University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands.
Diabetes Care. 2014 Sep;37(9):2515-21. doi: 10.2337/dc14-0154. Epub 2014 Jun 19.
Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors leading to atherosclerosis and diabetes. Diabetes is associated with both structural and functional abnormalities of the brain. MetS, even before diabetes is diagnosed, may also predispose to cerebral changes, probably through shared mechanisms. We examined the association of MetS with cerebral changes in patients with manifest arterial disease.
Cross-sectional data on MetS and brain MRI were available in 1,232 participants with manifest arterial disease (age 58.6 ± 10.1 years; 37% MetS). Volumes of brain tissue, ventricles, and white matter hyperintensities (WMH) were obtained by automated segmentation and expressed relative to intracranial volume. Infarcts were distinguished into lacunar and nonlacunar infarcts.
The presence of MetS (n = 451) was associated with smaller brain tissue volume (B -0.72% [95% CI -0.97, -0.47]), even in the subgroup of patients without diabetes (B -0.42% [95% CI -0.71, -0.13]). MetS was not associated with an increased occurrence of WMH or cerebral infarcts. Impaired glucose metabolism, abdominal obesity, and elevated triglycerides were individual components associated with smaller brain volume. Obesity and hypertriglyceridemia remained associated with smaller brain volume when patients with diabetes were excluded. Hypertension was associated with an increased occurrence of WMH and infarcts.
In patients with manifest arterial disease, presence of MetS is associated with smaller brain volume, even in patients without diabetes. Screening for MetS and treatment of its individual components, in particular, hyperglycemia, hypertriglyceridemia, and obesity, may prevent progression of cognitive aging in patients with MetS, even in a prediabetic stage.
代谢综合征（MetS）是一组心血管危险因素，可导致动脉粥样硬化和糖尿病。糖尿病与大脑的结构和功能异常都有关。即使在诊断出糖尿病之前，MetS 也可能使大脑发生变化，这可能是通过共同的机制。我们研究了代谢综合征与表现为动脉疾病的患者大脑变化之间的关系。
在 1232 名表现为动脉疾病的患者（年龄 58.6±10.1 岁；37%患有代谢综合征）中，我们获得了关于代谢综合征和脑 MRI 的横断面数据。通过自动分割获得脑组织、脑室和脑白质高信号（WMH）的体积，并相对于颅内体积表示。梗死分为腔隙性和非腔隙性梗死。
存在代谢综合征（n=451）与脑组织体积较小有关（B-0.72%[95%CI-0.97，-0.47]），即使在没有糖尿病的患者亚组中也是如此（B-0.42%[95%CI-0.71，-0.13]）。代谢综合征与 WMH 或脑梗死的发生率增加无关。葡萄糖代谢受损、腹部肥胖和甘油三酯升高是与脑体积较小相关的个体成分。当排除糖尿病患者时，肥胖和高甘油三酯血症仍与脑体积较小相关。高血压与 WMH 和梗死的发生率增加有关。
在表现为动脉疾病的患者中，存在代谢综合征与脑体积较小有关，即使在没有糖尿病的患者中也是如此。筛查代谢综合征及其各个成分，特别是高血糖、高甘油三酯血症和肥胖症，可能会预防代谢综合征患者认知老化的进展，即使在糖尿病前期也是如此。
