不同性别血运重建患者合并代谢综合征的住院和随访研究

Prognosis of metabolic syndrome in coronary artery disease patients of different genders

目的分析不同性别血运重建患者中合并代谢综合征的临床特征和预后。方法单中心注册研究(DESIRE),入选2001年7月1日至2004年6月30日在我院接受血管重建治疗,支架术或冠脉旁路移植术的所有患者,记录其临床资料,并进行门诊和电话随访,记录随访期间临床不良事件,患者死亡为随访终止,记录死亡时间。结果相应临床资料记录完整的患者2596例,其中符合我国代谢综合征患者女性(299例)明显高于男性(840例)(50.9%比41.8%,P<0.0001),随访时间为829±373 d(15～1691 d),随访成功80.8%。在女性患者中合并代谢综合征患者的心脑血管事件和死亡率增加(分别为女:12.1%,6.9%,男:10.6%,5.1%,),P=0.012]。应用 Logistic 回归分析,在校正了年龄、白细胞和肌酐水平后发现,合并代谢综合征是女性冠心病患者预后不良的惟一预测因子(OR 2.019,95%CI 1.751～2.506,P=0.023),而高血糖是合并代谢综合征患者预后不良的最重要危险因子(OR2.511,95%CI1.396～4.511,P=0.002)。结论在血运重建患者中,女性合并代谢综合征的比例明显高于男性,女性患者合并代谢综合征的预后不良,代谢综合征各成分中高血糖与不良预后直接相关。

Objective To analyze the prevalence and characteristics of metabolic syndrome （MS） in the patients with coronary artery disease （CAD） of different genders who underwent revascularization. Methods The clinical data of 2596 patients in the DESIRE （Drug-eluting Stent Impact on Revascularization） study who underwent percutaneous coronary intervention （PCI） or coronary artery bypass grafting （CABG） were analyzed and the patients were followed up till death. MS was diagnosed based on the Chinese standard （ modified ATP Ⅲ）. Results The mean follow-up time was 828.8 ：t： 373.2 days. 1139 of the 2596 patients were diagnosed as with MS. The prevalence of MS in the female patients was 50.9%, significantly higher than that in the male patients （41.8% ,P 〈0.0001 ）. Complication of MS was the only predictive factor of poor prognosis in female CAD patients （ OR = 2. 019, 95% CI = 1. 751-2. 506, P = 0.023）. Fasting blood glucose ≥ 110 mg/dl was responsible for most of the increased risk associated with MS （adjusted OR 2.511,95%CI 1.396 -4.511, P=0.002）. Conclusion In comparison with the male patients the female patients undergoing revascularization have a higher he prevalence of MS and worse prognosis. In the4 elements of MS hyperglycemia is directly associated with prognosis.