脑梗死合并代谢综合征的老年人群发病特点及其危险因素分析

Clinical characteristics and risk factors of cerebral infarction complicated with metabolic syndrome in the elderly

目的分析脑梗死合并代谢综合征老年人群发病特点及危险因素。方法收集2015年3月至2019年10月于江苏省扬州友好医院就诊的临床诊断为脑梗死的老年患者154例,其中合并代谢综合征患者80例(观察组),单纯脑梗死患者74例(对照组),对2组患者一般临床资料、血浆胆固醇(TC)、甘油三酯(TG)及高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、收缩压、舒张压、餐后2 h血糖、空腹胰岛素、神经功能和并发症发生情况进行比较,并对脑梗死合并代谢综合征相关因素进行多因素logistic回归分析。采用SPSS 21.0软件进行数据分析。根据数据类型,组间比较分别采用χ^(2)检验或者t检验。结果观察组患者BMI(28.3±3.5)kg/m^(2)、腰围(94.6±10.2)cm、吸烟史[35例(43.8%)]、饮酒史[33例(41.3%)]、高血压[57例(71.3%)]、高血糖[64例(80.0%)]和高血脂[49例(61.3%)]均高于对照组[25.7±2.9)kg/m^(2)、(89.3±9.4)cm、20例(27.0%)、18例(24.3%)、36例(48.6%)、39例(52.7%)、30例(40.5%)],差异均有统计学意义(均P<0.05)。观察组患者TC(5.25±1.13)mmol/L、TG(2.36±0.85)mmol/L、FPG(7.83±0.87)mmol/L、收缩压(149.32±12.41)mmHg(1 mmHg=0.133 kPa)、舒张压(89.34±9.12)mmHg、餐后2 h血糖(10.81±3.45)mmol/L和空腹胰岛素(10.86±2.75)mmol/L均高于对照组[(4.89±0.94)mmol/L、(1.82±0.64)mmol/L、(6.28±0.57)mmol/L、(141.71±11.52)mmHg、(82.31±7.61)mmHg、(7.87±3.14)mmol/L和(8.49±2.53)mmol/L],观察组HDL-C(0.94±0.24)mmol/L低于对照组(1.08±0.36)mmol/L,差异均有统计学意义(均P<0.05)。观察组患者神经功能评分(24.62±6.74)分、神经功能评分等级为重型的比例41.3%(33/80)、肺部感染11.3%(9/80)、心力衰竭28.8%(23/80)、肝肾衰竭的发生率16.3%(13/80),均高于对照组[(17.21±6.25)分、21.6%(16/74)、2.7%(2/74)、9.5%(7/74)、4.1%(3/74)],差异均有统计学意义(均P<0.05);观察组与对照组脑梗死的复发率比较,差异无统计学意义(P>0.05)。通过logistic回归分析发现高血压、FPG≥6.1 mmol/L、TG≥1.7 mmol/L、肺部感染及肥胖均为脑梗死合并代谢综合征的危险因素。结论脑梗死合并代谢综合征的老年患者的病情重,预后差,且高血压、FPG≥6.1 mmol/L、TG≥1.7 mmol/L、肺部感染及肥胖为脑梗死合并代谢综合征老年患者的危险因素。

Objective To analyze the clinical characteristics and risk factors of cerebral infarction complicated with metabolic syndrome in the elderly patients.Methods A total of 154 elderly patients diagnosed with cerebral infarction were collected from Friendship Hospital in Yangzhou,80 being complicated with metabolic syndrome(observation group)and 74 elderly being not(control group).The two groups were then compared in the general clinical data,plasma cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol(LDL-C)fasting blood glucose(FBG),systolic blood pressure,diastolic blood pressure,postprandial blood glucose,fasting insulin,neurological function and complications.Multivariate logistic regression analysis was performed on the related factors of cerebral infarction complicated with metabolic syndrome.SPSS statistics 21.0 was used for statistical analysis.Data comparison between two groups was perfomed usingχ^(2)test or t test depending on date type.Results In observation group,BMI was(28.3±3.5)kg/m^(2),waistline(94.6±10.2)cm,smoking history 35(43.8%),drinking history 33(41.3%),hypertension 57(71.3%),hyperglycemia 68(80.0%)and hyperglycemia blood lipids 49(61.3%),which were all higher than those in control group[25.7±2.9)kg/m^(2),(89.3±9.4)cm,20(27.0%)、18(24.3%)、36(48.6%)、39(52.7%)、30(40.5%)],with statistically significant difference(all P<0.05).In observation group,TC was(5.25±1.13)mmol/L,TG(2.36±0.85)mmol/L,FPG(7.83±0.87)mmol/L,systolic blood pressure(149.32±12.41)mmHg(1 mmHg=0.133 kPa),diastolic blood pressure(89.34±9.12)mmHg,2 h postprandial blood glucose(10.81±3.45)mmol/L and fasting insulin(10.86±2.75)mmol/L,which were all higher than those in control group[(4.89±0.94)mmol/L,(1.82±0.64)mmol/L,(6.28±0.57)mmol/L,(141.71±11.52)mmHg,(82.31±7.61)mmHg,(7.87±3.14)mmol/L and(8.49±2.53)mmol/L],while HDL-C in observation group[(0.94±0.24)mmol/L]was lower than that in control group[(1.08±0.36)mmol/L],with statistically significant differences(all P<0.05).In the observation group,the rate of neurological function score as(24.62±6.74)points,the rate of neurological function score as severe 41.3%(33/80),lung infection 11.3%(9/80),heart failure 28.8%(23/80),and liver and kidney failure 16.3%(13/80),which were all higher than those of the control group[(17.21±6.25)points,21.6%(16/74),2.7%(2/74),9.5%(7/74),4.1%(3/74)],with statistically significant differences(all P<0.05).There was no statistically significant difference in the recurrence rate of cerebral infarction between two groups(P>0.05).Logistic regression analysis showed that hypertension,FPG≥6.1 mmol/L,TG≥1.7 mmol/L,obesity and pulmonary infection were the risk factors of cerebral infarction complicated with metabolic syndrome in the elderly patients.Conclusion The elderly patients with cerebral infarction complicated with metabolic syndrome have serious illness and poor prognosis.Hypertension,FPG≥6.1 mmol/L,TG≥1.7 mmol/L,obesity and pulmonary infection are the risk factors.