165-2175.
[9]Brown WW, Peters RM, Ohmit SE, et al. Early detection of kidney disease in community settings:the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis. 2003; 42(1):22-35.
[10]张路霞,左力,徐国宾,等.北京市石景山地区中老年人群中慢性肾脏病的流行病学研究.华肾脏病杂志,2006；22:61～71.
[11]陈崴,王辉,董秀清,等.广州市城区普通人群中慢性肾脏病的流行病学研究.中华肾脏病杂志,2007；23(3)：425～427.
[12]Laaksonen DE, Lakka HM, Niskanen LK, et al. Metabolic syndrome and development of diabetes mellitus:application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. Am J Epidemiol.2002; 156(11): 1070-1077.
[13]Trevisan M, Liu J, Bahsas FB, Menotti A. Syndrome X and mortality:a population-based study.Risk Factor and Life Expectancy Research Group. Am J Epidemiol.1998; 148(10):958-966.
[14]Lakka HM, Laaksonen DE, Lakka TA, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA.2002; 288(21):2709-2716.
[15]Saely CH, Koch L, Schmid F, et al. Adult Treatment Panel III 2001 but not International Diabetes Federation 2005 criteria of the metabolic syndrome predict clinical cardiovascular events in subjects who underwent coronary angiography. Diabetes Care.2006; 29(4):901-907.
[16]National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease:evaluation, classification, and stratification. Am J Kidney Dis.2002; 39(1): S1-S266.
[17]Ma YC, Zuo L, Chen JH, et al. Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol.2006; 17(10): 2937-2944.
[18]Mancia G, De Backer G, Dominiczak A, et al. 2007 ESH-ESC practice Guidelines for the Management of Arterial Hypertension:ESH-ESC Task Force on the Management of Arterial Hypertension. JHypertens,2007,25:1751 - 1762.
[19]Executive summary:standards of medical care in diabetes-2009. Diabetes Care,2009, 32(1)1:S6-S12.
[20]Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. J Am Coll Cardiol,2004; 44:720-732.
[21]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2007年版),中华医学杂志.2008；88(18).
[22]Gu D, Reynolds K, Wu X, et al. Prevalence of the metabolic syndrome and overweight among adults in China. Lancet,2005;365(9468):1398-1405.
[23]罗不凡,杜琳,潘冰莹,等.广州市15岁以上居民代谢综合征流行特征分析.中国糖尿病杂志.2008；16(5)：267～270.
[24]卢伟,刘美霞,李锐,等.上海市15-74岁居民代谢综合症的流行特征.中华预防医学杂志,2006;40:262～268.
[25]Razak F, Anand S, Vuksan V, et al. Share Investigators ethnic differences in the relationships between obesity and glucose-metabolic abnormalities:a cross-sectional population-based study. Int J Obes (Lond).2005; 29(6):656-667.
[26]路庆丽,谢自敬,等.我国维吾尔族成人代谢综合征腰围适宜切点研究.中国糖尿病杂志.2008；2:79～82.
[27]陈力平,张毅,张丽芳,等.武钢产业人群代谢综合征腰围切点的研究.中国冶金工业医学杂志.2008;25(5)：53～537.
[28]王苏中,顾湲,李丽霞,等.北京方庄社区高血压患病率与管理现况的调查.中国慢性病预防与控制.1999；7(3):135～136.
[29]刘烈,邓惠鸿,岑润超.广东省高血压流行病学特征和危险因素分析.广东医学2002；23：417～419.
[30]王战建,张耀.糖尿病的流行病学及三级预防.河北医药,2004,26:289～290.
[31]Andersson S, Safari H, Mints M, et al. Type distribution, vira load and integration stat us of high-risk human papilloma viruses in pre-stages of cervical cancer (CIN). Br J Cancer,2005; 92(12):2195-2200.
[32]路方红,杨建民,金世宽,等.济南市城乡35-64岁人群代谢综合征现况调查.中国公共卫生2008;5(24):615～617.
[33]陈蕾,贾伟平,陆俊茜.上海市成人代谢综合征流行调查.中华心血管病杂志.2003；31(6)：909～912.
[34]Kalantar-Zadeh K, Koppel JD. Body mass index and risk for end-stage renal disease. Ann Intern Med.2006 2; 144(9):701.
[35]Ninomiya T, Kiyohara Y, Kubo M, et al. Metabolic syndrome and CKD in a general Japanese population:the Hisayama Study. Am JKidney Dis.2006; 48(3):383-391.
[36]Chen J, Muntner P, Hamm LL, et al. Insulin resistance and risk of chronic kidney disease in nondiabetic US adults. JAm Soc Nephrol.2003; 14(2):469-477.
[37]Chen J, Muntner P, Hamm LL, Jones DW, et al. The metabolic syndrome and chronic kidney disease in U.S. adults. Ann Intern Med.2004; 140(3):167-174.
[38]赵志刚,祝之明,杜彦社.代谢综合征的颈动脉粥样硬化特征.中华内科杂志.2003；42：625～627.
