异常代谢组分积聚与体位性低血压的关系

Relationship between the accumulation of metabolic syndrome components and orthostatic hypotension

目的探讨代谢综合征(MS)中的异常代谢组分积聚与体位性低血压(OH)的关系。方法选取2016年3月至2019年3月于福建医科大学附属第一医院门诊及住院治疗的患者2 201例,根据异常代谢组分数量[参考《中国高血压防治指南(2018年修订版)》],分为0个组分组(199例)、1~2个组分组(1 003例)和3~4个组分组(999例)。按照年龄(以65岁为切点)、性别、是否MS进行分层分析,比较各组间OH检出率,采用二元logistic回归分析OH的独立相关因素。结果从0个组分、1~2个组分到3~4个组分组,OH的检出率逐渐升高(5.0%比13.5%比17.9%,χ^2=24.307,P<0.05)。与非OH人群相比,OH患者的MS比例更高(55.2%比43.7%,χ^2=14.897,P<0.05)。老年人群比中青年人群的OH检出率高(22.3%比10.9%,χ^2=50.973,P<0.01)。二元logistic逐步回归分析结果表明:在所有研究对象中,异常代谢组分数量为OH的相关因素。随着异常代谢组分数量的增加,OH风险升高,与没有合并异常代谢组分的对象相比,合并4个异常代谢组分的对象OH风险增加2.274倍(OR=3.274,95%CI 1.626~6.594,P<0.05)。分层分析发现,异常代谢组分数量是中青年人群、女性和非MS人群OH的相关因素。结论异常代谢组分数量为OH的相关因素,随着异常代谢组分的积聚,即危险因素越多,OH发生的风险越高,在中青年、女性和非MS人群中尤为明显。

Objective To investigate the relationship between the accumulation of metabolic syndrome(MS) components and orthostatic hypotension(OH). Methods A total of 2 201 subjects were enrolled from March 2016 to March 2019 in the First Affiliated Hospital of Fujian Medical University. Subjects were divided into 0 component group(n=199), 1-2 components group(n=1 003) and 3-4 components group(n=999) based on the number of MS components according to the criteria of 2018 Chinese Guidelines for Prevention and Management of Hypertension. Stratified analyses were performed according to age, sex, and whether suffer from MS, and the incidence of OH was compared between each group. Binary logistic regression analysis was used to identify the independent risk factors of OH. Results The incidence of OH was significantly increased with the increment of MS components(5.0% in 0 component group vs 13.5% in 1-2 components group vs 17.9% in 3-4 components group, χ^2=24.307, P<0.05). Compared with subjects without OH, the incidence of MS in those with OH was significantly elevated(55.2% vs 43.7%, χ^2=14.897, P<0.05). The incidence of OH in the elderly subjects was significantly higher than that in the young and middle-aged subjects(22.3% vs 10.9%, χ^2=50.973, P<0.01). Binary logistic regression analysis showed that the number of MS components was associated with OH in all subjects, and the risk of OH was increased with the increment of MS components. Compared with the subjects without any MS component, the risk of OH increased by 2.274 times in the subjects with 4 MS components(OR=3.274,95% CI 1.626-6.594, P<0.05). Stratified analyses found that the number of MS components was independently associated with OH in the young and middle-aged, female and non-MS subjects. Conclusion The incidence of OH is elevated with the increased accumulation of MS components, especially in the young and middle-aged, female and non-MS subjects.