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研究生:金憲權
研究生(外文):Hsien-Chuan Chin
論文名稱:台灣地區學童代謝症候群盛行率及其組成成份與介白素-6單核苷酸多形性相關性研究
論文名稱(外文):Prevalence of metabolic syndrome and its components in relation to interleukin-6 single nucleotide polymorphism in Taiwanese children
指導教授:吳德敏吳德敏引用關係祝年豐祝年豐引用關係
指導教授(外文):Der-Min WuNain-Feng Chu
學位類別:碩士
校院名稱:國防醫學院
系所名稱:公共衛生學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2006
畢業學年度:94
語文別:中文
論文頁數:117
中文關鍵詞:兒童代謝症候群介白素-6單核苷酸多形性
外文關鍵詞:childrenmetabolic syndromeinterleukin-6single nucleotide polymorphism
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研究目的:世界各國兒童及成人代謝症候群盛行率有逐年上升趨勢,已成為重要的公共衛生議題。肥胖為代謝症候群發生主因之ㄧ。介白素-6(interleukin-6, IL-6)為一種與免疫及發炎相關之細胞激素,研究發現其與肥胖及糖尿病有關。本研究在探討台灣地區學童代謝症候群盛行率,並瞭解台灣地區兒童IL-6 -572 G/C(rs1800796)分布頻率,進而探討IL-6 -572 G/C(rs1800796)與代謝症候群相關性。
研究方法:本研究於2003年經三階段等比例抽樣篩檢1562名11~15歲學童(764名男童,798名女童)。學童代謝症候群定義採美國國家膽固醇教育計畫成人治療指引第三版(NCEP ATP Ш)定義之各變項其性別及年齡別90百分位作為診斷標準,包括:體位異常(BMI≧90百分位;腰圍≧90百分位;BMI或腰圍≧90百分位)、收縮壓或舒張壓≧90百分位、三酸甘油酯≧90百分位、高密度脂蛋白膽固醇≦10百分位或空腹血糖≧90百分位,只要有其中任三項異常即定義為代謝症候群。IL-6促進子-572 G/C (rs1800796)採Taqman 5’端核酸外切酵素法進行基因型鑑定。
研究結果:台灣地區男童依據不同體位異常標準(BMI≧90百分位;腰圍≧90百分位;BMI或腰圍≧90百分位)代謝症候群盛行率分別為4.1、4.6及4.8%,女童則分別為3.8、3.8及3.9%。控制年齡、吸菸、飲酒、青春期發育狀態及BMI(或腰圍)後,男童腰圍越大者代謝症候群(BMI、腰圍、BMI或腰圍≧90百分位診斷標準)危險性顯著增加(OR分別為1.06、1.17及1.14,95% CI=0.97~1.15、1.08~1.28及1.05~1.24)。女童BMI越高者代謝症候群(BMI、腰圍、BMI或腰圍≧90百分位診斷標準)危險性亦顯著增加(OR分別為1.42、1.33及1.36,95% CI=1.17~1.74、1.10~1.60及1.13~1.64)。台灣地區男童IL-6 rs1800796基因型分布頻率CC、CG及GG分別為58.0、36.9及5.1%;女童則分別為63.2、31.6及5.2%。男童IL-6 rs1800796(CC+CG)基因型收縮壓高於GG基因型(p<0.05);與女童結果類似(p=0.06)。男童IL-6 rs1800796基因型與三酸甘油酯有關(p<0.05),經事後比較發現CG基因型男童三酸甘油酯顯著高於GG基因型(71.8±33.1 vs. 55.1±22.1 mg/dl, p<0.05)。(CC+CG)基因型三酸甘油酯濃度高於GG基因型(p<0.05)。女童C對偶基因三酸甘油酯濃度低於G對偶基因(p<0.05)。女童C對偶基因空腹血糖過高盛行危險性為G對偶基因的1.54倍(95% CI=1.00~2.33)。
結論:本研究發現過重或肥胖學童代謝症候群盛行率明顯高於體位正常學童。其中男生腰圍及女生BMI與代謝症候群有較高相關性。而IL-6 -572 G/C (rs1800796)基因型與收縮壓、三酸甘油酯及空腹血糖等代謝症候群組成成份有關,其中(CC+CG)基因型男童有較高收縮壓與三酸甘油酯,女童則反之。IL-6 -572 G/C (rs1800796)對於學童代謝症候群可能有基因-性別間交互作用。
Objective: Metabolic syndrome (MS) is increasing steadily in children and adults, and becoming an important health issue in the world. Obesity is one of the most important risk factors associated with the development of MS. In addition, interleukin-6 (IL-6), a pleiotropic cytokine, is involved in immune and inflammatory response which may be linked between obesity and diabetes. The purpose of this study is to evaluate the prevalence of MS and also examine IL-6 -572G/C promoter polymorphism (rs1800796) in relation to MS and its components among children in Taiwan.
