Ko G T-C, So W-Y, Chan N N, Chan W-B, Tong P C-Y, Li J, Yeung V, Chow C-C, Ozaki R, Ma R C-W, Cockram C S, Chan J C-N
Department of Medicine, AH Nethersole Hospital, Tai Po, Hong Kong, China.
Diabetes Obes Metab. 2006 Jan;8(1):94-104. doi: 10.1111/j.1463-1326.2005.00475.x.
The aim of this study is to investigate the prevalence of metabolic syndrome (MES) in type 2 diabetic patients and the predictive values of the World Health Organization (WHO) and National Cholesterol Education Programme (NCEP) definitions and the individual components of the MES on total and cardiovascular mortality.
A prospective analysis of a consecutive cohort of 5202 Chinese type 2 diabetic patients recruited between July 1994 and April 2001.
The prevalence of the MES was 49.2-58.1% depending on the use of various criteria. There were 189 deaths (men: 100 and women: 89) in these 5205 patients during a median (interquartile range) follow-up period of 2.1 (0.3-3.6 years). Of these, 164 (87%) were classified as cardiovascular deaths. Using the NCEP criterion, patients with MES had a death rate similar to those without (3.51 vs. 3.85%). By contrast, based on the WHO criteria, patients with MES had a higher mortality rate than those without (4.3 vs. 2.4%, p = 0.002). Compared to patients with neither NCEP- nor WHO-defined MES, only the group with MES defined by the WHO, but not NCEP, criterion had significantly higher mortality rate (2.6 vs. 6.8%, p < 0.001). Using Cox regression analysis, only age, duration of diabetes and smoking were identified as independent factors for cardiovascular or total death. Among the various components of MES, hypertension, low BMI and albuminuria were the key predictors for these adverse events.
In Chinese type 2 diabetic patients, the WHO criterion has a better discriminative power over the NCEP criterion for predicting death. Among the various components of the MES defined either by WHO or NCEP, hypertension, albuminuria and low BMI were the main predictors of cardiovascular and total mortality.
本研究旨在调查2型糖尿病患者中代谢综合征（MES）的患病率，以及世界卫生组织（WHO）和美国国家胆固醇教育计划（NCEP）的定义及MES的各个组成部分对全因死亡率和心血管死亡率的预测价值。
对1994年7月至2001年4月期间招募的5202例中国2型糖尿病患者的连续队列进行前瞻性分析。
根据不同标准，MES的患病率为49.2%-58.1%。在这5205例患者中，中位（四分位间距）随访期为2.1（0.3-3.6年），期间有189例死亡（男性100例，女性89例）。其中，164例（87%）被归类为心血管死亡。采用NCEP标准时，患有MES的患者死亡率与未患MES的患者相似（3.51%对3.85%）。相比之下，根据WHO标准，患有MES的患者死亡率高于未患MES的患者（4.3%对2.4%，p = 0.002）。与既无NCEP定义也无WHO定义的MES的患者相比，仅根据WHO标准而非NCEP标准定义为MES的组死亡率显著更高（2.6%对6.8%，p < 0.001）。使用Cox回归分析，仅年龄、糖尿病病程和吸烟被确定为心血管或全因死亡的独立因素。在MES的各个组成部分中，高血压、低体重指数和蛋白尿是这些不良事件的关键预测因素。
在中国2型糖尿病患者中，WHO标准在预测死亡方面比NCEP标准具有更好的判别能力。在WHO或NCEP定义的MES的各个组成部分中，高血压、蛋白尿和低体重指数是心血管和全因死亡率的主要预测因素。
