代谢综合征及其各个组成部分对冠心病风险和严重程度的影响。
Impact of the metabolic syndrome and its individual components on risk and severity of coronary heart disease.
作者信息
Zhang Yifei, Hong Jie, Gu Weiqiong, Gui Minghui, Chen Ying, Zhang Yu, Chi Zhenni, Wang Weiqing, Li Xiaoying, Ning Guang
机构信息
Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrinology and Metabolism, Endocrine and Metabolic E-Institutes of Shanghai Universities (EISU) and Key Laboratory for Endocrinology and Metabolism of Chinese Health Ministry, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, People's Republic of China.
出版信息
Endocrine. 2009 Oct;36(2):233-8. doi: 10.1007/s12020-009-9214-y. Epub 2009 Jul 18.
The clinical use of criteria for metabolic syndrome (MetS) and its individual components with respect to risk prediction of coronary heart disease (CHD) remains uncertain. In this study, we investigated whether and to what extent MetS and its individual components were related to risk for CHD. A total of 1,028 subjects, who had undergone coronary angiography or were diagnosed as acute myocardial infarction, were selected according to inclusion criteria. MetS was diagnosed with National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) criteria. CHD was diagnosed with clinical data and confirmed by coronary angiography. The severity of coronary atherosclerosis was estimated by CHD Gensini cumulative index. All the patients were aged 33-87 years. The results showed that the age- and sex-adjusted odds ratios (ORs) for CHD in different individual components of MetS were as follows: low-high density lipoprotein (low-HDL), 3.15 (1.94-5.12); high-fasting plasma glucose (high-FPG), 2.26 (1.63-3.69); high-blood pressure (high-BP), 2.13 (1.38-3.29); high-triglycerides (high-TG), 1.55 (1.13-2.11); all P < 0.05, whereas high-body mass index (high-BMI), 0.75 (0.55-1.03) and high-waist circumference, 0.75 (0.51-1.10), both P > 0.05. Among all the components, the triad of low-HDL, high-FPG, and high-BP had the highest OR for CHD: 4.28 (3.12-5.87) (P < 0.001). MetS subjects had significant increases in number of disease vessel and CHD Gensini index (P < 0.001). When individual components of MetS were considered separately, groups with low-HDL, or high-FPG, or high-BP had significant increases in number of disease vessel and Gensini index (all P < 0.001). In conclusion, our present results demonstrated that individual components of MetS and their various combinations may have different contributions to CHD and the severity of coronary artery stenosis. Clinical focus should remain on establishing optimum-risk algorithms for CHD.
代谢综合征（MetS）及其各个组成部分在冠心病（CHD）风险预测方面的临床应用仍不明确。在本研究中，我们调查了MetS及其各个组成部分是否与CHD风险相关以及相关程度如何。根据纳入标准，共选取了1028名接受过冠状动脉造影或被诊断为急性心肌梗死的受试者。MetS依据美国国家胆固醇教育计划成人治疗专家组第三次报告（NCEP ATPIII）标准进行诊断。CHD通过临床数据诊断，并经冠状动脉造影确认。冠状动脉粥样硬化的严重程度通过CHD Gensini累积指数评估。所有患者年龄在33 - 87岁之间。结果显示，MetS不同个体组成部分中CHD的年龄和性别调整后的比值比（OR）如下：低高密度脂蛋白（low-HDL），3.15（1.94 - 5.12）；高空腹血糖（high-FPG），2.26（1.63 - 3.69）；高血压（high-BP），2.13（1.38 - 3.29）；高甘油三酯（high-TG），1.55（1.13 - 2.11）；所有P < 0.05，而高体重指数（high-BMI），0.75（0.55 - 1.03）以及高腰围，0.75（0.51 - 1.10），两者P > 0.05。在所有组成部分中，low-HDL、high-FPG和high-BP三联征的CHD OR最高：4.28（3.12 - 5.87）（P < 0.001）。MetS受试者的病变血管数量和CHD Gensini指数显著增加（P < 0.001）。当分别考虑MetS的各个组成部分时，low-HDL组、high-FPG组或high-BP组的病变血管数量和Gensini指数均显著增加（所有P < 0.001）。总之，我们目前的结果表明，MetS的各个组成部分及其不同组合对CHD和冠状动脉狭窄的严重程度可能有不同贡献。临床重点应继续放在建立CHD的最佳风险算法上。
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