社区中老年人群代谢综合征与颈动脉粥样硬化的关系

A community-based study on relations between metabolic syndrome and carotid atherosclerosis in a middle-aged population

目的探讨代谢综合征（MS）与颈动脉粥样硬化的关系，初步了解不同诊断标准的预测效果。方法于2008年对北京市两组中老年社区人群进行横断面调查，纳入分析者共1266人（男性598人，女性668人），年龄45。69岁。分别采用国际糖尿病联盟（IDF）、美国国家胆固醇教育计划成年人治疗组报告Ⅲ修订版（ATPⅢ修订版）和2007年公布的中国成人血脂异常防治指南（“指南”）标准诊断MS。结果IDF、ATPⅢ修订版和“指南”定义的MS患病率分别为39．0％、43．3％和30．9％。三种标准两两之间一致性测量Kappa系数分别为0．911、0．719和0．730。调整了年龄、性别、LDL—C、吸烟、饮酒后，三种定义的MS组CCA—IMT均显著高于非MS组（P〈0．001）。调整上述变量后，三种定义的MS均显著增加颈动脉内中膜斑块检出的危险性，OR值分别为1．499（95％CI：1．157～1．942）、1．696（95％CI：1．314～2．189）、1．763（95％CI：1．344～2．312）。结论三种标准定义的MS在吸烟、LDL-C等传统心血管病危险因素以外仍对颈动脉粥样硬化有独立预测作用，不同标准定义的MS与斑块检出风险关联强度可能存在性别差异。

Objective To explore the association between metabolic syndromes （MS） and carotid atherosclerosis and to estimate the predictive effects of MS under 3 different definitions. Methods A cross-sectional study was conducted in 2 community-based populations in Beijing, in 2008. 1266 subjects （598 men, 668 women）, aged 45-69, were included in the analyses. MS was defined by the criteria of International Diabetes Federation （IDF）, the revised NCEP ATP III （ATP III -R） and ＂The Guidelines of Dyslipidemia Control for Chinese Adult＂ （＂Guidelines＂） in 2007. Results The prevalence rates of MS by the 3 criteria were 39.0%, 43.3% and 30.9% respectively. The Kappa value for the measure of the agreement between each pair of the 3 definitions were 0.911, 0.719 and 0.730 respectively. The intima-media thickness in common carotid artery （CCA-IMT） was significantly higher （P〈0.001） in all MS groups than in non-MS groups, diagnosed with the 3 criteria independent of age, gender, LDL-C, and current smoking status. After adjustment of age,gender, LDL-C, and current smoking status, the classification of MS significantly increased the risk of prevalence of carotid atherosclerotic plaques, compared to the non-MS group. OR value were 1.499 （95% CI： 1.157-1.942） for IDF, 1.696 （95% CI： 1.314-2.189） for NCEP-R, 1.763 （95% CI： 1.344-2.312）for ＂Guideline＂ respectively. Conclusion Our research findings indicated that, when MS were defined with the 3 definitions, prediction on the risk of sub-clinical atherosclerosis would work beyond some of the conventional cardiovascular risk factors such as smoking, LDL-C. There might exist some differences in gender issue on the strength of association between MS when diagnosed by different criteria and carotid plaque.