| Objective: The occurrence of metabolic syndrome(metabolic syndrome,MetS)is a process of gradual accumulation of various metabolic disorders,which has undergone mutual transfer among multiple states,and its occurrence,development and changes are very complicated.Based on the longitudinal health check-up data for many years,this study uses the multi-state Markov model to describe and analyze the development and change process of MetS,in order to fully understand the characteristics of the development and change process of MetS,explore the initiator components of MetS and the important components that promote its development,and explore the influence of age and gender on the development and change process of MetS,predict the risk of MetS in the target population in the future,and provide a more comprehensive scientific basis for more effective prevention and control of the occurrence and development of MetS.Methods: From January 2010 to December 2017,the subjects who underwent two or more routine health check-up at the physical examination center of a tertiary hospital in Dalian were included in the research,and the longitudinal data of the health check-up cohort were established.MetS was diagnosed according to the Joint Interim Statement(JIS)of the International Diabetes Federation in 2009.Excel 2016 was used to build a database,and SPSS25.0 was used for statistical description and basic statistical analysis of data.MSM package in R3.5.1 software was used to construct a continuous multi-state Markov model with 8 states(healthy state,single blood pressure elevation state,single overweight/obesity state,single hyperglycemia state,single triglycerides(TG)elevation state,single high-density lipoprotein-cholesterol(HDL-C) reduction state and MetS state)to describe and analyze MetS development and change process and its influencing factors.Results: 1.This study finally included 10845 research subjects to constitute a valid analysis data set,of which 4977 were males(45.9%) and 5868 were females(54.1%).The baseline age was between 18-89 years.The number of subjects in healthy state at baseline was 3184(29.40%),the number of subjects in a state of single blood pressure elevation was 696(6.40%),the number of subjects in a state of single overweight/obesity was 466(4.30%),and the number of subjects in a state of single hyperglycemia 653(6.00%),the number of subjects in a state of in a state of single TG elevation was 130(1.20%),the number of subjects in a state of single HDL-C reduction was 984(9.1%),the number of subjects in the 2-abnormal-component state was 2099(19.40%),and the number of subjects in the MetS state was 2633(24.30%).The median follow-up time of the study population was 3.03 years.2.Multi-state Markov model of the research population: Subjects in the healthy state and the MetS state were tend to stay in their original state(transition frequency was 0.638,0.692 respectively),and the average sojourn time of the two states was also longer(1.709 years,2.195 years).Subjects who were in a healthy state were most likely to transfer to the single blood pressure elevation state(transition intensity q=0.199).Among the five single component states,the single overweight/obesity state and the single TG elevation state were easier to progress to the 2-abnormal-component state,and the transition intensity were 0.934 and 0.928,respectively.The intensity of the single overweight/obesity state that progressed to a 2-component abnormal state was 7.315(0.934vs0.131)times the intensity of returned to the healthy state,and the intensity of the single TG elevation state to the 2-abnormal-component state was equivalent to the intensity of its return to the healthy state(0.928vs0.852).The individual stayed in the single TG elevation state had the shortest sojourn time(0.562 years).3.Multi-state Markov model for males and females in the lower age group: Both males and females in the healthy state were prone to transfer to the single blood pressure elevation state(q=0.351,0.197).Among the five single component states,the single overweight/obesity state of males and females was both easier to progress to the 2-abnormal-component state,and the transition intensity was q=1.055 and q=0.798,respectively.Males and females stayed in the single blood pressure elevation state had a shorter sojourn time than in other single component states(0.613 years,0.510 years).4.Multi-state Markov model for males and females in higher age group: Both males and females in the healthy state were prone to transfer to the single blood pressure elevation state(q=0.421,0.236).Among the five single component states,the single overweight/obesity state of males and females was the most likely to progress to the 2-abnormal-component state,and the transition intensity was q=0.749 and 0.839,respectively.The sojourn time of males in the single HDL-C reduction state was shorter than that of other single abnormal-component states(0.748 years),while that of females in the single blood pressure elevation state was the shortest(0.753 years).5.The effect of age and gender on MetS state transition: Compared with women,men were more likely to develop from the healthy state to the single blood pressure elevation state(HR=1.785,95% CI: 1.52 to 2.102)and the single hyperglycemia state(HR=1.370,95%CI:1.131～1.659).The single blood pressure elevation,overweight/obesity,and hyperglycemia state in men were more likely to progress to the 2-abnormal-component state(HR=1.395,95% CI: 1.192-1.631;HR=1.321,95% CI: 1.140～1.532;HR=1.220,95% CI: 1.029～1.445).The 2-abnormal-component state of men were prone to progress to MetS state(HR=1.265,95% CI: 1.171～1.366),while men were not prone to develop from the healthy state to the single HDL-C reduction state(HR=0.638,95% CI: 0.494～0.825)and not prone to return from the 2-abnormalcomponent state to the single HDL-C reduction state(HR=0.325,95% CI: 0.267～0.395).Compared with the lower age group,the higher age group was more likely to develop from the healthy state to the single blood pressure elevation state and the single hyperglycemia state(HR=1.200,95%CI:1.030～1.397;HR=1.365,95%CI: 1.153～1.617),the higher age people were not prone to return from the MetS state to the 2-abnormalcomponent state(HR=0.715,95% CI: 0.652～0.783);The higher age people were less likely to return from the 2-abnormal-component state to the single overweight/obesity state(HR=0.714,95% CI: 0.613～0.833)and the single HDL-C reduction state(HR=0.488,95% CI: 0.421～0.566).Conclusion: 1.People in healthy state were most likely to transfer to the single blood pressure elevation state;Men were more prone to develop further abnormalities than women and as same as the higher age group than the lower age groups.2.Actively prevent and control overweight and obesity,and pay more attention to the occurrence of various metabolic abnormalities in men and older people,which will be helpful to prevent and control the occurrence and development of MetS. |
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