新陳代謝症候群流行病學：以台中市一醫學中心健檢者為例

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(1)196. 1. 2 1 2. 2000. 1. 2002. 12. 3053 (National Cholesterol Education Program. NCEP). (Third Report of the Expert Panel on Detection,. Evaluation, and Treatment of High Blood Cholesterol in Adults. ≥ 90 1711. ATP III). ≥ 80. (56.0%). 1342. ). t. (44.0%). 25.6%. 49.7 25.5%. 12.3. (. 20-87. 25.8%. (p = 0.912) 40 5.99. 64. 65. 20. 95%. 1.63-2.93 (. 39. (. 4.15-8.64 3.45. 8.51. 95%. 2.70-4.42. p < 0.001). ( 2.32-3.50. 1.47. 1.42. p < 0.001). 1.17-1.73 95%. 2.19. p < 0.001) 6.51-11.14 95%. (. 2.85. p < 0.001) 1.10-1.98. 95%. (. p < 0.05) 2005;10:196-203. High Blood Cholesterol in Adults (. ATP III) ). (National Cholesterol Education Program. NCEP). [1]. 2001 (. (Third Report of the Expert Panel on Detection, Evaluation, and Treatment of. X. ). WHO (body. 404. (waist-hip ratio). mass index). 2. [2] 2005. 5. 24. 2005. 6. 17. 2005. 6. 14. (proinflammatory state) (prothrombotic state). [3,4].

(2) 197. [5] 2000. 1. 2002. 12. 3053. 12. ATP III 4.6%. 29.4%. [6] :. ATP III (. 24.8%. 16.4% (. 20. Hitachi 736-15 (Tokyo. 28.3%) 29. 6.7%. 43.5%). Japan). 60-69 (body mass index. [7]. = (m)2. 24 ≤ BMI < 27. 18.5 ≤ BMI < 24. ATP III[1] (WHO). BMI ≥ 27. 1999. BMI). (kg). BMI < 18.5. [14] 10. [2] (the European Group for the Study of Insulin Resistance (EGIR)). 5. 1999. [8]. (American. Association of Clinical Endocrinologists. AACE). 2003. [9]. (TOSHIBA Sonolayer SSA-270A MHz transducer. Tochigi-Ken. convex-type 3.5 Japan). [15-17]. 1) 2). ATP III 2002. (. ). 3). 15. 4) 5). 14.99% (. 16.9%. 13.8%). 70. 79 200 mg/dL. 32.8% [10] [1] 7.0 mg/dL. [11]. 6.5 mg/dL [18]. [12]. 40. ATP III. 59. [13] 2000. [1]. 2002 ATP III. ≥ 130 mmHg ≥ 85 mmHg. [1] ≥ 110 mg/dL.

(3) 198. p (. )(. , %). 20-39 40-64 ≥ 65 ( (. 364 (58.1) 1163 (56.9) 184 (48.3) 1711 (56.0) 49.1 11.9 87.7 8.4 24.7 3.3 127.7 16.5 80.6 10.5 102.5 34.8 198.6 38.4 123.3 66.0. ) ) 2. (kg/m ) (mmHg) (mmHg) (mg/dL) (mg/dL) (mg/dL) (mg/dL) (mg/dL) (%) (%) *t. 45.1 11.7 6.7 1.4 14.8 7.5. 263 (41.9) 882 (43.1) 197 (51.7) 1342 (44.0) 50.5 12.7 82.5 10.4 23.9 3.9 121.2 20.2 75.8 11.1 101.3 32.1 198.2 38.9 95.0 55.3 54.3 13.9 5.4 1.3 14.5 5.4. 627 2045 381 3053 49.7 12.3. 0.0012* < 0.001* < 0.001* < 0.001* < 0.001* 0.2987* 0.7611*. 85.4 9.7 24.3 3.6 124.8 18.5 78.5 11.1 102.0 33.7 198.4 38.6 110.9 63.1 49.1 13.5 6.1 1.5 14.6 6.6. < 0.001* < 0.001* < 0.001* 0.838** 0.023**. **. ≥ 65. p. 20-39. 40-64. 28.8 23.2 26.5. 42.1 63.2 51.2. 50.0 81.2 66.1. < 0.001 < 0.001. 40.2 58.0 48.0. 32.7 4.9 21.1. 47.2 35.4 42.1. 65.2 75.6 70.6. < 0.001 < 0.001. 46.1 35.3 41.3. 3.3 3.0 3.2. 19.1 16.2 17.8. 29.3 34.5 32.0. < 0.001 < 0.001. 16.8 16.3 16.6. 25.5 3.8 16.4. 29.0 14.6 22.8. 25.0 22.3 23.6. 0.295 < 0.001. 27.8 13.6 21.6. 37.9 35.0 36.7. 38.3 42.9 40.3. 43.5 47.2 45.4. 0.384 0.020. 38.8 42.0 40.2. 17.3 5.3 12.3. 26.7 26.5 26.7. 34.2 49.7 42.3. < 0.001 < 0.001. 25.5 25.8 25.6. (%). (%). (%). (%). (%). (%).

