中国11省市代谢综合征不同组分及其组合形式与心血管病发病的关系

Incidence risk of cardiovascular diseases associated with specific combinations regarding the metabolic syndrome components

目的 研究代谢综合征（MS）不同组分及其组合形式与心血管病（CVD）发病危险的关系。方法 “中国多省市心血管病前瞻性队列研究”在11省市共入选35～64岁男女两性30378人，1992—2004年随访期间共发生急性CVD事件809例。采用《中国成人血脂异常防治指南》中定义的MS新标准分析MS的分布特征和MS各组分不同组合与CVD发病的关系。结果 （1）根据新标准，中国人群MS患病率为11．8％，男女分别为12、4％和9．0％，男性高于女性（P〈0．001）。（2）调整其他危险因素后，CVD危险随MS组分个数的增加而增加。仅有1个组分时，只有血压升高显著增加CVD危险；有2个组分时，10种组合中的5种显著增加CvD危险；≥3个组分（即MS）存在时共有16种组合，除4种罕见组合外，其他12种均显著增加CVD危险，其中危险最高的前7位均具有“腹部肥胖＋血压升高”的特征。结论 MS各组分的不同组合形式所具有的CvD发病危险有很大差异，≥3组分，特别是包含腹部肥胖和血压升高者，可以较好地检出CVD危险较高的个体。

Objective To investigate the risk of cardiovascular diseases （CVD） incidence related to different combinations of the metabolic syndrome（MS）components. Methods A total of 30 378 subjects aged 35 to 64 years were recruited from 11 provinces in a Chinese Multi-provincial Cohort Study and followed-up for new CVD from 1992 to 2004. MS was defined under the new criteria ＇Preventive Guideline of Dyslipidemia for Chinese Adults＇ , issued in 2007. CVD incidence rates and relative risks （ RR ） were estimated by different MS components and by their various combinations. Results （ 1 ） According to the new criteria, the prevalence of MS was 11.8 % for Chinese middle-age adults. The prevalence was 12.4 % in men,significantly higher than that in women （9.0 % ）. （2） Risk of CVD increased in proportion to the number of MS components after adjusting for other risk factors. If only 1 component was present, elevated blood pressure was the only significant predictor of CVD. When 2 components were present, 5 of the 10 combinations were associated with significantly higher risk. All combinations with ≥3 components（MS） had significant contribution except for those rare traits （〈0.5% of the whole sample）. Among the 16 combinations of ≥3 components,the feature of ＂central obesity and elevated blood pressure＂ was found in all the 7 combinations with the highest risk. Conclusion CVD risk associated with various number and combinations of MS components seemed to be heterogeneous. The clustering of ≥3 disorders, especially those with central obesity and elevated blood pressure could significantly predict the future development of CVD.