代谢综合征与心血管疾病和痴呆的关系

doi:10.3969/j.issn.1000-8535.2017.04.012

摘要/Abstract

摘要： 目的探讨代谢综合征(metabolic syndrome, MS)(指包括高血压,糖尿病,高脂血症和腹型肥胖的一组综合征)在中国南方老年病人的患病率、及其与心血管事件和痴呆关系。方法本研究为一个中国南方老年人代谢综合征的横断面研究。我们采集了患者的病史、人口学和生化资料。对比生化资料、心血管事件、痴呆等疾病在MS组和非MS组中的差异,并使用Logistic回归分析来寻找MS的独立影响因子。结果本研究共纳入206例患者。其中有92(44.66%)例患者符合代谢综合征的诊断标准。女性在MS组中35例(38.04%)明显高于在非MS组中28例(24.56%)。整体年龄(86.74± 6.10),在MS组(86.37±5.74)和非MS组(87.04±6.38)对比中无统计学意义。生化资料对比中,白细胞[(7.46±2.38) vs (6.46±2.35),P=0.003]和血肌酐[94.50(68.50, 129.33) vs 78.00(64.50, 99.75),P=0.004]在MS组中较高。Logistics单因素回归分析及多因素回顾分析提示白细胞、血肌酐和女性为MS的独立风险因子。心肌梗塞(35例,38.04%和心绞痛(28例, 24.56%)在MS组中明显高于非MS组中心肌梗塞(10例,8.77%)和心绞痛(39例,34.21%),两组比较有统计学意义,Logistics回归分析发现MS是心肌梗塞和心绞痛的独立影响因子;但是心衰和中风在两组对比中无统计学差别。痴呆(包括老年性痴呆和血管性痴呆)在MS组中明显低于非MS组:26例(28.26%)vs 50例(43.86%),提示MS可能对痴呆有预防作用。结论 MS在中国南方老年患者中普遍存在,女性、白细胞、血肌酐为MS的独立影响因子;MS是心肌梗塞和心绞痛的独立影响因子;MS中痴呆明显低于非MS组,可能对痴呆有预防保护性作用。

关键词: 代谢综合征, 心血管事件, 痴呆, 老年人

Abstract: Objective To study the prevalence and correlation between the metabolic syndrome MS (including hypertension, diabetes, hyperlipidemia and obesity) with cardiovascular and dementia in the elderly people of south China. Methods This cross-sectional research studied metabolic syndrome of the elderly in south China. We collected the demographics and chemotic data and compared them in MS and non-MS group. And Logistic regression was used to analyze the independent factor of MS and the relationship between MS and the cardiovascular disease and dementia. Results This study included 206 patients and 92 (44.66%) of them were diagnosed as MS. 35 patients (38.04%) in MS group were female and 28 female cases (24.56%) in non-MS group. The mean age of the sample was (86.74±6.10) and the comparison between the MS group (86.37±5.74) and non-MS group (87.04±6.38) was not significantly different. White blood cell (WBC) (7.46±2.38 vs 6.46±2.35,P=0.003) and serum creatinine (Scr) was significantly [94.50(68.50,129.33) vs 78.00(64.50, 99.75),P=0.004]in MS group versus in non-MS group. Single factor and Multinomial logistic regression found WBC, serum creatinine and female gender were the independent risk factors of MS. Myocardial infarction (35, 38.04%) and angina (28, 24.56%) were significantly higher in MS group than that in non-MS group (10, 8.77%) and (39, 34.21%), respectively, with P<0.05. Logistic regression found MS was an independent risk factor of myocardial infarction and angina but not in heart failure and stroke. Dementia (including Alzheimer disease and vascular dementia) was found lower in MS group (26, 28.26%) than that in non-MS group (50, 43.86%), the difference was significant and this means MS could be protective for dementia. Conclusion MS is prevalent in the elderly of south China. Female gender, WBC and Scr were independent factors of MS; MS was the independent risk factor of myocardial infarction and angina; dementia was significantly lower in MS group, implying MS could be protective to dementia.

Key words: Metabolic syndrome, Cardiovascular disease, Dementia, Elderly

谷文龙, 黄玉宇, 王红武, 何婷, 李昶, 王敏健. 代谢综合征与心血管疾病和痴呆的关系[J]. 广州医药, 2017, 48(4): 51-55.

GU Wenlong, HUANG Yuyu, WANG Hongwu, HE Ting, LI Chang, WANG Minjian. The relationship between diabetic syndrome and cardiovascular disease and dementia[J]. Guangzhou Medical Journal, 2017, 48(4): 51-55.