(4) 199. p. (%). (%). 0.912 1274 (74.5). 437 (25.5). 996 (74.2). 346 (25.8). 20-39. 550 (87.7). 77 (12.3). 40-64. 1500 (73.3). 545 (26.7). ≥ 65. 220 (57.7). 161 (42.3). 1227 (91.2). 118 (8.8). (. ). < 0.0001. < 0.0001 117 (97.5). 3 (2.5). 658 (68.3). 306 (31.7). 268 (42.9). 356 (57.1) < 0.0001. 1284 (77.4). 375 (22.6). 986 (70.7). 408 (29.3). 1716 (79.6). 441 (20.4). 554 (61.8). 342 (38.2). < 0.0001. < 0.0001 1558 (87.4). 225 (12.6). 712 (56.1). 558 (43.9). 1712 (74.8). 578 (25.2). 558 (73.1). 205 (26.9). 0.339. 0.013. [1]. 2053 (75.0). 683 (25.0). 217 (68.5). 100( 31.5). ≥ 150 mg/dL [1]. 1 7 11. < 40 mg/dL. (44.0%). < 50 mg/dL. [1] ≥ 80. ≥ 90. (56.0%) 49.7. 12.3. 1342 (. 20. ). [14]. [19] Excel 5.0 SPSS (Chinese Version 10.0 Taiwan). 10 25.5%. 25.8%. t p. 0.05. 25.6%. Sinter Information Corp. (p. 0.05) (p. 87.

(5) 200. (. 95%. ). 3.60 (0.18) (20-39. ). 40-64 ≥ 65 (. 0.78 (0.15). 2.19**. 1.63. 2.93. 1.79 (0.19). 5.99**. 4.15. 8.64. 0.88 (0.60). 0.41. 0.13. 1.34. 1.24 (0.13). 3.45**. 2.70. 4.42. 2.14 (0.14). 8.51**. 6.51. 11.14. 0.03 (0.10). 0.97. 0.80. 1.17. 0.35 (0.10). 1.42**. 1.17. 1.73. 1.05 (0.10). 2.85**. 2.3. 3.50. 0.39 (0.15). 1.47*. 1.10. 1.98. ). (< 200 mg/dL (. < 7.0. < 6.5 mg/dL. ( ( *p < 0.01. ) ). ) ) **p < 0.001. 0.01). 25.6%. 25.5%. 25.8% 2002. ( 15.0%. 16.9%. 13.8%) [10] (. 21.2%. 17.7%. 23.8%) (. ) [11] 40. 64. 65. 20. 39. (. ( 2.19. 5.99. 4.15-8.64. 95%. 12.9% 1.63-2.93. 15.5%. ) [12]. p < 0.001). (2001. 8. 2002. ( 3.45. 8.51. 6.51-11.14. 10.5%) ( 10. ). 40. (. 95%. 2.70-4.42. 16.1%. p < 0.001). 59 9.9%. 5.8% ) (. ) [13] (. 1.42. 95%. 1.17-1.73. p < 0.001). 49.1. 50.5 (. (. 2.85. 95%. 2.32-3.50. < 0.001). )[12]. 1.47. 42.7. 42.2. 47.1. 45.1) Cameron. 95%. p < 0.05) [20] (. 0.80-1.17. (. [13] (. 1.10-1.98. p. p = 0.7376). 0.97. 95%. [12].

