中老年人群代谢综合征与颈动脉斑块的关联性及其性别差异研究

Correlation between Metabolic Syndrome and Carotid Plaque of Middle- aged and Aged People and Its Gender Differences

目的探讨中老年人群代谢综合征(MS)与颈动脉斑块的关联性及其性别差异。方法在2011年6月—2013年12月某企业首次参加体检且年龄≥45岁的职工中,按每5岁一个年龄段分层,在各层中按比例随机抽取中老年人2 180例。最终选取符合纳入排除标准的中老年人1 770例,其中男813例,女957例(包括已绝经者673例、未绝经者284例)。采用颈动脉超声检查颈动脉有无斑块。MS诊断采用2009年国际统一标准(其中腹型肥胖采用亚洲人标准)。结果 1 770例中老年人中,MS患病率为40.3%(714/1 770),颈动脉斑块检出率为25.9%(459/1 770)。有无MS中老年男性、女性及总人群颈动脉斑块检出率间差异均有统计学意义(P<0.05)。随着MS组分数目的增加,中老年男性、女性及总人群的颈动脉斑块检出率均呈现增加趋势(P<0.001)。调整年龄、BMI、吸烟指数、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)和血尿酸(SUA)后,中老年男性〔OR(95%CI)=1.53(1.04,2.23),P=0.030〕和绝经后女性MS患者〔OR(95%CI)=1.60(1.08,2.38),P=0.020〕颈动脉斑块的检出风险增加。在中老年男性中,调整年龄、BMI、吸烟指数、LDL-C、TC、SUA后对颈动脉斑块检出影响较大的组分为血压升高〔OR(95%CI)=1.65(1.14,2.37),P=0.008〕和血糖升高〔OR(95%CI)=1.93(1.36,2.75),P<0.001〕;在中老年女性中,调整年龄、BMI、吸烟指数、LDL-C、TC、SUA和是否绝经后对颈动脉斑块检出影响较大的组分为血压升高〔OR(95%CI)=1.82(1.25,2.65),P=0.002〕。结论 MS是中老年男性和绝经后女性颈动脉斑块检出的独立危险因素;对不同性别中老年人颈动脉斑块检出产生主要影响的MS组分不同。

Objective To investigate correlation between metabolic syndrome and carotid plaque of middle - aged and aged people and its gender differences. Methods Staffs （aged ≥ 45 ） who participated in the physical examination for the first time in a company from June 2011 to December 2013 were stratified according to age groups of every 5 years, and 2 180 middle - aged and aged people were selected in proportion from each age group. According to inclusion and exclusion criteria, 1 770 middle -aged and aged people were finally selected, 813 were male and 957 were female （including 673 postmenopausal cases, 284 non - menopause cases） . Carotid ultrasound was used to check whether there was plaque in carotid artery. The international unified standard in 2009 was applied by MS diagnosis （which abdominal obesity using Asian standards） . Results Among 1 770 middle- aged and aged people, prevalence rate of MS was 40. 3% （714/1 770） , detection rate of carotid artery plaque was 25.9% （459/1 770） . There was significant difference in the detection rate of carotid artery plaque among middle - aged and aged males and females and the total population with or without MS （ P 〈 0.05 ） . With the increasing number of components in MS, the detection rate of carotid artery plaque in middle - aged and aged men and women as well as the total population showed an increasing trend （ P 〈 0. 001 ） . After adjustment of age, BMI, smoking index, low - density lipoprotein cholesterol （ LDL - C）, total cholesterol （ TC ） and serum uric acid （ SUA）, the detection risk of carotid artery plaque of middle - aged and aged men [OR （95%CI） =1.53 （1.04, 2. 23）, P=0.030） andpostmenopausalfemales [OR （95%CI） =1.60 （1.08, 2. 38）, P =0. 020） increased. Among middle - aged and aged men, blood pressure elevation [ OR （95% CI） = 1.65 （ 1.14, 2.37）, P=0.008] and blood glucose rising [OR （95%CI） =1.93 （1.36, 2.75）, P〈0.001） were the components that had great influence on detecting carotid artery plaque after adjustment of age, BMI, smoking index, LDL - C, TC and SUA ; among middle - aged and aged women, after adjusting age, BMI, smoking index, LDL - C, TC and SUA and menopause or not, the component that had great effect on detecting carotid artery plaque was blood pressure elevation [ OR （95% CI） = 1.82 （ 1.25, 2. 65 ） , P = 0. 002） . Conclusion MS is an independent risk factor of detecting carotid artery plaque in middle - aged and aged men and postmenopausal women ; the detection of carotid artery plaque among middle - aged and aged people of different genders was mainly influenced by different components of MS.