血清N末端B型利钠肽原与代谢综合征关系的横断面研究

Relationship between serum N-terminal pro-brain natriuretic peptide and metabolic syndrome： a cross-sectional study

目的分析血清N末端B型利钠肽原（NT—proBNP）与代谢综合征（MS）之间的关系。方法北京社区居民1323名纳入了本研究，其中男性559名，女性764名。MS依据中国成人血脂异常防治指南对2004年中华医学会糖尿病学分会建议的修订定义，439例诊断为MS。以多因素logistic回归分析计算MS发病危险比值比（OR），多元线性回归分析NT-proBNP与各指标间的相关关系。结果校正性别、年龄后，MS组NT-proBNP水平低于非MS组[32．51（29．17，36．14）ng／L比38．55（35．73，41．50）ng／L，P=0．012]；随着MS成分由0增加至4或5个，NT—proBNP水平呈线性下降趋势，分别为45．92、37．24、35．40、31．55和33．65ng／L（线性趋势P=0．043）。MS5个组分中，表现为腹部肥胖、较高血糖和高甘油三酯（TG）血症者，其NT．proBNP水平相应较低。校正年龄、性别、肌酐、肾小球滤过率估测值（eGFR）、低密度脂蛋白胆固醇（LDL—C）、尿酸、高敏c反应蛋白（hs-CRP）、吸烟、饮酒、运动等因素后，多元logistic回归分析显示，与NT—proBNP最低四分位水平相比，NT—proBNP的二、三、四分位水平MS发生风险OR值分别为0．782（95％CI：0．544～1．122，P〉0．05）、0．709（95％CI：0．489～1．028，P〉0．05）和0．604（95％CI：0．405～0．900，P〈0．05）。多元线性回归分析显示，NT-proBNP与女性（β=0．248，P〈0．001）、年龄（β=0．167，P〈0．001）、收缩压（β=0．154，P〈0．001）呈独立正相关，与腰围（β=-0．082，P=0．004）、舒张压（β=-0．085，P=0．015）、TG（β=-0．101，P〈0．001）、总胆固醇（β=-0．078，P：0．004）、eGFR（β=-0．150，P〈0．001）呈独立负相关。结论较高的NT—proBNP水平与MS发生风险降低相关，腹型肥胖可能是重要原因。

Objective To explore the relationship between serum N-terminal pro-brain natriuretic peptide （NT-proBNP） and metabolic syndrome （MS）. Methods A total of 1323 Beijing residents （559 male） were investigated. MS was defined by the modified 2004 Chinese Diabetes Society criteria and 439 cases were diagnosed as MS according to this criteria . Muhivariate logistic regression analysis was used to estimate the odds ratios （OR） of MS. Multiple linear regression analysis was performed to analyze the association between NT-proBNP and characteristic variables. Results NT-proBNP was significantly lower in MS group compared to non-MS group [ 32. 51 （29.17,36. 14） ng/L vs. 38.55 （35.73,41.50） ng/L, P = O. 012 ] after adjusted for age and gender. NT-proBNP level decreased with the presence of MS components （ from 0 to 4 or 5 ） （45.92,37.24,35.40,31.55 and 33.65 ng/L respectively, P = 0. 043 for linear trend）. Among the components, groups with larger waist circumference, higher fasting glucose and triglycerides were associated with lower NT-proBNP level. After adjustment for potential confounders, compared with the lowest NT-proBNP quartile, the adjusted odds ratio of the second, third and fourth quartile for having MS were O. 782 （95 % CI： 0. 544 - 1. 122, P 〉 0.05 ）, 0. 709 （ 95 % CI： O. 489 - 1. 028, P 〉 0. 05 ）, 0. 604 （ 95 % CI： O. 405 - O. 900, P 〈 0. 05 ） , respectively. Multiple linear regression analysis showed that female gender （ β= 0.248,P〈0.001）,age（β=0.167,P〈0.001）, systolic blood pressure （β =0.154,P〈0.001） were positively related to NT-proBNP level while waist circumference （ β = - 0. 082, P = 0. 004 ）, diastolic blood pressure （ β = - O. 085, P = 0. 015 ）, triglycerides （ β= - 0. 101, P 〈 O. 001 ）, total cholesterol （ β = -0.078,P = 0.004）, eGFR （β = -0.150, P 〈 0.001） were negatively corelated to NT-proBNP level. Conclusion In this cohort, higher serum NT-proBNP concentration is associated with lower incidence of metabolic syndrome.