Service de Néphrologie et Dialyse, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Faculté de Médecine, Université de Strasbourg, Strasbourg, France.
BMC Nephrol. 2020 Aug 13;21(1):343. doi: 10.1186/s12882-020-02004-3.
In the general population, metabolic syndrome (MetS) is predictive of major adverse cardiovascular events (MACE). Waist circumference (WC), a component of the MetS criteria, is linked to visceral obesity, which in turn is associated with MACE. However, in haemodialysis (HD) patients, the association between MetS, WC and MACE is unclear.
In a cross-sectional study of 1000 HD patients, we evaluated the prevalence and characterised the clinical predictors of MetS. The relationship between MetS and its components, alone or in combination, and MACE (coronary diseases, peripheral arteriopathy, stroke or cardiac failure), was studied using receiver operating characteristics (ROC) curves and logistic regression.
A total of 753 patients were included between October 2011 and April 2013. The prevalence of MetS was 68.5%. Waist circumference (> 88 cm in women, 102 cm in men) was the best predictor of MetS (sensitivity 80.2; specificity 82.3; AUC 0.80; p < 0.05). In multivariate analysis, MetS was associated with MACE (OR: 1.85; 95CI 1.24-2.75; p < 0.01), but not WC alone. There was a stronger association between the combination of abdominal obesity, hypertriglyceridaemia and low high-density lipoprotein cholesterol with MACE after exclusion of impaired fasting glucose and hypertension.
MetS is frequent and significantly associated with MACE in our haemodialysis cohort and probably in other European dialysis populations as well. In HD patients, a new simplified definition could be proposed in keeping with the concept of the "hypertriglyceridaemic waist".
在普通人群中，代谢综合征（MetS）可预测主要不良心血管事件（MACE）。腰围（WC）是 MetS 标准的一个组成部分，与内脏肥胖有关，而内脏肥胖又与 MACE 相关。然而，在血液透析（HD）患者中，MetS、WC 与 MACE 之间的关系尚不清楚。
我们对 1000 例血液透析患者进行了横断面研究，评估了 MetS 的患病率，并对其临床预测因素进行了特征描述。使用受试者工作特征（ROC）曲线和逻辑回归研究了 MetS 及其各组成部分单独或联合与 MACE（冠心病、外周动脉疾病、中风或心力衰竭）之间的关系。
共有 1013 例患者于 2011 年 10 月至 2013 年 4 月入组。MetS 的患病率为 68.5%。腰围（女性>88cm，男性>102cm）是 MetS 的最佳预测指标（敏感性 80.2%，特异性 82.3%，AUC 0.80，p<0.05）。多变量分析显示，MetS 与 MACE 相关（OR：1.85；95%CI 1.24-2.75；p<0.01），但与 WC 无关。排除空腹血糖受损和高血压后，腹部肥胖、高三酰甘油血症和低高密度脂蛋白胆固醇的联合与 MACE 之间的相关性更强。
在我们的血液透析队列中，MetS 很常见，且与 MACE 显著相关，在其他欧洲透析人群中可能也是如此。在 HD 患者中，可能需要提出一种新的简化定义，以符合“高三酰甘油血症性腰围”的概念。