[39]徐兴森,杨万涛,刘道燕,等.高血压合并代谢紊乱及对心肾血管的影响.中华高血压杂志.2006；14(Ⅱ)：894～898.
[40]陈秀玲,王莉,李贵森,等.健康体检者代谢综合征及肾功能相关性的调查,四川医学.2008；10:1426～1429.
[41]陈晓农,潘晓霞,朱杰,等.早、中期慢性肾功能衰竭的危险因素分析.诊断学理论与实践.2007；6(6)：513～518.
[42]Charlesworth JA, Kriketos AD, Jones JE, et al. Insulin resistance and postprandial triglyceride levels in primary renal disease. Metabolism.2005; 54(6):821-828.
[43]Hoehner CM, Greenlund KJ, Rith-Najarian S, et al. Association of the insulin resistance syndrome and microalbuminuria among nondiabetic native Americans. The Inter-Tribal Heart Project. J Am Soc Nephrol. 2002; 13(6):1626-1634.
[44]Hsu CY, McCulloch CE, Iribarren C, et al. Body mass index and risk for end-stage renal disease. Ann Intern Med.2006; 144(1):21-28.
[45]Kambham N, Markowitz GS, Valeri AM, et al. Obesity-related glomeruloPathy:an emerging epidemic. Kidney Int.2001; 59(4):1498-1509.
[46]Iseki K. Body mass index and the risk of chronic renal failure:the Asian experience Contrib Nephrol.2006; 151:42-56.
[47]Reynolds K, Gu D, Muntner P, Chen J, et al. Body mass index and risk of ESRD in China. Am J Kidney Dis.2007; 50(5):754-764.
[48]Whelton PK, Perneger TV, He J, et al. The role of blood pressure as a risk factor for renal disease:a review of the epidemiologic evidence. JHum Hypertens.1996; 10(10): 683-689
[49]Mule G, Cottone S, Nardi E, et al. Metabolic syndrome in subjects with essential hypertension:relationships with subclinical cardiovascular and renal damage. Minerva Cardioangiol.2006; 54(2):173-194.
[50]Pavkov ME, Knowler WC, Bennett PH, et al. Increasing incidence of proteinuria and declining incidence of end-stage renal disease in diabetic pima Indians. Kidney Int. 2006;70(10):1840-1846.
[51]Hsu CY, Lin F, Vittinghoff E, Shlipak MG. Racial differences in the progression from chronic renal insufficiency to end-stage renal disease in the United States.J Am Soc Nephrol.2003; 14(11):2902-2907.
[52]Fenton SS, Schaubel DE, Desmeules M, et al. Hemodialysis versus peritoneal dialysis: a comparison of adjusted mortality rates. Am J Kidney Dis.1997; 30(3):334-342.
[53]Muntner P, Coresh J, Smith JC, et al. Plasma lipids and risk of developing renal dysfunction:the atherosclerosis risk in communities study. Kidney Int.2000; 58(1): 293-301.
[54]姚峥.代谢综合征的肾脏损害[J].中国医师进修杂志,2006;9(8):19～21
[55]朱文华,方力争.代谢综合征各组分对高尿酸血症的影响[J].中华内科杂志,2006;45(3)：228～229.
[56]Sanchez-Lozada LG, Tapia E, Santamaria J, et al. Mild hyperuricemia induces vasoconstriction and maintains glomerular hypertension in normal and remnant kidney rats. Kidney Int.2005; 67(1):237-247.
[57]Toprak 0, Cirit M, Esi E, et al. HyPeruricemia as a risk factor for contrast-induced nephropathy in Patients with chronic kidney disease. Catheter Cardiovasc Interv.2006; 67(2):227-235.
[58]Padang C, Muirden KD, Schumacher HR, et al. Characteristics of chronic gout in Northern Sulawesi, Indonesia. JRheumatol. 2006; 33(9):1813-1817
[59]Chen J, Gu D, Chen CS, et al. Association between the metabolic syndrome and chronic kidney disease in Chinese adults. Nephrol Dial Transplant.2007; 22(4): 1100-1106.
[60]边琪,袁伟杰,等.代谢综合征及其代谢因子号慢性肾损害相关性的临床研究.中华肾脏病杂志.2005；7(21):389～393.
[61]Hunsicker LG, Adler S, Caggiula A, et al. Predictors of the progression of renal disease in the Modification of Diet in Renal Disease Study. Kidney Int.1997; 51: 1908-1919.
[62]Muntner P, Coresh J, Smith JC, et al. Plasma lipids and risk of developing renaldys function:the atherosclerosis risk in communities study. Kidney Int.2000; 58:293-301.
[1]Lim HS, Patel JV, Lip GY. Metabolic syndrome:a definition progress. Circulation. 2004; 110(4):e35.
[2]Saely CH, Koch L, Schmid F, et al. Adult Treatment Panel Ⅲ 2001 but not International Diabetes Federation 2005 criteria of the metabolic syndrome predict clinical cardiovascular events in subjects who underwent coronary angiography. Diabetes Care.2006; 29(4):901-907.
