社区中老年人群代谢综合征与颈动脉粥样硬化的关系

Abstract

目的 探讨代谢综合征(MS)与颈动脉粥样硬化的关系,初步了解不同诊断标准的预测效果.方法 于2008年对北京市两组中老年社区人群进行横断面调查,纳入分析者共1266人(男性598人,女性668人),年龄45～69岁.分别采用国际糖尿病联盟(IDF)、美国国家胆固醇教育计划成年人治疗组报告Ⅲ修订版(ATPⅢ修订版)和2007年公布的中国成人血脂异常防治指南("指南")标准诊断MS.结果 IDF、ATPⅢ修订版和"指南"定义的MS患病率分别为39.0%、43.3%和30.9%.三种标准两两之间一致性测量Kappa系数分别为0.911、0.719和0.730.调整了年龄、性别、LDL-C、吸烟、饮酒后,三种定义的MS组CCA-IMT均显著高于非MS组(P＜0.001).调整上述变量后,三种定义的MS均显著增加颈动脉内中膜斑块检出的危险性,OR值分别为1.499(95%CI:1.157～1.942)、1.696(95%CI:1.314～2.189)、1.763(95%CO:1.344～2.312).结论 三种标准定义的MS在吸烟、LDL-C等传统心血管病危险因素以外仍对颈动脉粥样硬化有独立预测作用,不同标准定义的MS与斑块检出风险关联强度可能存在性别差异.

Objective To explore the association between metabolic syndromes (MS) and carotid atherosclerosis and to estimate the predictive effects of MS under 3 different definitions.Methods A cross-sectional study was conducted in 2 community-based populations in Beijing,in 2008.1266 subjects (598 men,668 women),aged 45-69,were included in the analyses.MS was defined by the criteria of International Diabetes Federation (IDF),the revised NCEPATPm (ATP Ⅲ-R) and "The Guidelines of Dyslipidemia Control for Chinese Adult" ( "Guidelines" ) in 2007.Results The prevalence rates of MS by the 3 criteria were 39.0%,43.3% and 30.9% respectively.The Kappa value for the measure of the agreement between each pair of the 3 definitions were 0.911,0.719 and 0.730 respectively.The intima-media thickness in common carotid artery (CCA-IMT) was significantly higher (P＜0.001) in all MS groups than in non-MS groups,diagnosed with the 3 criteria independent of age,gender,LDL-C,and current smoking status.After adjustment of age,gender,LDL-C,and current smoking status,the classification of MS significantly increased the risk of prevalence of carotid atberosclerotic plaques,compared to the non-MS group.OR value were 1.499 (95% CI:1.157-1.942) for IDF,1.696 (95% CI:1.314-2.189) for NCEP-R,1.763 (95% CI:1.344-2.312) for "Guideline" respectively.Conclusion Our research findings indicated that,when MS were defined with the 3 definitions,prediction on the risk of sub-clinical atberosclerosis would work beyond some of the conventional cardiovascular risk factors such as smoking,LDL-C.There might exist some differences in gender issue on the strength of association between MS when diagnosed by different criteria and carotid plaque.