Cordero Fort Alberto, Gavira Juan José, Alegría-Barrero Eduardo, Castaño Sara, Martín Ana, Ubilla Matías, Mastrobuoni Stefano, Alegría Ezquerra Eduardo, Herreros Jesús, Rábago Gregorio
Department of Cardiology and Cardiovascular Surgery, Clínica Universitaria de Navarra, Pamplona, Spain.
J Heart Lung Transplant. 2006 Oct;25(10):1192-8. doi: 10.1016/j.healun.2006.06.012.
Metabolic syndrome (MS) is a cluster of cardiovascular risk factors highly prevalent in patients with ischemic heart disease (IHD), the main etiologic cause for heart transplantation (HT).
Data for 111 HT patients of a single institution were collected. The assessment of MS was made, according to the ATP III criteria, when 3 of the following diagnostic criteria were present: waist circumference >102 cm (men) or >88 cm (women); triglycerides > or =150 mg/dl; HDL-cholesterol <40 mg/dl (men) or <50 mg/dl (women); blood pressure > or =130/85 mm Hg; and fasting glucose > or =110 mg/dl, or diabetes mellitus previously diagnosed. Renal function was assessed by glomerular filtration rate, as estimated by the MDRD abbreviated equation.
Mean age of the 111 HT patients was 63.0 (11.0) years and 101 (91.0%) were men. The median time since transplant was 7.0 (3.0 to 13.0) years, and IHD was the primary cause for HT (56.8%). The prevalence of MS was 42.3% and was statistically higher in patients with IHD prior to HT (52.4% vs 27.2%; p = 0.007). Patients with MS were older but had the same time of follow-up since their HT. An analysis of the sample in tertiles of years since HT showed that MS was more prevalent in subjects who received HT due to IHD only in the lowest and highest tertile. Fifty-three patients (47.7%) had abdominal obesity, 47 (43.2%) were overweight and 22 (19.8%) were obese; most patients with abdominal obesity were diagnosed with MS (82.6%). Multivariate analysis showed a strong association between abdominal obesity and MS (odds ratio [OR] 6.2, 95% confidence interval [CI] 1.9 to 19.8), even after adjustment for body mass index, and also showed an independent association of MS with severe renal dysfunction (OR 9.8; p = 0.02).
MS is highly prevalent in HT patients and abdominal obesity is the leading cause of this clustering. IHD status and time since HT are major determinants in the prevalence of MS in HT patients.
代谢综合征（MS）是一组心血管危险因素，在缺血性心脏病（IHD）患者中高度流行，缺血性心脏病是心脏移植（HT）的主要病因。
收集了一家单一机构111例心脏移植患者的数据。根据ATP III标准，当出现以下3项诊断标准时，对代谢综合征进行评估：腰围>102 cm（男性）或>88 cm（女性）；甘油三酯>或=150 mg/dl；高密度脂蛋白胆固醇<40 mg/dl（男性）或<50 mg/dl（女性）；血压>或=130/85 mmHg；空腹血糖>或=110 mg/dl，或先前诊断为糖尿病。通过MDRD简化方程估算的肾小球滤过率评估肾功能。
111例心脏移植患者的平均年龄为63.0（11.0）岁，101例（91.0%）为男性。移植后的中位时间为7.0（3.0至13.0）年，缺血性心脏病是心脏移植的主要原因（56.8%）。代谢综合征的患病率为42.3%，在心脏移植前患有缺血性心脏病的患者中统计学上更高（52.4%对27.2%；p = 0.007）。患有代谢综合征的患者年龄较大，但自心脏移植后的随访时间相同。对心脏移植后年份三分位数的样本分析表明，仅在最低和最高三分位数中，因缺血性心脏病接受心脏移植的患者中代谢综合征更为普遍。53例患者（47.7%）有腹部肥胖，47例（43.2%）超重，22例（19.8%）肥胖；大多数腹部肥胖患者被诊断为代谢综合征（82.6%）。多变量分析显示腹部肥胖与代谢综合征之间存在强关联（优势比[OR]6.2，95%置信区间[CI]1.9至19.8），即使在调整体重指数后也是如此，并且还显示代谢综合征与严重肾功能不全存在独立关联（OR 9.8；p = 0.02）。
代谢综合征在心脏移植患者中高度流行，腹部肥胖是这种聚集的主要原因。缺血性心脏病状态和心脏移植后的时间是心脏移植患者中代谢综合征患病率的主要决定因素。
