代谢综合征患者血脂异常类型与颈动脉粥样硬化的关系

The relationship between dyslipidemia and carotid artery atherosclerosis in patients with metabolic syndrome

目的研究代谢综合征(MS)患者不同类型血脂异常对颈动脉粥样硬化(AS)的影响。方法将918例AS患者分为3组:正常胆固醇(N-TC)组(502例)、单纯高胆固醇(HC)组(190例)和混合性HC(M-HC)组(226例);N-TC组再分为4个亚组:TG与HDL-C均正常组(112例)、高TG(H-TG)组(61例)、低HDL-C(L-HDL-C)组(186例)、高TG与低HDL-C混合(H-TG+L-HDL-C)组(143例),分析各血脂异常组对颈动脉损害的影响。结果HC组与M-HC组的颈动脉内膜中层厚度(IMT)、斑块数目均显著高于N-TC组(P<0.05);M-HC组斑块发生率(65.9%)显著高于N-TC组(44.5%)和HC组(56.0%)(P<0.01)。N-TC的4个亚组中,IMT、斑块数目、斑块发生率在各组间差异无统计学意义(P>0.05);多元逐步回归分析表明:年龄和DBP与IMT最相关,年龄与斑块数目最相关。结论MS合并HC对颈AS的影响显著高于高TG或低HDL-C血症;N-TC的MS患者,年龄和DBP对颈AS具有显著影响。

Objective To study the relationship between dyslipidemia and carotid artery atherosclerosis in patients with metabolic syndrome（MS）. Methods 918 patients with MS were divided into three groups： normal total cholesterol（n= 502, N-TC）, isolated hypercholesterolemia （HC） （ n = 190） and mixed HC（n=226, M-HC）. The N-TC group was divided into four subgroups： normal triglyceride（N-TG） plus normal high density lipoprotein（N-HDL） （n= 112）, high TG（n= 61 patients）, low HDL-C （n= 186）, mixed group（n=143）. Serum lipid profile and ultrasonography for carotid artery were examined. Results Both carotid intima-media thickness （IMT） and number of plaque were higher in isolated and combined HC groups than in normal cholesterol group（P〈0.05）. The incidence rate of carotid plaque was higher in combined HC（65.9%）than in N-TC （44.5%） and isolated HC groups（56.0%） （P〈0.01）. IMT,number of plaque and incidence rate of carotid plaque were in no statistic difference among four subgroups of MS with normal cholesterol level（P〉0.05）. Stepwise regression analysis indicated that age and DBP were related to IMT while age was related to the number of plaque. Conclusions MS combining HC has much more significant influence on carotid artery atherosclerosis than high TG and low HDL-C. The age and DBP have significant influence on carotid artery atherosclerosis of MS with normal cholesterol.