[3]Laaksonen DE, Lakka HM, Niskanen LK, et al. Metabolic syndrome and development of diabetes mellitus:application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. Am J Epidemiol.2002; 156(11): 1070-1077.
[4]Trevisan M, Liu J, Bahsas FB, Menotti A. Syndrome X and mortality:a population-based study.Risk Factor and Life Expectancy Research Group. Am J Epidemiol.1998; 148(10):958-966.
[5]Lakka HM, Laaksonen DE, Lakka TA, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA.2002; 288(21):2709-2716.
[6]Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults:findings from the third National Health and Nutrition Examination Survey. JAMA.2002; 287(3):356-359.
[7]Hu G, Qiao Q, Tuomilehto J, Balkau B, et al. DECODE Study Group. Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women. Arch Intern Med.2004; 164(10):1066-1076.
[8]顾东风,Reynolds K,杨文杰,等.中国成年人代谢综合征的患病率.中华糖尿病杂志,2005,13(3)：181～186.
[9]脑卒中、冠心病发病危险因素进一步研究协作组.11省市队列人群代谢综合征的流行病学研究.中华预防医学杂志.2002,36(5):298～300.
[10]Boden G, Shulman GI. Free fatty acids in obesity and type 2 diabetes:defining their role in the development of insulin resistance and beta-cell dysfunction.Eur J Clin Invest.2002; 32 (Supp 13):14-23.
[11]藤森新.代谢综合征与嘌呤代谢异常.日本医学介绍,2005,26(5):210～211
[12]Jowett JB, Elliott KS, Curran JE, et al. Genetic variation in BEACON influences quantitative variation in metabolic syndrome-related phenotypes. Diabetes.2004; 53(9): 2467-2472.
[13]Widen E, Lehto M, Kanninen T, et al. Association of a polymorphism in the P3-adrenergic receptor gene with features of the insulin resistance syndrome in Finns. N Engl J Med.1995; 333:348-351.
[14]Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease:a position statement from Kidney Disease:Improving Global Outcomes (KDIGO). Kidney Int.2005; 67(6):2089-2100.
[15]Levey AS, Coresh J, Balk E, et al. National Kidney Foundation. National Kidney Foundation practice guidelines for chronic kidney disease:evaluation, classification, and stratification. Ann Intern Med.2003; 139(2):137-147.
[16]Garg AX, Kiberd BA, Clark WF, et al. Albuminuria and renal insufficiency prevalence guides population screening:results from the NHANES III. Kidney Int.2002; 61(6): 2165-2175.
[17]Brown WW, Peters RM, Ohmit SE, et al. Early detection of kidney disease in community settings:the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis. 2003; 42(1):22-35.
[18]张路霞,左力,徐国宾,等.北京市石景山地区中老年人群中慢性肾脏病的流行病学研究.华肾脏病杂志,2006；22:61～71.
[19]陈崴,王辉,董秀清,等.广州市城区普通人群中慢性肾脏病的流行病学研究.中华肾脏病杂志,2007；23(3)：425～427.
[20]陈晓农,潘晓霞,朱杰,等.早、中期慢性肾功能衰竭的危险因素分析.诊断学理论与实践,2007；6(6)：513～518.
[21]Chen J, Muntner P, Hamm LL, et al. Insulin resistance and risk of chronic kidney disease in nondiabetic US adults. J Am Soc Nephrol.2003; 14(2):469-477.
[22]Chen J, Muntner P, Hamm LL, Jones DW, et al. The metabolic syndrome and chronic kidney disease in U.S. adults. Ann Intern Med.2004; 140(3):167-174.
[23]赵志刚,祝之明,杜彦社.代谢综合征的颈动脉粥样硬化特征.中华内科杂志.2003；42：625～627.
[24]徐兴森,杨万涛,刘道燕,等.高血压合并代谢紊乱及对心肾血管的影响.中华高血压杂志.2006；14(Ⅱ)：894～898.
[25]陈秀玲,王莉,李贵森,等.健康体检者代谢综合征及肾功能相关性的调查,四川医学.2008;10:1426～1429.
[26]Charlesworth JA, Kriketos AD, Jones JE, et al. Insulin resistance and postprandial triglyceride levels in primary renal disease. Metabolism.2005; 54(6):821-828.
[27]Hoehner CM, Greenlund KJ, Rith-Najarian S, et al. Association of the insulin resistance syndrome and microalbuminuria among nondiabetic native Americans. The Inter-Tribal Heart Project. J Am Soc Nephrol.2002; 13(6):1626-1634.
[28]Hsu CY, McCulloch CE, Iribarren C, et al. Body mass index and risk for end-stage renal disease. Ann Intern Med.2006; 144(1):21-28.
[29]Kambham N, Markowitz GS, Valeri AM, et al. Obesity-related glomerulopathy:an emerging epidemic. Kidney Int.2001; 59(4):1498-1509.