参考文献

[1] REAVEN G M. Role of insulin resistance in human disease[J]. Diabetes,1988(37):1595-1607.
[2] GRUNDY S M, CLEEMAN J I, DANIELS S R, et al. Diagnosis and management of the metabolic syndrome. An American Heart Association/National Heart, Lung, and Blood Institute Scientifc Statement. Executive summary[J]. Cardiol Rev, 2005(13): 322-327.
[3] ALBERTI K G, ZIMMET P, SHAW J. Metabolic syndrome-a new world-wide defnition. A Consensus Statement from the International Diabetes Federation[J]. Diabet Med, 2006(23): 469-480.
[4] MOY F M, BULGIBA A. The modified NCEP ATP III criteria maybe better than the IDF criteria in diagnosing Metabolic Syndrome among Malays in Kuala Lumpur[J]. BMC Public Health, 2010(10): 678.
[5] SAFIRI S, KHAZAEI S, MANSORI K, et al. All cause mortality and body mass index in a young Asian occupational cohort without baseline metabolic syndrome components: Methodological issues[J]. Int J Cardiol,2017(229):90.
[6] YOUNIS A, YOUNIS A, TZUR B, et al. Metabolic syndrome is independently associated with increased 20-yearmortality in patients with stable coronary artery disease[J]. Cardiovasc Diabetol, 2016, 15(1):149.
[7] CHEN Q, ZHANG Y, DING D, et al. Metabolic syndrome and its individual components with mortality among patients with coronary heart disease[J]. Int J Cardiol,2016(224):8-14.
[8] LI Z, YANG X, YANG J, et al. The cohort study on prediction of Incidence of all-Cause mortality by metabolic syndrome[J]. PLoS One, 2016, 11(5):e0154990.
[9] AMOUZEGAR A, MEHRAN L, HASHEMINIA M, et al. The predictive value of metabolic syndrome for cardiovascular and all-cause mortality: Tehran Lipid and Glucose Study[J]. Diabetes Metab Res Rev, 2017, 33(1):e 2819.
[10] LOKE S S, CHANG H W, LI W C. Association between metabolic syndrome and bone mineral density in a Taiwanese elderly population[J]. J Bone Miner Metab, 2017(16):1-9.
[11] NG T P, FENG L, NYUNT M S, et al. Metabolic Syndrome and the Risk of Mild Cognitive Impairment and Progression to Dementia: Follow-up of the Singapore Longitudinal Ageing Study Cohort[J]. JAMA Neurol, 2016,73 (4):456-463.
[12] CAI W, URIBARRI J, ZHU L, CHEN X, et al. Oral glycotoxins are a modifiable cause of dementia and the metabolic syndrome in mice and humans[J]. Proc Natl Acad Sci U S A, 2014, 111(13):4940-4945.
[13] MULLER M, TANG MX, SCHUPF N, et al. Metabolic syndrome and dementia risk in a multiethnic elderly cohort[J]. Dement Geriatr Cogn Disord, 2007, 24(3):185-192.
[14] VAGUE J. La differenciation sexuelle, facteur determinant des formes de l'obesite[J]. Presse Med, 1947(30):339-340.
[15] REAVEN G M. Banting lecture 1988. Role of insulin resistance in human disease[J]. Diabetes, 1988, 37:1595-1607.
[16] ALBERTI K G, ZIMMET P Z. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation[J]. Diabet Med, 1998(15):539-553.
[17] BALKAU B, CHARLES M A. Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR)[J]. Diabet Med, 1999(16):442-443.
[18] ALBERTI K G, ZIMMET P, SHAW J, et al. IDF Epidemiology Task Force Consensus Group: The metabolic syndrome da new worldwide definition 2005[J]. Lancet, 2005(366):1059-1062.
[19] EXPERT PANEL ON DETECTION, EVALUATION, AND TREATMENT OF HIGH BLOOD CHOLESTEROL IN ADULTS. Executive summary of the third report of The National Cholesterol Education Program (NCEP) Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III)[J]. JAMA, 2001, 285(19): 2486-2489.
[20] YANG J, LIU J, LIU J, et al. Genetic association study with metabolic syndrome and metabolic-related traits in a cross-sectional sample and a 10-year longitudinal sample of Chinese elderly population[J]. PLoS One, 2014, 9(6): 100548.
[21] VISCOGLIOSI G, ANDREOZZI P, CHIRIAC I M, et al. Screening cognition in the elderly with metabolic syndrome[J]. Metab Syndr Relat Disord, 2012, 10(5):358-362.
[22] BABIO N, IBARROLA-JURADO N, BULLÓ M, et al. White blood cell counts as risk markers of developing metabolic syndrome and its components in the PREDIMED study[J]. PLoS One, 2013,8(3): e58354.
[23] WANG J, LI X, HAN X, et al. Serum creatinine levels and risk of metabolic syndrome in a middle-aged and older Chinese population[J]. Clin Chim Acta, 2015(440):177-182.
[24] PUCCI G, ALCIDI R, TAP L, et al. Sex- and gender-related prevalence, cardiovascular risk and therapeutic approach in metabolic syndrome: a review of the literature[J]. Pharmacol Res, 2017(120):34-42.
[25] LIU L, MIURA K, FUJIYOSHI A, et al. Impact of metabolic syndrome on the risk of cardiovascular disease mortality in the United States and in Japan[J]. Am J Cardiol,2014, 113(1):84-89.
[26] TUNE J D, GOODWILL A G, SASSOON D J, et al. Cardiovascular consequences of metabolic syndrome[J]. Transl Res, 2017(183):57-70.
[27] NG T P, FENG L, NYUNT M S, et al. Metabolic Syndrome and the Risk of Mild Cognitive Impairment and Progression to Dementia: Follow-up of the Singapore Longitudinal Ageing Study Cohort[J]. JAMA Neurol, 2016, 73(4):456-463.
[28] SOLFRIZZI V, SCAFATO E, CAPURSO C, et al. Italian Longitudinal Study on Aging Working Group. Metabolic syndrome, mild cognitive impairment, and progression to dementia. The Italian Longitudinal Study on Aging[J]. Neurobiol Aging, 2011, 32(11):1932-1941.
[29] RAFFAITIN C, GIN H, EMPANA J P, et al. Metabolic syndrome and risk for incident Alzheimer's disease or vascular dementia: the Three-City Study[J]. Diabetes Care, 2009,32(1):169-174.
[30] WONG S K, CHIN K Y, SUHAIMI F H, et al. The relationship between metabolic syndrome and osteoporosis: a review[J]. Nutrients,2016, 8(6):347.