(6) 201. 20. 39. 12.3%. 26.7%. 65. 40. 40. 64. 65. 20. 1.42. 95%. p < 0.001). Nobukazu Ishizaka. (. 2.19 4.15. 5.99. 95%. 8.64. [23] 1.63-2.93 [24]. p < 0.001) (. ). 20. [25]. 39. 17.3% 40. ( 1.17-1.73. 39. (. 64. 42.3%. (. 5.3% 2.32-3.50. 64. 26.7%. 26.5%) (. 95% (. 65. 34.2%. 2.85. p < 0.001). 95%. 49.7%). 1.10-1.98. 1.47. p < 0.05). Park [12] ATP III [21]. [1]. [26] (p. [21]. 0.05) (p. 0.01). [12] Park YW (Third National Health and Nutrition Examination. [21]. NHANES III). Survey. [21]. Cameron. 14 ATP III. [20]. ( 8.51 11.14. 95%. 2.70-4.42. p < 0.001). 1.17. 0.97. p = 0.7376). 6.51-. NHANES III. Framingham Heart Study. (. 3.45. [21,22]. 95%. 0.80-. 1. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-97. 2. World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications Part 1: diagnosis and classification of diabetes mellitus. Geneva (Switzerland): Department of Noncommunicable Disease Surveillance, 1999. 3. Festa A, D'Agostino R Jr, Howard G, et al. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation 2000;102: 42-7. 4. Festa A, D'Agostino R Jr, Tracy RP, et al. Elevated levels of acute-phase proteins and plasminogen activator inhibitor-1 predict the development of type 2 diabetes: the insulin resistance atherosclerosis study. Diabetes 2002; 51:1131-7..

(7) 202. 5. Isomaa B, Almgren P, Tuomi T, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001;24:683-9. 6. Ford ES. Prevalence of the metabolic syndrome in US populations. [Review] Endocrinol Metab Clin North Am 2004;33:333-50. 7. 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;287:356-9. 8. Balkau B, Charles MA. Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR). Diabet Med 1999;16:442-3. 9. Einhorn D, Reaven GM, Cobin RH, et al. American College of Endocrinology position statement on the insulin resistance syndrome. Endocr Pract. 2003;9:23752. 10. http://www.bhp.doh.gov.tw/asp/news/file/20051251540 90XP3WQ/. .ppt. Accessed. May 2005 11.Chuang SY, Chen CH, Tsai ST, et al. Clinical identification of the metabolic syndrome in Kinmen. Acta Cardiol Sin 2002;18:16-23. 12. Chuang SY, Chen CH, Chou P. Prevalence of metabolic syndrome in a large health check-up. J Chin Med Asso 2004;67:611-20. 13. 2003;10:143-54 14.World Health Organization: The Asia-Pacific Perspective. Redefining Obesity and its Treatment. http://www.diabetes.com.au/pdf/obesity_report.pdf Accessed June 2005 15.Chang WY, Chen CJ, Lu SN, et al. Relationship between fatty liver, alanine aminotransferase, HBsAg and hepatitis C virus. J Gastroenterol Hepatol 1992;7: 455-8. 16. Lin DY, Sheen IS, Chiu CT, et al. Clinical significance of ultrasonographic fatty liver in asymtomatics: analysis. of 1040 check-up subjects. J Med Ultrasound 1993;1: 165-71. 17.Lin SC, Shih SC, Kao CR, et al. Prevalence of antibodies to hepatitis C virus in patients with nonalcoholic fatty liver. Chung Hua I Hsueh Tsa Chih (Taipei) 1995;56:80-5. 18. Saggiani F, Pilati S, Targher G, et al. Serum uric acid and related factors in 500 hospitalized subjects. Metabolism 1996;45:1557-61. 19. World Health Organization. Physical Status: the Use and Interpretation of Anthropometry. Geneva. WHO, 1995. 20.Cameron AJ, Shaw JE, Zimmet PZ. The metabolic syndrome: prevalence in worldwide populations. [Review] Endocrinol Metab Clin North Am 2004;33: 351-75. 21. Park, YW, Zhu, S, Palaniappan, L, et al. The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988-1994. Arch Intern Med 2003;163:427-36. 22. Wilson PW, Kannel WB, Silbershatz H, et al. Clustering of metabolic factors and coronary heart disease. Arch Intern Med 1999;159:1104-9. 23.Ishizaka N, Ishizaka Y, Toda E, et al. Association between serum uric acid, metabolic syndrome, and carotid atherosclerosis in Japanese individuals. Arterioscler Thromb Vasc Biol 2005;25:1038-44. 24. Culleton BF, Larson MG, Kannel WB, et al. Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study. Ann Intern Med 1999;131:713. 25. Clausen JO, Borch-Johnsen K, Ibsen H, et al. Analysis of the relationship between fasting serum uric acid and the insulin sensitivity index in a population-based sample of 380 young healthy Caucasians. Eur J Endocrinol 1998;138:63-9. 26. Jackson R, Stewart A, Beaglehole R, et al. Alcohol consumption and blood pressure. Am J Epidemiol 1985; 122:1037-44..