[30]Iseki K. Body mass index and the risk of chronic renal failure:the Asian experience Contrib Nephrol.2006; 151:42-56.
[31]Reynolds K, Gu D, Muntner P, Chen J, et al. Body mass index and risk of ESRD in China. Am J Kidney Dis.2007; 50(5):754-764.
[32]Whelton PK, Perneger TV, He J, et al. The role of blood pressure as a risk factor for renal disease:a review of the epidemiologic evidence. J Hum Hypertens.1996; 10(10): 683-689.
[33]Mule G, Cottone S, Nardi E, et al. Metabolic syndrome in subjects with essential hypertension:relationships with subclinical cardiovascular and renal damage. Minerva Cardioangiol.2006; 54(2):173-194.
[34]Ballantyne GH, Gumbs A, Modlin IM. Changes in insulin resistance following bariatric surgery and the adipoinsular axis:role of the adipocy to kines, leptin, adiponectin and resistin. Obes Surg.2005; 15(5):692-699.
[35]E1-Atat FA, Stas SN, McFarlane SI, Sowers JR. The relationship between hyperinsulinemia, hypertension and progressive renal disease. J Am Soc Nephrol.2004; 15(11):2816-2827.
[36]Pavkov ME, Knowler WC, Bennett PH, et al. Increasing incidence of proteinuria and declining incidence of end-stage renal disease in diabetic Pima Indians. Kidney Int. 2006; 70(10):1840-1846.
[37]Hsu CY, Lin F, Vittinghoff E, Shlipak MG. Racial differences in the progression from chronic renal insufficiency to end-stage renal disease in the United States.J Am Soc Nephrol.2003; 14(11):2902-2907.
[38]Fenton SS, Schaubel DE, Desmeules M, et al. Hemodialysis versus peritoneal dialysis: a comparison of adjusted mortality rates. Am J Kidney Dis.1997; 30(3):334-342.
[39]Muntner P, Coresh J, Smith JC, et al. Plasma lipids and risk of developing renal dysfunction:the atherosclerosis risk in communities study. Kidney Int.2000; 58(1): 293-301.
[40]姚峥.代谢综合征的肾脏损害[J].中国医师进修杂志,2006;9(8):19～21.
[41]朱文华,方力争.代谢综合征各组分对高尿酸血症的影响.中华内科杂志,2006,45(3)：228～229.
[42]Sanchez-Lozada LG, Tapia E, Santamaria J, et al. Mild hyperuricemia induces vasoconstriction and maintains glomerular hypertension in normal and remnant kidney rats. Kidney Int.2005; 67(1):237-247.
[43]Toprak O, Cirit M, Esi E, et al. Hyperuricemia as a risk factor for contrast-induced nephropathy in patients with chronic kidney disease. Catheter Cardiovasc Interv.2006; 67(2):227-235.
[44]Padang C, Muirden KD, Schumacher HR, et al. Characteristics of chronic gout in Northern Sulawesi, Indonesia. JRheumatol.2006; 33(9):1813-1817.
[45]Chen J, Gu D, Chen CS, et al. Association between the metabolic syndrome and chronic kidney disease in Chinese adults. Nephrol Dial Transplant.2007; 22(4): 1100-1106.
[46]边琪,袁伟杰,等.代谢综合征及其代谢因子号慢性肾损害相关性的临床研究.中华肾脏病杂志.2005；7(21):389～393.
[47]Razak F, Anand S, Vuksan V, et al. SHARE Investigators Ethnic differences in the relationships between obesity and glucose-metabolic abnormalities:a cross-sectional population-based study. Int J Obes (Lond).2005; 29(6):656-667
[48]Jia WP, Xiang KS, Chen L, et al. Epidemiological study on obesity and its comorbidities in urban Chinese older than 20 years of age in Shanghai, China.Obes Rev. 2002; 3(3):157-165.
[49]路庆丽,谢自敬,等.我国维吾尔族成人代谢综合征腰围适宜切点研究.中国糖尿病杂志.2008；2:79～82.
[50]陈力平,张毅,张丽芳,等.武钢产业人群代谢综合征腰围切点的研究.中国冶金工业医学杂志.2008；25(5)：533～537.
[51]Levey AS, Atkins R, Coresh J, et al. Chronic kidney disease as a global public health problem:approaches and initiatives-a position statement from Kidney Disease Improving Global Outcomes. Kidney Int.2007; 72(3):247-259.
[2]Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults:findings from the third National Health and Nutrition Examination Survey. JAMA.2002; 287(3):356-359.
[3]Hu G, Qiao Q, Tuomilehto J, Balkau B, Borch-Johnsen K, Pyorala K; DECODE Study Group. Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women. Arch Intern Med. 2004; 164(10):1066-1076.
[4]顾东风,Reynolds K,杨文杰,等.中国成年人代谢综合征的患病率。中华糖尿病杂志,2005,13(3)：181～186.
[5]脑卒中、冠心病发病危险因素进一步研究协作组.11省市队列人群代谢综合征的流行病学研究.中华预防医学杂志,2002,36(5):298～300.
