代谢综合征颈动脉斑块相关因素分析

Risk factors of carotid atherosclerosis in patients with metabolic syndrome

目的研究代谢综合征(MS)患者颈动脉斑块的危险因素及不同程度颈动脉斑块的相关因素。方法将上海复旦大学附属华山医院老年病科2005年1月至2007年1月收治患者按2005年国际糖尿病联盟的MS诊断标准分为MS组219例,非代谢综合征(NMS)组182例。测定血压、血脂、血糖、胰岛素、C-反应蛋白、尿蛋白等指标,计算胰岛素敏感指数,询问用药史。B超测定双侧颈动脉观察指标,半定量估计斑块的范围及严重程度,分为4级。结果与NMS组患者比较,MS组颈动脉斑块的发生率更高,颈动脉斑块的程度更严重(P<0.05),MS者发生颈动脉斑块的危险性是NMS者的2.01～4.12倍。餐后2h血糖、脂蛋白a、胰岛素敏感指数、胰岛素抵抗指数、体重指数、C-反应蛋白等检验指标与颈动脉斑块严重程度相关;颈动脉斑块程度越重,TC/HDL比值越高(F=5.89,P=0.003)。尿蛋白、尿肌酐、尿蛋白肌酐比值在各组间差异也有统计学意义。结论MS是颈动脉斑块的危险因素,抗血小板及降脂药物者可能有助于减少颈动脉斑块的发生,减缓颈动脉斑块的发展。TC/HDL比值的临床意义有待进一步研究。

Objective Studying risk factors of carotid atheroselerosis in metabolic syndrome（MS） , and the relative factors with progression of carotid atherosclerosis. Methods A total of 401 elders were included in the present study. MS was defined by the criteria of IDF（219 MS, 182 NMS）. All subjects were required to have blood pressure monitored. Venous blood was collected after an overnight fast. Total serum cholesterol, triglycerides, high-density lipoprotein cholesterol （HDL） ,low-density lipoprotein cholesterol （LDL） , apolipoprotein B, lipoprotein a, high-sensitive C-reactive protein, and fasting glucose and insulin were tested; insulin sensitivity index and insulin resistant index were estimated. Uria sample was also collected to test mieroalbumiuria,creatine and Alb/Cr. Carotid atherosclerosis was determined by B-mode ultra- sound,and number and diameter of plaques,if present,were measured to obtain an atherosclerosis score. Results The occurrence of carotid atherosclerosis was significantly higher in MS（ P 〈 0. 05 ）. MS had more severe carotid atheroselerosis than NMS（OR 2. 01 -4. 12）. Significant differences between subjects with MS and NMS were found for the components of the MS,as well as for other risk factors ： systolic and diastolic blood pressure, BMI, postprandial glucose,postprandial insulin ,HOMA-IR ,HDL, Lpa, Alb/Cr and C-reactive protein ,which also correlated with severity of progression of ca- rotid atheroselerosis. TC/HDL ratio ~ as higher ill MS than in NMS, and was significantly different（ F = 5.89, P = 0. 003） among different progression of carotid atherosclerosis. Conclusion MS is a risk factor of carotid atherosclerosis;taking antiplatelet drugs or antilipid drugs may help to decrease the progression of carotid atherosclerosis in MS. The clinical value of TC/HDL needs further study.