代谢综合征合并糖尿病与心血管疾病关系

Association of comorbidity of metabolic syndrome and diabetes mellitus with cardiovascular disease

目的 了解代谢综合征（MS）合并糖尿病（DM）与心血管病（CVD）的关系,为预防和控制CVD的发病提供参考依据。方法 采用前瞻性研究方法,于1999年4月—2004年6月对在江苏省分层整群抽取的8 685名≥35岁居民进行基线调查,并于2006年3月—2007年10月对基线调查满5年并符合本研究标准的3 887名居民进行随访,分析并比较MS各组分和DM与CVD的关系。结果 随访期间3 887名居民中新发CVD 116例,发病率为2.98%;调整基线调查时年龄、性别及其他CVD危险因素和MS组分后,仅高血压（RR=2.58,95%CI=1.55-4.29）和DM（RR=3.54,95%CI=2.28-4.96）与CVD有联系;正常组、患MS但无DM组、患DM但无MS组和MS合并DM组CVD累计发病率分别为1.53%、4.47%、9.17%和13.30%;调整基线调查时性别、年龄及其他CVD危险因素后,患MS但无DM组、患DM但无MS组和MS合并DM组CVD的发病风险分别为正常组的1.96、4.11和7.10倍;调整性别、年龄和其他危险因素后,MS患者中患DM者相对于未患DM者发生CVD的RR值及其95%CI 为2.23（1.65-3.29）,而DM患者中患MS者相对于未患MS者发生CVD的RR值及其95%CI 为1.36（0.85-2.03）;高血压组基线为DM者和非DM者随访CVD累计发病率分别为16.0%和4.0%;血压正常组基线为DM者和非DM者随访CVD累计发病率分别为7.5%和1.1%;调整基线调查时年龄、性别及其他CVD危险因素和MS组分后,高血压组DM者随访期间患CVD的风险是非DM者的3.31倍,血压正常组DM者随访期间患CVD的风险是非DM者的6.02倍。结论 MS合并DM患者更易患CVD,控制DM可降低MS患者CVD的发病风险。

Objective To investigate the relationship between metabolic syndrome（MS） complicated with diabetes mellitus（DM） and cardiovascular disease（CVD） and to provide reference data for the prevention and control of CVD.Methods By means of prospective study method,a baseline survey was carried out among 8 685 participants aged≥35 years selected with stratified cluster sampling from Jiangsu province from April 1999 to June 2004.During the period from March 2006 to November 2007,a total of 3 887 participants completed the 5 year follow-up.Logistic regression and Cox regression were used in the analyses.Results During the follow-up period,116 subjects developed CVD among 3 887 participants.After adjustments for age,gender,and other CVD risk factors and MS components,only DM and blood pressure were associated with CVD,with the adjusted risk ratio（aRR）（95% confidence interval[95%Cl]） of 3.54（2.28-4.96） and 2.58（1.55-4.29）.The cumulative incidence of CVD was 1.53%,4.47%,9.17%,and 13.30% for the participants without MS or DM,with only MS,with only DM,and with both DM and MS,respectively.After adjusting for sex,age and other risk factors,compared with the healthy,the participants with only MS,with DM,and with both MS and DM had the aRR of 1.96,4.11,and 7.10,respectively.After adjusting for gender,age,and other risk factors,compared to the participants with only MS,the aRR（95%CI） for CVD of the participants with both MS and DM was 2.23（1.65-3.29）,while the aRR（95%CI） of for the DM participants with MS was 1.36（0.85-2.03） compared those without MS.The cumulative incidences of CVD among hypertensive participants with and without DM at the baseline survey were 16.0% and 4.0%,and those of normtensive participants were 7.5% and 1.1%.After adjustment for baseline age,gender,other CVD risk factors,and components of MS,the hypertensive participants with DM had a 3.31 times higher risk of CVD than those without DM and the normtensive participants with DM had a 6.02 times risk of CVD than those without DM.Conclusion MS patients with DM have higher risk for CVD and the control of DM can reduce the incidence of CVD among MS patients.