[6]Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease:a position statement from Kidney Disease:Improving Global Outcomes (KDIGO). Kidney Int.2005; 67(6):2089-2100.
[7]Levey AS, Coresh J, Balk E, et al. National Kidney Foundation. National Kidney Foundation practice guidelines for chronic kidney disease:evaluation, classification, and stratification. Ann Intern Med.2003; 139(2):137-147.
[8]Garg AX, Kiberd BA, Clark WF, et al. Albuminuria and renal insufficiency prevalence guides population screening:results from the NHANES III. Kidney Int.2002; 61(6): 2165-2175.
[9]Brown WW, Peters RM, Ohmit SE, et al. Early detection of kidney disease in community settings:the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis. 2003; 42(1):22-35.
[10]张路霞,左力,徐国宾,等.北京市石景山地区中老年人群中慢性肾脏病的流行病学研究.华肾脏病杂志,2006；22:61～71.
[11]陈崴,王辉,董秀清,等.广州市城区普通人群中慢性肾脏病的流行病学研究.中华肾脏病杂志,2007；23(3)：425～427.
[12]Laaksonen DE, Lakka HM, Niskanen LK, et al. Metabolic syndrome and development of diabetes mellitus:application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. Am J Epidemiol.2002; 156(11): 1070-1077.
[13]Trevisan M, Liu J, Bahsas FB, Menotti A. Syndrome X and mortality:a population-based study.Risk Factor and Life Expectancy Research Group. Am J Epidemiol.1998; 148(10):958-966.
[14]Lakka HM, Laaksonen DE, Lakka TA, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA.2002; 288(21):2709-2716.
[15]Saely CH, Koch L, Schmid F, et al. Adult Treatment Panel III 2001 but not International Diabetes Federation 2005 criteria of the metabolic syndrome predict clinical cardiovascular events in subjects who underwent coronary angiography. Diabetes Care.2006; 29(4):901-907.
[16]National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease:evaluation, classification, and stratification. Am J Kidney Dis.2002; 39(1): S1-S266.
[17]Ma YC, Zuo L, Chen JH, et al. Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol.2006; 17(10): 2937-2944.
[18]Mancia G, De Backer G, Dominiczak A, et al. 2007 ESH-ESC practice Guidelines for the Management of Arterial Hypertension:ESH-ESC Task Force on the Management of Arterial Hypertension. JHypertens,2007,25:1751 - 1762.
[19]Executive summary:standards of medical care in diabetes-2009. Diabetes Care,2009, 32(1)1:S6-S12.
[20]Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. J Am Coll Cardiol,2004; 44:720-732.
[21]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2007年版),中华医学杂志.2008；88(18).
[22]Gu D, Reynolds K, Wu X, et al. Prevalence of the metabolic syndrome and overweight among adults in China. Lancet,2005;365(9468):1398-1405.
[23]罗不凡,杜琳,潘冰莹,等.广州市15岁以上居民代谢综合征流行特征分析.中国糖尿病杂志.2008；16(5)：267～270.
[24]卢伟,刘美霞,李锐,等.上海市15-74岁居民代谢综合症的流行特征.中华预防医学杂志,2006;40:262～268.
[25]Razak F, Anand S, Vuksan V, et al. Share Investigators ethnic differences in the relationships between obesity and glucose-metabolic abnormalities:a cross-sectional population-based study. Int J Obes (Lond).2005; 29(6):656-667.
[26]路庆丽,谢自敬,等.我国维吾尔族成人代谢综合征腰围适宜切点研究.中国糖尿病杂志.2008；2:79～82.
[27]陈力平,张毅,张丽芳,等.武钢产业人群代谢综合征腰围切点的研究.中国冶金工业医学杂志.2008;25(5)：53～537.
[28]王苏中,顾湲,李丽霞,等.北京方庄社区高血压患病率与管理现况的调查.中国慢性病预防与控制.1999；7(3):135～136.
[29]刘烈,邓惠鸿,岑润超.广东省高血压流行病学特征和危险因素分析.广东医学2002；23：417～419.
[30]王战建,张耀.糖尿病的流行病学及三级预防.河北医药,2004,26:289～290.
[31]Andersson S, Safari H, Mints M, et al. Type distribution, vira load and integration stat us of high-risk human papilloma viruses in pre-stages of cervical cancer (CIN). Br J Cancer,2005; 92(12):2195-2200.
[32]路方红,杨建民,金世宽,等.济南市城乡35-64岁人群代谢综合征现况调查.中国公共卫生2008;5(24):615～617.
[33]陈蕾,贾伟平,陆俊茜.上海市成人代谢综合征流行调查.中华心血管病杂志.2003；31(6)：909～912.
[34]Kalantar-Zadeh K, Koppel JD. Body mass index and risk for end-stage renal disease. Ann Intern Med.2006 2; 144(9):701.
[35]Ninomiya T, Kiyohara Y, Kubo M, et al. Metabolic syndrome and CKD in a general Japanese population:the Hisayama Study. Am JKidney Dis.2006; 48(3):383-391.