(8) 203. Epidemiology of Metabolic Syndrome: A Hospital-based Study in Taichung 1. 2. Yu-Lung Chen, Kuan-Fu Liao , Shih-Wei Lai , Tsai-Chung Li 1. Department of Family Medicine, Department of Internal Medicine, China Medical University Hospital; 2. Institute of Chinese Medicine, China Medical University, Taichung, Taiwan.. Purpose. This cross-sectional study explored the epidemiology of metabolic syndrome in Taichung. M e t h o d s . We retrospectively analyzed people who had cumulatively undergone periodic health check-ups at a medical center in Taichung from January 2000 to December 2002. In total, 3053 people were enrolled in this study. The prevalence of metabolic syndrome was estimated according to the criteria proposed by NCEP/ATP III; the criteria were modified to include abdominal obesity and the cut-offs of waist circumference (≥ 90 cm for men and ≥ 80 cm for women) in Taiwan. Data were analyzed by the t test, chi-square test and multivariate logistic regression. Results. There were 1711 men (56.0%) and 1342 women (44.0%). The mean age was 49.7 12.3 years (age range, 20 to 87 yr). Overall, the prevalence of metabolic syndrome was 25.6% (25.5% in men and 25.8% in women). After controlling for other covariates, multivariate logistic regression analysis showed that people aged 40 to 64 years and 65 years and older were more likely to develop metabolic syndrome (odds ratio = 2.19 and 5.99, 95% CI = 1.63 to 2.93 and 4.15 to 8.64, respectively, p < 0.001) compared with individuals aged 20 to 39 years in the reference group. We also found that overweight and obese people were more likely to develop metabolic syndrome (OR = 3.45 and 8.51, 95% CI = 2.70 to 4.42 and 6.51 to 11.14, respectively, p < 0.001). Other significant risk factors of metabolic syndrome included hyperuricemia (OR = 1.42, 95% CI = 1.17 to 1.73, p < 0.001), fatty liver (OR = 2.85, 95% CI = 2.32 to 3.50, p < 0.001), and alcoholism (OR = 1.47, 95% CI = 1.10 to 1.98, p < 0.05). Conclusions. The prevalence of metabolic syndrome is relatively high in Taichung. We hope the results of this study will provide additional information for the development of preventive measures of metabolic syndrome in Taiwan. ( Mid Taiwan J Med 2005;10:196-203 ). Key words epidemiology, evidence-based medicine, metabolic syndrome, prevalence. Received : 24 May 2005.. Revised: 14 June 2005.. Accepted : 17 June 2005. Address reprint requests to : Shih-Wei Lai, Department of Family Medicine, China Medical University Hospital, 2 Yuh-Der Road, Taichung 404, Taiwan..

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