Davis Timothy M E, Bruce David G, Davis Wendy A
School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Western Australia, Australia.
Diabetes Res Clin Pract. 2007 Dec;78(3):412-7. doi: 10.1016/j.diabres.2007.06.007. Epub 2007 Jul 23.
To determine whether the metabolic syndrome (MS) predicts fatal outcome in type 1 diabetes, we assessed prospective data from 127 patients from the observational community-based Fremantle Diabetes Study. Causes of death were classified as cardiac or other. The mean+/-S.D. age of the patients was 42.0+/-15.7 years and 57.5% were male. MS defined by the World Health Organisation (WHO), National Cholesterol Education Program's Adult Treatment Panel (ATP) III and the International Diabetes Federation (IDF) consensus definitions was present in 44.9, 42.1 and 39.4% of patients, respectively. There were 29 deaths (22.8%) during a mean of 11.0 years of follow-up, 55% of which were cardiac. In Cox proportional hazards models incorporating all plausible contributory variables (including individual MS components), none of the definitions was independently associated with cardiac or all-cause death (p>or=0.49 in each case). When component variables were removed, the WHO definition weakly predicted cardiac death (p=0.045). Microalbuminuria was a significant predictor of cardiac mortality (p<or=0.001). A minority of our community-based type 1 patients had the MS and its presence did not add significant prognostic predictive value to conventional vascular risk factors.
为了确定代谢综合征（MS）是否可预测1型糖尿病的致死结局，我们评估了基于社区的弗里曼特尔糖尿病观察性研究中127例患者的前瞻性数据。死亡原因分为心脏相关或其他原因。患者的平均年龄±标准差为42.0±15.7岁，男性占57.5%。分别有44.9%、42.1%和39.4%的患者符合世界卫生组织（WHO）、美国国家胆固醇教育计划成人治疗专家组（ATP）III以及国际糖尿病联盟（IDF）共识定义的MS。在平均11.0年的随访期间，有29例死亡（22.8%），其中55%为心脏相关死亡。在纳入所有可能的影响变量（包括MS的各个组成部分）的Cox比例风险模型中，没有一种定义与心脏相关死亡或全因死亡独立相关（每种情况p≥0.49）。当去除组成变量后，WHO定义对心脏相关死亡有较弱的预测作用（p=0.045）。微量白蛋白尿是心脏相关死亡率的显著预测因素（p≤0.001）。我们社区中的少数1型糖尿病患者患有MS，其存在并未给传统血管危险因素增加显著的预后预测价值。