[36]Chen J, Muntner P, Hamm LL, et al. Insulin resistance and risk of chronic kidney disease in nondiabetic US adults. JAm Soc Nephrol.2003; 14(2):469-477.
[37]Chen J, Muntner P, Hamm LL, Jones DW, et al. The metabolic syndrome and chronic kidney disease in U.S. adults. Ann Intern Med.2004; 140(3):167-174.
[38]赵志刚,祝之明,杜彦社.代谢综合征的颈动脉粥样硬化特征.中华内科杂志.2003；42：625～627.
[39]徐兴森,杨万涛,刘道燕,等.高血压合并代谢紊乱及对心肾血管的影响.中华高血压杂志.2006；14(Ⅱ)：894～898.
[40]陈秀玲,王莉,李贵森,等.健康体检者代谢综合征及肾功能相关性的调查,四川医学.2008；10:1426～1429.
[41]陈晓农,潘晓霞,朱杰,等.早、中期慢性肾功能衰竭的危险因素分析.诊断学理论与实践.2007；6(6)：513～518.
[42]Charlesworth JA, Kriketos AD, Jones JE, et al. Insulin resistance and postprandial triglyceride levels in primary renal disease. Metabolism.2005; 54(6):821-828.
[43]Hoehner CM, Greenlund KJ, Rith-Najarian S, et al. Association of the insulin resistance syndrome and microalbuminuria among nondiabetic native Americans. The Inter-Tribal Heart Project. J Am Soc Nephrol. 2002; 13(6):1626-1634.
[44]Hsu CY, McCulloch CE, Iribarren C, et al. Body mass index and risk for end-stage renal disease. Ann Intern Med.2006; 144(1):21-28.
[45]Kambham N, Markowitz GS, Valeri AM, et al. Obesity-related glomeruloPathy:an emerging epidemic. Kidney Int.2001; 59(4):1498-1509.
[46]Iseki K. Body mass index and the risk of chronic renal failure:the Asian experience Contrib Nephrol.2006; 151:42-56.
[47]Reynolds K, Gu D, Muntner P, Chen J, et al. Body mass index and risk of ESRD in China. Am J Kidney Dis.2007; 50(5):754-764.
[48]Whelton PK, Perneger TV, He J, et al. The role of blood pressure as a risk factor for renal disease:a review of the epidemiologic evidence. JHum Hypertens.1996; 10(10): 683-689
[49]Mule G, Cottone S, Nardi E, et al. Metabolic syndrome in subjects with essential hypertension:relationships with subclinical cardiovascular and renal damage. Minerva Cardioangiol.2006; 54(2):173-194.
[50]Pavkov ME, Knowler WC, Bennett PH, et al. Increasing incidence of proteinuria and declining incidence of end-stage renal disease in diabetic pima Indians. Kidney Int. 2006;70(10):1840-1846.
[51]Hsu CY, Lin F, Vittinghoff E, Shlipak MG. Racial differences in the progression from chronic renal insufficiency to end-stage renal disease in the United States.J Am Soc Nephrol.2003; 14(11):2902-2907.
[52]Fenton SS, Schaubel DE, Desmeules M, et al. Hemodialysis versus peritoneal dialysis: a comparison of adjusted mortality rates. Am J Kidney Dis.1997; 30(3):334-342.
[53]Muntner P, Coresh J, Smith JC, et al. Plasma lipids and risk of developing renal dysfunction:the atherosclerosis risk in communities study. Kidney Int.2000; 58(1): 293-301.
[54]姚峥.代谢综合征的肾脏损害[J].中国医师进修杂志,2006;9(8):19～21
[55]朱文华,方力争.代谢综合征各组分对高尿酸血症的影响[J].中华内科杂志,2006;45(3)：228～229.
[56]Sanchez-Lozada LG, Tapia E, Santamaria J, et al. Mild hyperuricemia induces vasoconstriction and maintains glomerular hypertension in normal and remnant kidney rats. Kidney Int.2005; 67(1):237-247.
[57]Toprak 0, Cirit M, Esi E, et al. HyPeruricemia as a risk factor for contrast-induced nephropathy in Patients with chronic kidney disease. Catheter Cardiovasc Interv.2006; 67(2):227-235.
[58]Padang C, Muirden KD, Schumacher HR, et al. Characteristics of chronic gout in Northern Sulawesi, Indonesia. JRheumatol. 2006; 33(9):1813-1817
[59]Chen J, Gu D, Chen CS, et al. Association between the metabolic syndrome and chronic kidney disease in Chinese adults. Nephrol Dial Transplant.2007; 22(4): 1100-1106.
[60]边琪,袁伟杰,等.代谢综合征及其代谢因子号慢性肾损害相关性的临床研究.中华肾脏病杂志.2005；7(21):389～393.
[61]Hunsicker LG, Adler S, Caggiula A, et al. Predictors of the progression of renal disease in the Modification of Diet in Renal Disease Study. Kidney Int.1997; 51: 1908-1919.
