血脂异常会诊中的代谢综合征

Monteiro Sílvia, Dias Patrícia, Madeira Sofia, de Moura Pereira, Silva José Manuel, Providência Luís A, Alves de Moura J J

Serviços de Medicina II e Cardiologia, Hospital da Universidade de Coimbra, Coimbra, Portugal.

Rev Port Cardiol. 2006 Sep;25(9):821-31.

AIMS

To evaluate the prevalence of the metabolic syndrome (MS) in dyslipidemia consultations, according to the criteria established by the National Cholesterol Education Program Adult Treatment Panel III (ATP III); to classify patients with MS according to ATP III risk categories and prevention type (primary versus secondary); and to evaluate evolution to type 2 diabetes in these patients.

METHODS

A retrospective study was conducted based on analysis of the clinical records of 470 patients followed in dyslipidemia consultations at Internal Medicine II of Coimbra University Hospitals. MS was defined as the presence of three or more of the following abnormalities: waist circumference > 102/88 cm (male/female), triglyceride levels > or =150 mg/dl, HDL-cholesterol level < 40/50 mg/dl (male/female), blood pressure > or = 130/85 mmHg and fasting glucose > or = 110 mg/dl. The patients were classified into three risk categories according to the major risk factors defined by ATP III, regardless of LDL-cholesterol level.

RESULTS

MS was diagnosed in 31.3% of the patients; 53.7% were male and mean age was 52.7+/-11.9 years. The most prevalent anomaly was hypertriglyceridemia (95.9%), followed by waist circumference (76.1%), HDL cholesterol (73.5%), blood pressure (69.4%) and fasting glycemia (36.7%). Based on the risk categories identified by ATP III, 30.6% of the patients had no or only one risk factor, 66.7% had multiple (2 or more) risk factors and 2.7% had coronary disease or an equivalent risk profile. 97.3% of the patients with MS were in primary prevention. 18.4% developed diabetes, the majority within 1-3 years of the first consultation.

CONCLUSIONS

Our study identified a high MS prevalence in patients followed in dyslipidemia consultations, particularly in older age-groups. More than half of the MS patients had an intermediate risk profile and most of them were in primary prevention. We also found that a fifth of non-diabetic patients developed diabetes during follow-up.

目的

根据美国国家胆固醇教育计划成人治疗组第三次报告（ATP III）制定的标准，评估血脂异常门诊患者中代谢综合征（MS）的患病率；根据ATP III风险类别和预防类型（一级预防与二级预防）对MS患者进行分类；并评估这些患者发生2型糖尿病的情况。

方法

基于对科英布拉大学医院内科二部血脂异常门诊随访的470例患者临床记录的分析进行一项回顾性研究。MS定义为存在以下三种或更多异常情况：腰围>102/88厘米（男性/女性）、甘油三酯水平≥150毫克/分升、高密度脂蛋白胆固醇水平<40/50毫克/分升（男性/女性）、血压≥130/85毫米汞柱以及空腹血糖≥110毫克/分升。根据ATP III定义的主要危险因素，将患者分为三个风险类别，不考虑低密度脂蛋白胆固醇水平。

结果

31.3%的患者被诊断为MS；53.7%为男性，平均年龄为52.7±11.9岁。最常见的异常是高甘油三酯血症（95.9%），其次是腰围（76.1%）、高密度脂蛋白胆固醇（73.5%）、血压（69.4%）和空腹血糖（36.7%）。根据ATP III确定的风险类别，30.6%的患者没有或只有一个危险因素，66.7%有多个（两个或更多）危险因素，2.7%有冠心病或同等风险状况。97.3%的MS患者处于一级预防。18.4%的患者发展为糖尿病，大多数在首次就诊后的1至3年内。