伴高血糖的代谢综合征致脑卒中风险

Impact of metabolic syndrome with hyperglycemia on prevalence of stroke in Chinese

目的探讨糖尿病、伴或不伴高血糖的代谢综合征（MS）对脑卒中发生的影响。方法选取2002年中国居民营养与健康状况调查人群中25～75岁共44100人，进行问卷调查、人体测量及血糖、血脂等指标测定。单因素及多因素分析探讨糖尿病组、正常血糖MS组、轻度高血糖MS组及糖尿病合并MS组，与对照组比较，脑卒中患病率的差异。结果各年龄组MS患病率均随年龄增高而升高，同一个年龄段的空腹血糖（FPG）≥5．6mmol／L组MS患病率显著高于FPG〈5．6mmol／L组（各年龄组：25～34岁，35～44岁，45～54岁及≥55岁4组分别为23．5％比2．2％，37．2％比4．O％，45．0％比7．O％，53．0％比9．5％，P〈0．01）。对照组、糖尿病组、正常血糖MS组、轻度高血糖MS组及糖尿病合并MS组脑卒中的患病率分别为0．19％、2．94％、2．27％、2．89％和4．11％。调整年龄、性别、吸烟及LDL—C因素影响后，糖尿病组及MS各组脑卒中危险的OR值分别为6．75、7．52、7．11和8．75，但糖尿病组及MS各组相邻两组间比较差异无统计学意义（P〉0．05）。糖尿病合并MS组与正常血糖MS组比较，脑卒中危险OR值为1．84（P〈0．01）。结论（1）有糖代谢异常人群MS患病率远高于血糖正常人群。（2）合并糖代谢异常的MS对脑卒中的发生起非常重要作用。（3）糖尿病单因素对脑卒中的影响也不容忽视。

Objective To investigate the impact of metabolic syndrome （MS） with or without hyperglycemia on stroke prevalence compared to that of diabetes alone. Methods 44 100 subjects, 20 570 males and 23 530 females, aged 25 - 75, who had participated in the Chinese Residents Nutrition and Health Examination Survey held in the mainland of China 2002, underwent anthropometry, measurement of total cholesterol （TC）, triglyceride （TG）, high density lipoprotein cholesterol （HDL-C）, high density lipoprotein cholesterol （LDL-C）, fasting plasma glucose （FPG）, and 2 hour plasma glucose （2 h PG） after 75 g oral glucose tolerance test （OGTY）. 22 570 subjects, 10 698 males and 11 872 females, were divided into 5 groups ： control group without MS risk factors （ n = 17 518 ）, Group of diabetes mellitus （DM） without MS （ n = 638 ）, group of MS with normoglycemia （ n = 2501 ）, Group of MS with mild hyperglycemia （ n = 1058 ）, and group MS with DM （ n = 855 ）. The relationship between MS and stroke was studied by multiple logistic regression analysis. Results The prevalence of MS increased along with age. The MS prevalence rates of the subjects with FPG≥ 5.6 mmol/L in the age groups 25 -34, 35 -44, 45 -54, and 〉155 were 23.5%, 37.2% , 45.7% , and 53.0% respectively, all significantly higher than those of the subjects with the FPG 〈5.6 mmol/L （2.2%, 4.7%, 7.8%, and 9.5% respectively, all P 〈 0.01 ）. The prevalence rates of stroke of the groups of DM, normal blood sugar with MS, mild hyperglycemia with MS, and DM with MS were 2.94%, 2.27%, 2. 89%, and 4. 11%, respectively, all significantly higher than that of the control group （0. 19 % , all P 〈 0. 01 ）. After adjustment for age, sex, smoking status, and LDL-C, no significant difference was observed between the neighboring MS groups （ all P 〉 0.05 ）. Compared to the group of MS with normoglycemia, the OR value for stroke of the DM with MS was 1.84 （95% CI 1.20 - 2.83, P 〈 0.01 ）, which was still significant after adjusting for LDL-C （ P 〈 0.05 ）. Conclusion （ 1 ） People with gloucose intolerance had very high prevalence of stroke than novmoglgcemic people. （2） Hyperglycemia in MS has an extremely important role in the impact of MS on stroke in Chinese. （3） Diabetes by itself has the same significance as the combination of MS components in the development of stroke.