本帖最後由 p11111 於 2009-4-1 23:34 編輯
作者：Laurie Barclay, MD
出處：WebMD醫學新聞
March 17, 2009 — 根據一項發表在三月號的美國呼吸與重症照護醫學期刊的斷面性、以群眾為基礎研究，不論性別為何，肺功能受損與代謝症候群有關。
法國巴黎第七Denis Diderot大學INSERM U700的Nathalie Leone醫師與其同事們寫到，肺功能受損與代謝症候群與心臟血管發病率及死亡率風險上升有關；肺功能與代謝症候群之間關聯的證據是薄弱的。
這項研究的目的在於以代謝症候群部分為基礎，評估肺功能受損的風險。該研究樣本包括121,965位於1999至2006年於巴黎研究Preventives et Cliniques中心接受評估的男性與女性。
肺功能以第一秒使力吐氣容積（FEV1）或是使力肺容積（FVC）來定義，若該容積為正常值下限，則定義為肺功能受損，而代謝症候群則是根據美國心臟醫學會與國家心臟、肺臟與血液機構的標準定義。以邏輯式迴歸模式及主要組成分析來評估肺功能受損與代謝症候群特定部分之間的關係。
除了年齡、性別、吸菸狀態、飲酒、教育程度與身體質量指數、休閒時間活動、與心臟血管疾病病史之外，肺功能受損與代謝症候群（盛行率為15%）有關。以FEV1來說，勝算比（OR）為1.28（95%信賴區間[CI]為1.20-1.37），以FVC來說，OR為1.41（95% CI為1.31-1.51）。
原因分析發現有三個因素可以預測肺功能受損，分別是「血脂肪」（低的高密度脂蛋白[HDL]、高三酸甘油酯）、「葡萄糖與血壓」（高的空腹血糖、高血壓）、以及「腹部肥胖」（腰圍過大）。雖然這三個因素都反向地與肺功能有關，腹部肥胖是肺功能受損最大的預測因子（OR為1.94[95% CI為1.80-2.09]，而FEV1與FVC的OR為2.11[95% CI為1.95-2.29]）。女性與男性所得到的結果相仿。
研究作者寫到，我們發現不論性別為何，肺功能受損與代謝症候群之間有獨立關係，特別是腹部肥胖；需要未來的研究來釐清這之間的關係。
在隨後的主編評論中，來自土桑市亞利桑那大學的Paul Enright醫師表示，目前有足夠證據建議在進行呼氣測試前先量腰圍。
Enright醫師表示，腹部肥胖接著可以在付印的報告中特別地被強調，因此闡釋報告的臨床醫師們可以將肥胖的效應列入考量；相較於其他肥胖標記，例如腰圍與臀部的比例，或是腹部高度，腰圍較容易測量，當病患鬆弛他們的腹部肌肉時，即可以皮尺測量。
Caisse Nationale d'Assurance Maladie與Caisse Primaire d'Assurance Maladie de Paris贊助這項研究。研究作者們與Enright醫師表示沒有相關資金上的往來。
Lung Function Impairment Linked to Metabolic Syndrome in Both Sexes
By Laurie Barclay, MD
Medscape Medical News
March 17, 2009 — There is a positive independent relationship between lung function impairment and metabolic syndrome in both sexes, primarily related to abdominal obesity, according to the results of a cross-sectional, population-based study reported in the March issue of the American Journal of Respiratory and Critical Care Medicine.
"Increased risk for cardiovascular morbidity and mortality has been related to both lung function impairment and metabolic syndrome," write Nathalie Leone, MD, from INSERM U700, Universite Denis Diderot, Paris VII, France, and colleagues. "Data on the relationship between lung function and metabolic syndrome are sparse."
The goal of this study was to assess the risk for lung function impairment based on components of the metabolic syndrome. The study sample consisted of 121,965 men and women evaluated between 1999 and 2006 at the Paris Investigations Preventives et Cliniques Center.
Lung function impairment was defined as forced expiratory volume in 1 second (FEV1) or forced vital capacity (FVC), at lower limit of normal, and the metabolic syndrome was defined by criteria from the American Heart Association and the National Heart, Lung, and Blood Institute. Differential associations between lung function impairment and specific components of metabolic syndrome were assessed with a logistic regression model and principal component analysis.
Independently of age, sex, smoking status, alcohol consumption, educational level, body mass index, leisure-time physical activity, and cardiovascular disease history, lung function impairment was associated with metabolic syndrome (prevalence, 15.0%). For FEV1, odds ratio (OR) was 1.28 (95% confidence interval [CI], 1.20 - 1.37), and for FVC, OR was 1.41 (95% CI, 1.31 - 1.51).
Factor analysis revealed 3 factors predictive of impaired lung function: "lipids" (low high-density lipoprotein [HDL] cholesterol levels, high triglyceride levels), "glucose-blood pressure" (high fasting glycemia, high blood pressure), and "abdominal obesity" (large waist circumference). Although all 3 factors were inversely related to lung function, abdominal obesity was the strongest predictor of lung function impairment (OR, 1.94 [95% CI, 1.80 - 2.09] and OR, 2.11 [95% CI, 1.95 - 2.29] for FEV1 and FVC, respectively). Findings were similar among women and men.
"We found a positive independent relationship between lung function impairment and metabolic syndrome in both sexes, predominantly due to abdominal obesity," the study authors write. "Further studies are required to clarify the underlying mechanisms."
In an accompanying editorial, Paul Enright, MD, from the University of Arizona in Tucson, suggests that there is now enough evidence to recommend that waist circumference always be measured before spirometry tests.
"Abdominal obesity could then be highlighted on the printed report so that the physician interpreting the report could take the effect of obesity into account," Dr. Enright writes. "Waist size is easier to measure, using a cloth tape at the umbilicus while the patient relaxes their stomach muscles, than other indices of obesity such as waist/hip ratio or abdominal height."
The Caisse Nationale d'Assurance Maladie and the Caisse Primaire d'Assurance Maladie de Paris supported this study. The study authors and Dr. Enright have disclosed no relevant financial relationships.
Am J Respir Crit Care Med. 2009;179:432-433, 509-516. |
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