[62]Muntner P, Coresh J, Smith JC, et al. Plasma lipids and risk of developing renaldys function:the atherosclerosis risk in communities study. Kidney Int.2000; 58:293-301.
[1]Lim HS, Patel JV, Lip GY. Metabolic syndrome:a definition progress. Circulation. 2004; 110(4):e35.
[2]Saely CH, Koch L, Schmid F, et al. Adult Treatment Panel Ⅲ 2001 but not International Diabetes Federation 2005 criteria of the metabolic syndrome predict clinical cardiovascular events in subjects who underwent coronary angiography. Diabetes Care.2006; 29(4):901-907.
[3]Laaksonen DE, Lakka HM, Niskanen LK, et al. Metabolic syndrome and development of diabetes mellitus:application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. Am J Epidemiol.2002; 156(11): 1070-1077.
[4]Trevisan M, Liu J, Bahsas FB, Menotti A. Syndrome X and mortality:a population-based study.Risk Factor and Life Expectancy Research Group. Am J Epidemiol.1998; 148(10):958-966.
[5]Lakka HM, Laaksonen DE, Lakka TA, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA.2002; 288(21):2709-2716.
[6]Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults:findings from the third National Health and Nutrition Examination Survey. JAMA.2002; 287(3):356-359.
[7]Hu G, Qiao Q, Tuomilehto J, Balkau B, et al. DECODE Study Group. Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women. Arch Intern Med.2004; 164(10):1066-1076.
[8]顾东风,Reynolds K,杨文杰,等.中国成年人代谢综合征的患病率.中华糖尿病杂志,2005,13(3)：181～186.
[9]脑卒中、冠心病发病危险因素进一步研究协作组.11省市队列人群代谢综合征的流行病学研究.中华预防医学杂志.2002,36(5):298～300.
[10]Boden G, Shulman GI. Free fatty acids in obesity and type 2 diabetes:defining their role in the development of insulin resistance and beta-cell dysfunction.Eur J Clin Invest.2002; 32 (Supp 13):14-23.
[11]藤森新.代谢综合征与嘌呤代谢异常.日本医学介绍,2005,26(5):210～211
[12]Jowett JB, Elliott KS, Curran JE, et al. Genetic variation in BEACON influences quantitative variation in metabolic syndrome-related phenotypes. Diabetes.2004; 53(9): 2467-2472.
[13]Widen E, Lehto M, Kanninen T, et al. Association of a polymorphism in the P3-adrenergic receptor gene with features of the insulin resistance syndrome in Finns. N Engl J Med.1995; 333:348-351.
[14]Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease:a position statement from Kidney Disease:Improving Global Outcomes (KDIGO). Kidney Int.2005; 67(6):2089-2100.
[15]Levey AS, Coresh J, Balk E, et al. National Kidney Foundation. National Kidney Foundation practice guidelines for chronic kidney disease:evaluation, classification, and stratification. Ann Intern Med.2003; 139(2):137-147.
[16]Garg AX, Kiberd BA, Clark WF, et al. Albuminuria and renal insufficiency prevalence guides population screening:results from the NHANES III. Kidney Int.2002; 61(6): 2165-2175.
[17]Brown WW, Peters RM, Ohmit SE, et al. Early detection of kidney disease in community settings:the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis. 2003; 42(1):22-35.
[18]张路霞,左力,徐国宾,等.北京市石景山地区中老年人群中慢性肾脏病的流行病学研究.华肾脏病杂志,2006；22:61～71.
[19]陈崴,王辉,董秀清,等.广州市城区普通人群中慢性肾脏病的流行病学研究.中华肾脏病杂志,2007；23(3)：425～427.
[20]陈晓农,潘晓霞,朱杰,等.早、中期慢性肾功能衰竭的危险因素分析.诊断学理论与实践,2007；6(6)：513～518.
[21]Chen J, Muntner P, Hamm LL, et al. Insulin resistance and risk of chronic kidney disease in nondiabetic US adults. J Am Soc Nephrol.2003; 14(2):469-477.
[22]Chen J, Muntner P, Hamm LL, Jones DW, et al. The metabolic syndrome and chronic kidney disease in U.S. adults. Ann Intern Med.2004; 140(3):167-174.
[23]赵志刚,祝之明,杜彦社.代谢综合征的颈动脉粥样硬化特征.中华内科杂志.2003；42：625～627.
[24]徐兴森,杨万涛,刘道燕,等.高血压合并代谢紊乱及对心肾血管的影响.中华高血压杂志.2006；14(Ⅱ)：894～898.
[25]陈秀玲,王莉,李贵森,等.健康体检者代谢综合征及肾功能相关性的调查,四川医学.2008;10:1426～1429.
[26]Charlesworth JA, Kriketos AD, Jones JE, et al. Insulin resistance and postprandial triglyceride levels in primary renal disease. Metabolism.2005; 54(6):821-828.
