代谢综合征及其干预治疗临床意义的初步研究

Preliminary study of the clinical significance of metabolic syndrome and its interventional treatment

目的探讨心血管疾病(CVD)与代谢综合征(MS)及其各组分的相关性;并收集未并发CVD的 MS患者进行干预治疗,探讨其对CVD事件的作用.方法收集未并发CVD的 MS患者,分多因子干预组(MFI)97例及加用二甲双胍组(Met组)105例,前组按其代谢异常作相应的药物治疗,后组加用二甲双胍1.5～2.0 g/d,平均随访4.6年,以冠心病、脑卒中、颈或股动脉内膜中层厚度(IMT)作为心血管事件,评价两种治疗方法的疗效.结果①Logistic回归分析显示,CVD的风险因子中MS的危险性高于胰岛素抵抗指数(HOMA-IR),尿白蛋白排泄率(UAER)高于其他单一危险因子.② MFI 组<3年、>3年的CVD事件发生率分别为5.1%和16.5%,明显高于Met组的3.8%和10.5%(P<0.05).结论 MS是CVD的主要风险因子,并与其各组分异常成正相关.药物干预有不同程度的疗效,但加用二甲双胍可显示较好的效果,可能由于二甲双胍兼有涵盖MS多重代谢异常的改善,早用及长期使用对保护靶器官可望取得更好的效果.

Objective To investigate the correlation of cardiovascular disease （CVD） with metabolic syndrome （MS） and together of the components in MS patients complicated with CVD and to investigate the effects of interventional therapy on the prevalence of CVD events in vice verga. Methods ①144 MS patients complicated with CVD were analyzed by multiple logistic regression analysis to assess the association of CVD with MS and it scomponents. ② MS patients without CVD were divided into multifactorial interventional treatment group and metformin group, the former group was treated according to the changes of metabolic abnormalities, the patients in the latter group were taken Glucophage 1.5-2.0 g/d in addition. All of them were followed up for an average of 4.6 years. The different effects of intervention on the prevalence of CVD events were assessed. Results ①Multiple variables analysis showed that the risk factors of CVD were MS〉 HOMA-IR and UAER〉single risk factor. ②The prevalence of CVD events in multifactorial interventional treatment group was higher than that in metformin group. The ratios of CVD events were 5.1% vs 3.8% three years ago, and 16.5% vs 10.5% three years later. Conclusions MS is the main risk factor in CVD events, showing positive correlation with the number of the metabolic abnormalities. Drug interventions were efficacious in different degrees, but showed better results after additon of metformin, probably due to improvement of the metabolic abnormalities at mutliple levels and achievement in protecting target organs through early and long term application. （Shanghai Med J, 2005,28：565-568）.