代谢综合征各组分在新诊断2型糖尿病患者心血管风险中的作用

Different impacts of the components of metabolic syndrome on cardiovascular risk in newly-diag-nosed type 2 diabetes mellitus

【摘要】目的探讨代谢综合征（MS）各组分对既往无冠心病（CHD）病史的新诊断2型糖尿病（T2DM）患者心血管疾病（CVD）危险因子及Framingham风险评分（FRV）的影响。方法共纳入212例患者，将MS除血糖外的各个组分进行三分位分组，比较CVD常见危险因子，如吸烟、BMI、血压、血脂异常、糖化血红蛋白（HbAlC）、简易稳态模型法计算的胰岛素抵抗指数（HOMA—IR）水平以及FRV高危、中危组发生率的区别，并通过Logistic回归分析观察MS各个组分对CVD风险的影响。结果随BMI、TG、平均动脉压（MAP）三分位水平增加，CVD各危险因子均呈增加趋势，FRV高危及中危组比例也呈增加趋势；而HDL—C三分位分组变化与此相反。二元Logistic回归分析显示MS各组分：BMI、收缩压、舒张压、HbAlc、TG均是FRV非低危组（中危或高危）的危险因素，其OR值分别为2．794（95％CI：2．390—2．408）、2．601（95％CI：1．974—3．701）、1．476（95％CI：1．231—2．048）、2．964（95％CI：1．925—3．282）、1．464（95％CI：0．934—2．294）；HDL—C为保护性因素，其OR值为0．732（95％CI：0．023—0．962）。Logistic逐步回归分析显示收缩压、BMI、HbAlC、HDL—C进入回归方程，偏回归系数分别为0．784、1．213、1．679、-0．854（均P〈0．05或P〈0．01）。结论新诊断的T2DM患者MS各组分均与CVD风险相关，但对CYD危险因子的区分度有所区别，对CVD风险的影响也不同。

[ Abstract] Objective To investigate the different impacts of the components of metabolic syn- drome （MS） on cardiovascular disease （CVD） risk factors and Framingham risk value （FRV） in newly-di- agnosed type 2 diabetes mellitus （T2DM） patients without coronary heart disease （CHD）. Methods A to- tal of 212 newly-diagnosed T2DM patients was divided into three groups based on the components of MS,in- cluding body mass index （BMI）, triglyceride （TG） , high density lipoproteins cholesterol （HDL-C）, and mean arterial pressure （MAP） tertile, respectively. The general CVD risk factors [ smoking, BMI, TG, HDL-C, total cholesterol （ TC）, low density lipoproteins cholesterol （ LDL-C）, HbA1 C, homeostasis model assessment of insulin resistance （HOMA-1R）, and FRV] were compared among the groups. Logistic re- gression analysis was used to observe the different impact of MS components on CVD risk. Results With the increasing of BMI, TG and MAP tertiles, all the CVD risk factors and the ratio of FRV middle-risk group or high-risk group had the tendency of augmentation. With the increasing of HDL-C tertiles, all the CVD risk factors and the ratio of FRV middle-risk group or high-risk group was in downtrend. Binary logistic regression analysis indicted that BMI, systolic pressure, diastolic pressure, HbAI c and TG were risk factors of FRV non-low-risk group （middle-risk and high-risk groups）, HDL-C was the protective factor. The odds ratios （ORs） of BMI, systolic pressure, diastolic pressure, HbAlc ,TG and HDL-C were 2. 794 （95% C1 ：2. 390 - 2. 408 ）, 2. 601 （95 % CI ： 1. 974 - 3.701 ）, 1. 476 （95 % CI ： 1.231 - 2. 048 ）, 2. 964 （95 % CI ：1. 925 -3. 282） ,1. 464（95% CI ：0. 934 -2. 294）, and 0. 732（95% CI ：0. 023 -0. 962）, respectively.Logistic stepwise regression analysis indicated that systolic pressure, BMI, HbA1 C, and HDL-C were en- tered into the regression equation, and the partial regression coefficient was 0. 784, 1. 213, 1. 679, and - 0. 854, respectively （ P 〈 0. 05 or P 〈 0. 01 ）. Conclusions All the components of MS in newly-diag- nosed T2DM were correlated with CVD risk factors. However, they should be weighed differently.