不同组分构成的代谢综合征与中国成人脑卒中的关联性

Association of stroke and different combinations of metabolic syndrome components in Chinese adults

目的 分析中国成人代谢综合征及不同组分与脑卒中发病的关系。方法 资料来自2002年中国居民健康与营养状况调查，20～75岁成人47414人，代谢综合征的诊断采用2005年国际糖尿病联盟的定义。结果 （1）血压和腰围是与脑卒中发病最重要的相关因素。随着危险因素的聚集，脑卒中发病的风险增加，本组脑卒中388例。Logistic回归分析发现与无任何危险因素的人群相比，调整了年龄、性别、吸烟、低密度脂蛋白胆固醇（LDL-C）水平后，携带1、2．3及4个以上危险因素的个体患脑卒中的OR值（95％CI）分别为3．01（1．89～4．81），4．37（2．72～7．01），9．20（5．75～14．73），13．09（7．98～21．49）。（2）在各种不同组分的组合中，同时存在血压增高、高血糖、低高密度脂蛋白胆固醇（HDL．C）和中心型肥胖的人群，脑卒中患病风险最大，OR=16．58（95％CI 8．78～31.32），代谢综合征组总的OR=10．79（95％CI6．81～17．10）。甘油三酯（TG）升高非卒中发病的独立危险因素。（3）不同年龄段脑卒中的发病与代谢危险因素聚集的关系不同，35岁以下人群脑卒中的发病与血糖、血压、血脂、肥胖等危险因素无关，35～55岁人群舒张压、HDL-C降低对发病最为有关，55岁以上人群收缩压、腰围最为有关。结论以肥胖为中心的代谢综合征是脑卒中发病的重要危险因素。不同组分构成的代谢综合征在卒中发病中的危险度不同。中年以上的脑卒中与代谢危险因素的聚集相关。

Objective To analyze the association of stroke and metabolic syndrome as well as its component combinations in Chinese adults. Methods Logistic regression was used to analyze the data, including anthropometric measurement, fasting plasma glucose （FPG）, blood lipids, and histories of smoking, drinking, and ananmesis, of 47 414 subjects, 22 305 males and 2 5105 females, aged 20 -75, obtained from Chinese National Health and Nutrition Survey in 2002. Results （ 1 ） Blood pressure and waist circumference were the most important factors associated with stroke. Along with the clustering of the risk factors, the subjects became more liable to suffer from stroke. Logistic regression showed that after adjustment for age, sex, smoking status, and LDL-C level, the odd ratio （OR） values of the individuals with one, two, three, and four or more factors were 3.01 （ 1.89 - 4. 81 ）, 4. 37 （ 2.72 - 7.01 ）, 9.20 （ 5.75 - 14.73 ）, and 13.09 （7.98 - 21.49 ） respectively. （2） The combinations of raised hypertension plus hyperglycemia and low LDL-C and central obesity were the most hazard groups, with the OR values of 16.58 （95 % CI 8.78 - 31.32 ） for stroke. The OR value for the full metabolic syndrome was 10.79 （ 95 % CI 6.81 - 17.10）. Hypertriglyceridemia was not an independent risk factor of stroke. （3） The relationships of metabolic risk factors and stroke were various among different age groups. Stroke was not related with blood glucose, blood pressure, serum lipids, and obesity in the subjects under 35 ; in those aged 35 -55, diastolic Bp and low HDL-C were most significantly related to stroke; as for those above 55, systolic Bp and waist circumference were most significantly related to stroke. Conclusion Central obesity cored metabolic syndrome is an important risk factor of stroke. Different combinations of the components attribute variously to stroke. In people above middle age, stroke is related to metabolic risk factors.