代谢综合征组分异常积聚与肱踝动脉脉搏波传导速度的关系

Association between the accumulation of metabolic syndrome abnormal components and arterial pulse wave velocity among adult individuals undergoing routine health examination

目的探讨代谢综合征组分异常积聚与肱踝动脉脉搏波传导速度（baPWV）的关系。方法本研究为横断面调查。采用分层抽样的方法抽取2016年1至12月浙江省11个地市25-75岁的健康体检者9 201例作为研究对象。测定入选者的代谢综合征组分，包括收缩压、舒张压、腰围、空腹血糖、甘油三酯和高密度脂蛋白胆固醇（HDL-C）。采用动脉硬化诊断仪VP1000（BP-203RPEⅢ）测定入选者的baPWV，并计算baPWV改变率，以baPWV改变率≥10%为异常。采用线性回归分析各代谢综合征组分与baPWV改变率的相关性，采用logistic回归分析分析各代谢综合征组分积聚对baPWV改变率异常的影响，采用方差分析各代谢综合征组分分层与baPWV改变率的关系。结果（1）代谢综合征组分与baPWV改变率相关性的线性回归分析结果：baPWV改变率与收缩压、舒张压、腰围、空腹血糖和甘油三酯均成正相关（β值分别是0.518、0.616、0.208、2.778、1.862，P均〈0.001）,与HDL-C呈负相关（β=-1.339，P〈0.001），其中与收缩压、舒张压和空腹血糖的相关性较强。（2）代谢综合征组分异常积聚对baPWV改变率异常影响的logistic回归分析结果：有代谢综合征者baPWV改变率异常者所占的比例是无代谢综合征者的2.595倍（P〈0.001）。随着代谢综合征组分异常数量的增加，baPWV改变率异常的风险增加，组分数为1、2、3、4、5个时baPWV改变率异常的风险分别是异常组分0个时的1.913、2.884、3.833、6.161和11.176倍（P均〈0.001）。（3）代谢综合征组分异常的各种组合形式对baPWV改变率异常影响的logistic回归分析结果：每个组分异常对baPWV改变率异常均有影响，其中血压（收缩压和/或舒张压）、空腹血糖对baPWV改变率异常有显著影响，OR值分别为4.68、2.45。2个组分异常的所有组合均对baPWV改变率异常有显著影响，其中影响最大的组合是血压＋空腹血糖（OR=5.104，95%CI 4.281-6.085,P〈0.001）。3个组分异常的所有组合均对baPWV改变率异常有显著影响，其中影响最大的组合是血压＋空腹血糖＋甘油三酯（OR=5.385，95%CI 4.245-6.831，P〈0.001）。4个组分异常的所有组合对baPWV改变率异常均有显著影响，其中影响最大的组合是血压＋空腹血糖＋腰围＋甘油三酯（OR=6.519，95%CI 4.731-8.984，P〈0.001）。在2个以上代谢综合征组分异常的组合中对baPWV改变率异常影响较大（OR〉2.0）的前22个组合中均包括血压＋空腹血糖。（4）代谢综合征各组分分层与baPWV改变率的关系：将代谢综合征各组分各自分为3层与baPWV改变率进行分析，结果发现除HDL-C外，其余各代谢综合征组分（收缩压、舒张压、空腹血糖、甘油三酯和腰围）的水平越高baPWV改变率越大（F值分别为1 224.66、832.89、192.72、112.79和56.22，P均〈0.001）。结论代谢综合征组分异常积聚与baPWV改变率密切相关，其中血压和空腹血糖对baPWV改变率影响最大。代谢综合征组分异常积聚可作为评估早期动脉硬化功能改变的重要依据。

ObjectiveTo explore the association between the accumulation of metabolic syndrome （MS） components and abnormal brachial ankle pulse wave velocity （baPWV）, and to investigate the effect of accumulation of abnormal metabolic components on abnormal baPWV among adult individuals undergoing routine health examination.MethodsIt＇s a cross-sectional study. Data from 9 201 stratified sampled subjects, aged between 25 to 75 years old, who took part in the annual health checkups in 11 cities of Zhejiang Province from January to December 2016, were analyzed. Blood pressure（BP）, fasting plasma glucose（FPG）, waist circumference（WC）, triglyceride（TG）, high-density lipoprotein cholesterols（HDL-C） were defined as MS components. The baPWV was measured by VP-1000 （BP-203RPE Ⅲ） and ΔbaPWV （measured baPWV-reference baPWV/reference baPWV） ×100 （%）〉 10% was defined as abnormal. The relationship between MS components and ΔbaPWV was analyzed by linear regression, and impact of accumulation of MS components on ΔbaPWV was analyzed by logistic regression, and the ΔbaPWV in subjects with different levels of MS components were analyzed by analysis of variance.Results（1） The linear regression analysis demonstrated a positive correlation between ΔbaPWV and MS components including systolic blood pressure, diastolic blood pressure, WC, FPG, TG, while ΔbaPWV was negatively correlated with HDL-C. The β values were 0.518, 0.616, 0.208, 2.778, 1.862, -1.339, respectively （all P〈0.001）, indicating a strong association between ΔbaPWV and systolic blood pressure, diastolic blood pressure, and FPG. （2） The logistic regression analysis showed that the proportion of abnormal ΔbaPWV was 2.595 times higher in MS individuals than in non-MS individuals （P〈0.001）. Abnormal ΔbaPWV increased in proportion with increase in numbers of the metabolic components （OR=1.913, 2.884, 3.833, 6.161, 11.176 in individuals with 1,2,3,4,5 metabolic components, respectively, all P〈0.001）. （3） The logistic analysis suggested that each component of MS could affect baPWV,and OR was 4.68, 2.45 for systolic blood pressure and/or diastolic blood pressure and FPG. All combinations of 2 components of MS also significantly affected baPWV,and OR value was the highest （5.104（95%CI 4.281-6.085）, P〈0.001） for FPG＋BP. All combinations of 3 components of MS significantly affected baPWV,and OR value was the highest（5.385（95%CI 4.245-6.831）, P〈0.001） for BP＋FPG＋TG. All combinations of 4 components of MS affected baPWV,and OR value was the highest （6.519（95%CI 4.731-8.984）, P〈0.001） for BP＋FPG＋WC＋TG. （4） Finally, every component of MS was divided into 3 levels, their impact on abnormal ΔbaPWV was analyzed. Prevalence of abnormal ΔbaPWV significantly increased with the increasing levels of the metabolic components expect for HDL-C, the F values were 1 224.66, 832.89, 192.72, 112.79 and 56.22, respectively （all P〈0.001）, indicating that higher levels of metabolic components significantly affected the ΔbaPWV.ConclusionsMS and accumulation of abnormal MS components are closely related with abnormal ΔbaPWV, and the combination of BP and FPG have the greatest impact on the abnormal ΔbaPWV. Analysis on the accumulation of MS components might serve as an early indicator of arteriosclerosis.