Methods: After multi-stage sampling, we totally enrolled 1562 school children (764 boys and 798 girls) in Taipei at 2003. Modified NCEP ATP-Ш criteria were applied to define MS (with age- and gender-specific 90th percentile cut-off point of study variables). Subjects have three or more of following cardio-metabolic abnormalities are considered as MS: high blood pressure, high fasting glucose, high triglyceride, low HDL-C and obesity. The genotype of IL-6 rs1800796 SNP was determined by Pre-design TaqMan® assay using TaqMan® probes and Universal PCR Master Mix from Applied Biosystems ( Foster City, CA, USA).
Results: Using different anthropometric criteria (BMI≧90th; WC≧ 90th; BMI/WC≧90th percentile criteria) for obesity, the overall prevalence of MS was 4.1, 4.6 and 4.8 % for boys and was 3.8, 3.8 and 3.9 % for girls. Furthermore, after adjusting for the potential confounders and anthropometric variables, the odds ratio of MS (by BMI, WC, BMI/WC criteria) was 1.06 (95% CI 0.97~1.15), 1.17 (95% CI 1.08~1.28) and 1.14 (95% CI 1.05~1.24) for every increase 1 cm of WC in boys. For girls, the odds ratio of MS (by BMI, WC, BMI/WC criteria) was 1.42 (95% CI 1.17~1.74), 1.33 (95% CI 1.08~1.28) and 1.36 (95% CI 1.05~1.24) for every increase 1 unit of BMI in girls. Among 934 children, the frequency of IL-6 -572 promoter polymorphism CC, CG and GG was 58.0, 36.9 and 5.1% for boys and 63.2, 31.6 and 5.2% for girls. IL-6 -572 G/C polymorphism was associated with blood pressure (BP) and triglyceride (TG) levels among children. Boys with (CC+CG) genotype had higher systolic BP (SBP) and TG than GG genotype (p<0.05). Among them, the CG genotype boys had higher TG level than GG genotype (71.8±33.1 vs. 55.1±22.1 mg/dl, p<0.05). However, for girls, C-allele carriers had higher TG level and more percentage of high glucose level than the G-allele carriers (p<0.05). The odds ratio of high glucose level for C-allele carriers girls was 1.54 (95% CI 1.00~2.33) when compared with G-allele carriers.
Conclusions: The prevalence of MS was significantly increased among children with larger BMI or WC. Furthermore, WC for boys and BMI for girls seemed the more significantly anthropometric variable associated with MS than others. More interestingly, IL-6 -572 G/C polymorphism is associated with blood pressure, TG and glucose levels in children. However, there is possible a gene-gender interaction of IL-6 -572 G/C polymorphism on metabolic syndrome components among Taiwanese children.
表目錄 Ⅲ
附表目錄 Ⅴ
圖目錄 Ⅵ
附錄目錄 Ⅶ
中文摘要 Ⅷ
英文摘要 Ⅹ
第一章緒言 1
第一節 研究背景及重要性 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 代謝症候群定義 4
第二節 代謝症候群流行病學研究 12
第三節 代謝症候群致病機轉 16
第四節 肥胖與代謝症候群及其組成成份相關 22
第五節 介白素-6單核苷酸多形性與代謝症候群及其組成成份相關 23
第六節 研究假設 27
第三章材料與方法 28
第一節 研究設計與研究對象 28
第二節 研究工具 30
第三節 操作型定義 36
第四節 統計分析 38
第四章結果 47
第一節 學童代謝症候群盛行率調查 47
第二節 介白素-6 rs1800796單核苷酸多形性與代謝症候群相關研究 53
第五章討論 56
第一節 學童代謝症候群盛行率比較 56
第二節 介白素-6 rs1800796單核苷酸多形性與代謝症候群相關探討 59
第三節 研究限制 63
第六章結論與建議 64
第七章參考文獻 67
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