Assistance Publique-Hôpitaux de Paris, Service d'Endocrinologie et des Maladies de la Reproduction, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
Neuroendocrinology. 2010;92 Suppl 1:96-101. doi: 10.1159/000314272. Epub 2010 Sep 10.
Although the concept of metabolic syndrome (MetS) as a disease entity continues to be debated, it provides a means by which patients at risk for diabetes and cardiovascular disease can be identified and categorized with routinely available criteria. Insulin resistance plays a central role in these abnormalities. Risk factors include central obesity, elevated fasting glucose, hypertension, elevated serum triglycerides, and low high-density-lipoprotein cholesterol. Various definitions of MetS have been proposed since 1998. Recently, a joint statement by several major organizations concluded that three abnormal values in a series of five criteria determined whether a person had MetS, and that elevated waist circumference was not an obligatory feature. A single set of cutoff points was proposed, except for waist circumference, which should be defined according to population and ethnic group. Cushing's syndrome (CS) represents an archetype of MetS. High glucocorticoid levels lead to muscle, liver and adipocyte insulin resistance. Almost all patients with CS are obese or overweight, and have abdominal visceral adiposity. Many also have glucose metabolism abnormalities (21-60% and 20-47% of the patients have impaired glucose tolerance and diabetes, respectively), hypertension (more than 70% of the patients), and elevated triglyceride levels (20% of the patients). Almost two thirds of CS patients fulfill at least three criteria for MetS. The elevated incidence of diabetes and premature atherosclerosis (directly related to the length of exposure to hypercortisolism), and the increased mortality (particularly cardiovascular mortality) relative to the general population (2 to 4 times higher) show that the predictive value of MetS is also valid in CS. Effective treatment of hypercortisolism improves each of the five MetS components, but MetS and carotid atherosclerosis persist in most patients, and the cardiovascular risk therefore remains elevated. This calls for aggressive treatment of comorbidities and for very long-term follow-up.
尽管代谢综合征（MetS）作为一种疾病实体的概念仍存在争议，但它为识别和分类有糖尿病和心血管疾病风险的患者提供了一种方法，这些患者可以通过常规可用的标准来识别和分类。胰岛素抵抗在这些异常中起着核心作用。危险因素包括中心性肥胖、空腹血糖升高、高血压、血清甘油三酯升高和高密度脂蛋白胆固醇降低。自 1998 年以来，已经提出了各种代谢综合征的定义。最近，几个主要组织的联合声明得出结论，一系列五个标准中的三个异常值决定了一个人是否患有代谢综合征，并且腰围升高不是强制性特征。除了腰围，应该根据人群和种族来定义，提出了一套单一的截止值。库欣综合征（CS）代表代谢综合征的一个原型。高糖皮质激素水平导致肌肉、肝脏和脂肪细胞胰岛素抵抗。几乎所有 CS 患者都肥胖或超重，并且存在腹部内脏脂肪堆积。许多人也有葡萄糖代谢异常（分别有 21-60%和 20-47%的患者糖耐量受损和糖尿病）、高血压（超过 70%的患者）和甘油三酯水平升高（20%的患者）。几乎三分之二的 CS 患者至少符合代谢综合征的三个标准。糖尿病和早发性动脉粥样硬化的发病率升高（直接与暴露于高皮质醇的时间长短有关），以及与一般人群相比（高 2 至 4 倍）死亡率升高（尤其是心血管死亡率）表明代谢综合征的预测价值在 CS 中也是有效的。皮质醇过多症的有效治疗改善了五个代谢综合征成分中的每一个，但代谢综合征和颈动脉粥样硬化在大多数患者中仍然存在，因此心血管风险仍然升高。这需要积极治疗合并症并进行非常长期的随访。