[27]Hoehner CM, Greenlund KJ, Rith-Najarian S, et al. Association of the insulin resistance syndrome and microalbuminuria among nondiabetic native Americans. The Inter-Tribal Heart Project. J Am Soc Nephrol.2002; 13(6):1626-1634.
[28]Hsu CY, McCulloch CE, Iribarren C, et al. Body mass index and risk for end-stage renal disease. Ann Intern Med.2006; 144(1):21-28.
[29]Kambham N, Markowitz GS, Valeri AM, et al. Obesity-related glomerulopathy:an emerging epidemic. Kidney Int.2001; 59(4):1498-1509.
[30]Iseki K. Body mass index and the risk of chronic renal failure:the Asian experience Contrib Nephrol.2006; 151:42-56.
[31]Reynolds K, Gu D, Muntner P, Chen J, et al. Body mass index and risk of ESRD in China. Am J Kidney Dis.2007; 50(5):754-764.
[32]Whelton PK, Perneger TV, He J, et al. The role of blood pressure as a risk factor for renal disease:a review of the epidemiologic evidence. J Hum Hypertens.1996; 10(10): 683-689.
[33]Mule G, Cottone S, Nardi E, et al. Metabolic syndrome in subjects with essential hypertension:relationships with subclinical cardiovascular and renal damage. Minerva Cardioangiol.2006; 54(2):173-194.
[34]Ballantyne GH, Gumbs A, Modlin IM. Changes in insulin resistance following bariatric surgery and the adipoinsular axis:role of the adipocy to kines, leptin, adiponectin and resistin. Obes Surg.2005; 15(5):692-699.
[35]E1-Atat FA, Stas SN, McFarlane SI, Sowers JR. The relationship between hyperinsulinemia, hypertension and progressive renal disease. J Am Soc Nephrol.2004; 15(11):2816-2827.
[36]Pavkov ME, Knowler WC, Bennett PH, et al. Increasing incidence of proteinuria and declining incidence of end-stage renal disease in diabetic Pima Indians. Kidney Int. 2006; 70(10):1840-1846.
[37]Hsu CY, Lin F, Vittinghoff E, Shlipak MG. Racial differences in the progression from chronic renal insufficiency to end-stage renal disease in the United States.J Am Soc Nephrol.2003; 14(11):2902-2907.
[38]Fenton SS, Schaubel DE, Desmeules M, et al. Hemodialysis versus peritoneal dialysis: a comparison of adjusted mortality rates. Am J Kidney Dis.1997; 30(3):334-342.
[39]Muntner P, Coresh J, Smith JC, et al. Plasma lipids and risk of developing renal dysfunction:the atherosclerosis risk in communities study. Kidney Int.2000; 58(1): 293-301.
[40]姚峥.代谢综合征的肾脏损害[J].中国医师进修杂志,2006;9(8):19～21.
[41]朱文华,方力争.代谢综合征各组分对高尿酸血症的影响.中华内科杂志,2006,45(3)：228～229.
[42]Sanchez-Lozada LG, Tapia E, Santamaria J, et al. Mild hyperuricemia induces vasoconstriction and maintains glomerular hypertension in normal and remnant kidney rats. Kidney Int.2005; 67(1):237-247.
[43]Toprak O, Cirit M, Esi E, et al. Hyperuricemia as a risk factor for contrast-induced nephropathy in patients with chronic kidney disease. Catheter Cardiovasc Interv.2006; 67(2):227-235.
[44]Padang C, Muirden KD, Schumacher HR, et al. Characteristics of chronic gout in Northern Sulawesi, Indonesia. JRheumatol.2006; 33(9):1813-1817.
[45]Chen J, Gu D, Chen CS, et al. Association between the metabolic syndrome and chronic kidney disease in Chinese adults. Nephrol Dial Transplant.2007; 22(4): 1100-1106.
[46]边琪,袁伟杰,等.代谢综合征及其代谢因子号慢性肾损害相关性的临床研究.中华肾脏病杂志.2005；7(21):389～393.
[47]Razak F, Anand S, Vuksan V, et al. SHARE Investigators Ethnic differences in the relationships between obesity and glucose-metabolic abnormalities:a cross-sectional population-based study. Int J Obes (Lond).2005; 29(6):656-667
[48]Jia WP, Xiang KS, Chen L, et al. Epidemiological study on obesity and its comorbidities in urban Chinese older than 20 years of age in Shanghai, China.Obes Rev. 2002; 3(3):157-165.
[49]路庆丽,谢自敬,等.我国维吾尔族成人代谢综合征腰围适宜切点研究.中国糖尿病杂志.2008；2:79～82.
[50]陈力平,张毅,张丽芳,等.武钢产业人群代谢综合征腰围切点的研究.中国冶金工业医学杂志.2008；25(5)：533～537.
[51]Levey AS, Atkins R, Coresh J, et al. Chronic kidney disease as a global public health problem:approaches and initiatives-a position statement from Kidney Disease Improving Global Outcomes. Kidney Int.2007; 72(3):247-259.