Reindel Jörg, Zander Eckhard, Heinke Peter, Kohnert Klaus-Dieter, Allwardt Christiane, Kerner Wolfgang
Klinik für Diabetes und Stoffwechselkrankheiten, Herz-Kreislaufzentrum Mecklenburg-Vorpommern, Karlsburg.
Herz. 2004 Aug;29(5):463-9. doi: 10.1007/s00059-004-2606-0.
Type 1 diabetes is known to be associated with increased cardiovascular disease in the presence of nephropathy and hypertension. It was the aim of the present study to elucidate whether or not clinical findings of metabolic syndrome (MS) are further increasing cardiovascular morbidity among type 1 diabetics.
In the present cross-sectional study, 1,241 type 1 diabetics were included. These patients attended the Diabetes Clinic Karlsburg, Germany, from February 1, 2002 to December 31, 2003. The presence of the following findings was taken into consideration as clinical features of MS in type 1 diabetes: fasting triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), body mass index (BMI), daily insulin requirement/kg body weight (b.w.), increased blood pressure > 130/85 mmHg, including overt arterial hypertension. In each of the five categories the highest quintile in each sample was assessed: TG 2.9 +/- 3.6 mmol/l, HDL-C 1.48 +/- 0.46 mmol/l, BMI 29.1 +/- 4.98 kg/m(2) height, insulin requirement 0.71 +/- 0.23 IU/kg b.w., systolic blood pressure 130 +/- 12.3 mmHg. MS was defined as the presence of at least three categories. Among 1,241 type 1 diabetics (651 men, 590 women), 226 patients (129 men, 97 women) fulfilled the criteria of MS. The risk of MS was assessed by multiple regression analysis. Risk variables were: age, diabetes duration, sex, glycated hemoglobin (HbA(1c)), actual smoking, neuropathy, albumin excretion rate (AER), regular alcohol consumption, retinopathy, peripheral vascular disease (PVD), coronary heart disease (CHD), TGs, HDL-C, low-density lipoprotein cholesterol (LDL-C), cholesterol, blood pressure increase, BMI, increased insulin requirement, and foot syndrome. After adjusting for age, the variables were separately included into the mathematical model. The risk of MS was assessed after excluding the variables defining MS.
Type 1 diabetics with MS were characterized by higher age (46 vs. 36 years; p < 0.01), and longer diabetes duration (19 vs. 16 years; p < 0.01). The risk of MS was independently associated (odds ratios) with higher age (40-59 years; 4.21; p < 0.01), increased HbA(1c) (1.41; p < 0.01), PVD (2.28; p < 0.01), CHD (2.19; p < 0.01), and the foot syndrome (4.17; p < 0.01). There were no significant associations of MS with type 2 diabetes heredity (first and second degree).
Patients with type 1 diabetes and the presence of findings of MS are suffering from increased cardiovascular morbidity. The risk of MS increases with the age and HbA(1c). Life style factors such as weight gain and muscular inactivity seem to have an influence on the pathogenesis of MS in type 1 diabetes, thereby increasing cardiovascular morbidity.
已知1型糖尿病在合并肾病和高血压时与心血管疾病风险增加相关。本研究旨在阐明代谢综合征（MS）的临床特征是否会进一步增加1型糖尿病患者的心血管疾病发病率。
在本横断面研究中，纳入了1241例1型糖尿病患者。这些患者于2002年2月1日至2003年12月31日在德国卡尔斯堡糖尿病诊所就诊。以下临床表现被视为1型糖尿病中MS的临床特征：空腹甘油三酯（TGs）、高密度脂蛋白胆固醇（HDL-C）、体重指数（BMI）、每日胰岛素需求量/千克体重（b.w.）、血压升高>130/85 mmHg，包括显性动脉高血压。在五个类别中的每一个类别中，评估每个样本中的最高五分位数：TG 2.9±3.6 mmol/l、HDL-C 1.48±0.46 mmol/l、BMI 29.1±4.98 kg/m²身高、胰岛素需求量0.71±0.23 IU/kg b.w.、收缩压130±12.3 mmHg。MS被定义为至少存在三个类别。在1241例1型糖尿病患者（651例男性，590例女性）中，226例患者（129例男性，97例女性）符合MS标准。通过多元回归分析评估MS风险。风险变量包括：年龄、糖尿病病程、性别、糖化血红蛋白（HbA1c）、当前吸烟情况、神经病变、白蛋白排泄率（AER）、规律饮酒情况、视网膜病变、外周血管疾病（PVD）、冠心病（CHD）、TGs、HDL-C、低密度脂蛋白胆固醇（LDL-C）、胆固醇、血压升高、BMI、胰岛素需求量增加以及足部综合征。在调整年龄后，将这些变量分别纳入数学模型。在排除定义MS的变量后评估MS风险。
患有MS的1型糖尿病患者具有更高的年龄（46岁对36岁；p<0.01）和更长的糖尿病病程（19年对16年；p<0.01）。MS风险与更高年龄（40 - 59岁；4.21；p<0.01）、升高的HbA1c（1.41；p<0.01）、PVD（2.28；p<0.01）、CHD（2.19；p<0.01）以及足部综合征（4.17；p<0.01）独立相关（优势比）。MS与2型糖尿病遗传（一级和二级）无显著关联。
患有1型糖尿病且存在MS临床表现的患者心血管疾病发病率增加。MS风险随年龄和HbA1c升高而增加。体重增加和肌肉活动不足等生活方式因素似乎对1型糖尿病中MS的发病机制有影响，从而增加心血管疾病发病率。
