Diamantopoulos E J, Andreadis E A, Tsourous G I, Ifanti G K, Katsanou P M, Georgiopoulos D X, Vassilopoulos C V, Dimitriadis G, Raptis S A
4th Department of Internal Medicine and Unit for Vascular Medicine, Evangelismos State General Hospital, Athens, Greece.
Exp Clin Endocrinol Diabetes. 2006 Jul;114(7):377-83. doi: 10.1055/s-2006-924319.
The metabolic syndrome (MetS) is a cluster of risk factors related to cardiovascular disease. Prediabetes, identified by impaired fasting glucose and/or impaired glucose tolerance, may predict future development of diabetes mellitus. However, it is not clear whether MetS and prediabetes represent the same or different clinical entities. This study compares MetS and prediabetes in terms of cardiovascular risk factors and target organ damage.
A total of 524 overweight and obese (body mass index, BMI >or= 27 kg/m (2)) adults, mean age 53.6 +/- 10.3 years, 264 men and 260 women, were studied. All participants underwent a thorough clinical and laboratory evaluation, including an oral glucose tolerance test and insulin measurements. Echocardiography, carotid ultrasonography, and pulse wave analysis were also performed for the detection of target organ damage. NCEP-ATP III and ADA criteria were used for the diagnosis of MetS and prediabetes.
The prevalence of MetS and prediabetes was 38.7 and 25.4 %, respectively. Overall, 129 individuals (24.6 %) had MetS without prediabetes (group M) and another 59 (11.3 %) prediabetes without MetS (group P). Group P had decreased albumin excretion (p = 0.033) and more thickened common carotid intima-media in comparison to group M (p = 0.032). Furthermore, group M was associated with higher C-reactive protein levels. Multiple logistic regression analysis revealed that advanced age (p < 0.0001, OR 1.11, 95 % CI 1.06 - 1.16), low insulin secretion (p < 0.0001, OR 0.05, 95 % CI 0.02 - 0.18 for insulinogenic index), and increased insulin resistance (p = 0.0003, OR 3.22, 95 % CI 1.71 - 6.07 for HOMA-IR) were associated with group P.
Our data demonstrate that MetS and prediabetes have an overlapping pattern. MetS appears to have a more pronounced effect on early renal dysfunction and increased inflammatory activation, while prediabetes tends to be associated with early carotid structural changes. These findings may be due to a different pathophysiologic substrate of these clinical phenotypes in terms of insulin resistance and secretion, as well as to the varying prevalence of cardiovascular risk factors.
代谢综合征（MetS）是一组与心血管疾病相关的危险因素。空腹血糖受损和/或糖耐量受损所定义的糖尿病前期可能预示着未来糖尿病的发生。然而，尚不清楚MetS和糖尿病前期是代表相同还是不同的临床实体。本研究比较了MetS和糖尿病前期在心血管危险因素和靶器官损害方面的情况。
共研究了524名超重和肥胖（体重指数，BMI≥27kg/m²）的成年人，平均年龄53.6±10.3岁，男性264名，女性260名。所有参与者均接受了全面的临床和实验室评估，包括口服葡萄糖耐量试验和胰岛素测量。还进行了超声心动图、颈动脉超声检查和脉搏波分析以检测靶器官损害。采用NCEP-ATP III和ADA标准诊断MetS和糖尿病前期。
MetS和糖尿病前期的患病率分别为38.7%和25.4%。总体而言，129名个体（24.6%）患有MetS但无糖尿病前期（M组），另有59名（11.3%）患有糖尿病前期但无MetS（P组）。与M组相比，P组的白蛋白排泄减少（p = 0.033），颈总动脉内膜中层增厚更明显（p = 0.032）。此外，M组的C反应蛋白水平更高。多因素logistic回归分析显示，高龄（p < 0.0001，OR 1.11，95%CI 1.06 - 1.16）、胰岛素分泌低（p < 0.0001，胰岛素生成指数的OR 0.05，95%CI 0.02 - 0.18）和胰岛素抵抗增加（p = 0.0003，HOMA-IR的OR 3.22，95%CI 1.71 - 6.07）与P组相关。
我们的数据表明，MetS和糖尿病前期有重叠模式。MetS似乎对早期肾功能障碍和炎症激活增加有更明显的影响，而糖尿病前期往往与早期颈动脉结构变化有关。这些发现可能是由于这些临床表型在胰岛素抵抗和分泌方面的病理生理底物不同，以及心血管危险因素的患病率不同所致。
