不同诊断标准下的代谢综合征与无症状心血管损害的相关性研究

Incidence of asymptomatic cardiovascular impairments in patients with metabolic syndrome defined by different criteria

目的选取无心血管疾病史的上海北部社区老年人群为研究对象,探讨无症状心血管损害与4种不同诊断标准判定的代谢综合征(metabolic syndrome,MS)的关系。方法研究选择1958例无心血管疾病史的老年人群,年龄66.5-73.1岁。MS的定义依据以下标准:2005年美国国家胆固醇教育计划成人治疗专家组第三次会议(National Cholesterol Education Program Adult Treatment PanelⅢ,NCEPⅢ)、国际糖尿病联盟(International Diabetes Federation,IDF)、中华医学会糖尿病学分会(Chinese Diabetes Society,CDS)和中国成人血脂异常防治指南制定联合委员会(Chinese Joint Committee for Developing Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults,JCDCG)。无症状心血管损害指标包括测定左心室质量指数、二尖瓣峰值血流速度/舒张早期组织多普勒血流速度、颈股脉搏波传导速度、踝臂指数、动脉斑块和尿白蛋白/肌酐比值。二分类Logistic回归模型用于评价无症状心血管损害与4种不同诊断标准判定的MS之间的相关性。结果(1)NCEPⅢ(2005)、IDF、CDS和ICDCG诊断标准判别的MS患病率分别为46.4%,37.1%,21.6%和28.7%。(2)未校正的Logistic回归分析显示,4种不同诊断标准判定的MS均与左心室肥厚、左心室舒张功能不全、动脉硬化和微量白蛋白尿显著相关(均P<0.01)。(3)在校正了年龄、性别、吸烟和早发心血管疾病家族史后,左心室肥厚、左心室舒张功能不全、动脉硬化和微量白蛋白尿与4种不同诊断标准判定的MS的关联仍存在(均P<0.01)。结论在上海北部社区老年人群中,不同诊断标准判定的MS与无症状心血管损害均密切相关。

Objective To analyze the incidence of asymptomatic cardiovascular impairments in patients with metabolic syndrome(MS)defined by different diagnostic criteria.Methods A total of 1958 elderly residents of northern Shanghai communities aged 66.5 to 73.1 years without a history of cardiovascular disease were enrolled in the study.MS was defined according to the following criteria:the National Cholesterol Education Program Adult Treatment PanelⅢ(NCEPⅢ)in 2005,the International Diabetes Federation(IDF),the Chinese Diabetes Society(CDS),and the Chinese Joint Committee for Developing Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults(JCDCG).The left ventricular mass index(LVMI),peak transmitral pulsed Doppler velocity/early diastolic tissue Doppler velocity,carotid-femoral pulse wave velocity,ankle-brachial index,arterial plaque,and urinary albumin-creatinine rate were evaluated in all participants.The association of various cardiovascular impairments with MS defined by four different diagnostic criteria was analyzed by logistic regression models.Results The prevalence of MS in participants was 46.4%,37.1%,21.6%,and 28.7%according to the NCEPⅢ(2005),IDF,CDS,and JCDCG diagnostic criteria,respectively.The incidence of LV hypertrophy(LVH),LV diastolic dysfunction,arteriosclerosis and microalbuminuria was significantly associated with MS defined by all the four criteria(all P<0.01).After adjustment for age,sex,smoking status,and family history of premature CVD,the LVH,LV diastolic dysfunction,arteriosclerosis and microalbuminuria were still significantly associated with MS defined by all 4 diagnostic criteria(all P<0.01).Conclusion The study indicates that all four diagnostic definitions of MS were significantly related to cardiac,macro-and micro-circulatory abnormalities in community-dwelling elderly without a history of cardiovascular disease.