代谢综合征在缺血性卒中患者心脑血管事件发生中的作用  

Metabolic syndrome is an independent risk factor for cardiovascular disease events in patients with ischemic stroke

作　　者：刘川[1] 冯明[1] 方向华[1] 穆丽媛 刘宏军[1] 张红梅[1] 秦晓明[1] 江滨[3] 金松龄 

机构地区：[1]首都医科大学宣武医院,100053 [2]北京市社区卫生协会 [3]北京市神经外科研究所

出　　处：《中华心血管病杂志》2011年第4期358-362,共5页Chinese Journal of Cardiology

基　　金：基金项目：首都医学发展基金重点支持项目（2005-2051）

摘　　要：目的 探讨缺血性卒中患者合并代谢综合征（metabolic syndrome,MS）与心血管（cardiovascular disease,CVD）事件发病的关系.方法于2003年1月至2006年12月期间对北京市5家二级医院所属的社区卫生服务中心/站就诊的首次或二次缺血性卒中患者进行登记,进行基线调查,随后进行随访,记录CVD事件发病情况,随访截止到2008年12月31日.采用2004年中华医学会糖尿病学分会关于代谢综合征的建议定义MS,用COX比例风险模型计算风险比（HR）和95%可信区间（95%CI）,并控制各种混杂因素.结果共入选1087例缺血性卒中患者,基线调查时MS患病率为40.4%.随访时间平均3.5年,共有178例患者新发CVD事件.结果显示,MS是CVD事件发生的独立预报因素,在控制了年龄、性别、吸烟、饮酒、婚姻、文化程度、就诊医院、卒中次数、卒中病程、抑郁状态、认知功能、ADL依赖等因素后,MS组CVD事件发病危险是非MS组的1.44倍（HR：1.44,95% CI：1.06～1.95）;结果还显示,与仅有1个MS组分的患者相比,存在2个、3个以上MS组分的患者,其CVD事件发病的危险分别增加了30%（HR：1.30,95%CI：0.83～2.04）和69%（HR：1.69,95% CI：1.11～2.56）.MS各组分中,高血糖和高血压是CVD事件发病的独立危险因素,危险分别增加了78%（HR：1.78,95%CI：1.26～2.52）和91%（HR：1.91,95%CI：1.11～3.30）.结论 MS是缺血性卒中患者发生CVD事件的独立危险因素,CVD事件的发生与代谢组分异常的数量呈剂量反应关系.Objective To explore the association between metabolic syndrome （MS） and risk of cardiovascular disease events （CVD） in patients with ischemic stroke. Method A total of 1087 patients with ischemic stroke were enrolled from 5 community-based medical centres and underwent baseline evaluation on risk factors of stroke during the period of Jar. 2003 to Dec. 2006. After baseline survey, all patients were followed up until Dec 31, 2008 and new CVD events were recorded. MS was defined using CDS criteria. Proportional hazard models were used to assess the HRus and 95% CI of CVD events associated with MS and other components. Results The prevalence of MS was 40. 4% at baseline. During an average follow-up of 3.5 years, 178 patients developed new CVD events. After adjusted for age, gender, smoking,drinking, marriage status, education level, hospitalization, recurrence of stroke, stroke duration,depression, cognition impairment and ADL, MS remains the independent predictor for the risk of CVD events. Compared with patients with non-MS, the risk of CVD events increased by 44% （HR：1.44, 95%CI：1.06-1.95 ）. The risk of CVD also increased with the number of MS components. Compared with patients with 1 or less than 1 components of MS, the risk of CVD events increased by 30% （HR：1. 30,95%CI：0.83-2.04） in those with 2 components and by 69% （ HR： 1.69,95% CI： 1.11-2.56） in those with 3or more components of MS. Hypertension and hyperglycemia and impaired fasting glucose also served as independent risk factors for CVD event （ all P 〈 0. 001 ） . Conclusions MS was independently associated with increased risk of CVD events in patients with ischemic stroke. There was a dose-response relationship between the numbers of MS components and the risk of CVD event.

关 键 词：代谢综合征X 脑血管意外 前瞻性研究 

分 类 号：R589[医药卫生—内分泌] R743.3[医药卫生—内科学]