代谢综合征可能比传统危险因素更能预测冠心病患者预后

目的 分析冠心病血运重建患者心血管危险因素的流行情况及对预后的影响,探讨集中了5个心血管危险因素(肥胖,糖代谢异常,高血压,高甘油三酯血症,低高密度脂蛋白胆固醇血症)的代谢综合征在冠心病患者中的流行趋势和预后意义.方法 研究对象来自单中心注册研究DESIRE(Drug-Eluting Stent Impact on Revascularization),入选2003年7月至2004年9月30日在我院接受血运重建治疗(经皮冠状动脉介入或冠脉旁路移植术)的所有患者,记录其临床资料,及随访期间临床不良事件,患者死亡为随访终止,记录死亡时间.代谢综合征定义采用美国2005年美国胆固醇教育计划成人治疗专家组修订(2005 NCEP ATP Ⅲ)的代谢综合征定义,以体质指数(BMI)≥25 kg/m2代替腹围指标.结果 相应临床资料记录完整的患者1911例,平均年龄(60±10)岁,男性1458例,占76.3%.截止到2007年底随访时间中位数为3.5年(293～1855 d).把患者按照是否发生主要不良心脑血管事件(MACCE)分为2组,发现在MACCE组仅空腹血糖明显高于无MACCE组(P=0.049).应用多因素Logistic分析,未发现传统心血管危险因素对随访期间的MACCE和病死率有明显影响,未见任何传统心血管危险因素对预后有预测意义,而只有把集合了5个心血管危险因素的代谢综合征作为一个整体危险因素,和其他传统危险因素一起放入Logistic模型中,观察对预后的影响时,发现只有代谢综合征可以显著预测冠心病患者的预后(P=0.035,OR=1.319,95%CI 1.020-1.706).结论 在冠心病血运重建患者中,传统心血管危险因素中只有代谢综合征可以预测冠心病患者的不良预后.

Metabolic syndrome may be better at predicating the prognosis of coronary artery disease than other traditional cardiovascular risk factors

Objective The prevalence of cardiovascular risk factors is growing.People with metabolic syndrome (MS) plus five cardiovascular risk factors are at a higher risk of developing coronary artery disease (CAD).The effect of metabolic syndrome on outcomes in patients with preexisting CAD has not been well studied.The present study Wag conducted to assess the prevalence,characteristics and longterm prognosis of CAD with metabolic syndrome and to determine which factor is the most influential prognostic factor of CAD.Methods The DESIRE(drug-eluting stent impact on revascularizafion) registry represented a database of 2368 CAD patients between July 2003 and September 2004.The median long-term follow-up Was 3.5 years (293-1855 days).Metabolic syndrome was based on the modified version of Adult Treatment Panel (ATP) Ⅲ Definition of Metabolic Syndrome in 2005 using body mass index (BMI) instead of waist circumference.We tested the utility of MS and its components to predict the incidence of major adverse cardiac and cerebral events (MACCE) in a large cohort of patients undergoing revascu|arization.Results The presence of MACCE was predicted only by MS (OR=1.319,95% CI 1.020-1.706,P=0.035) but not other cardiovascular risk factors,such as advance age,male,smoking,high LDL cholesterol and CAD family history.MS was present in 45.6% (high fasting glucose 44.5%;high triglyceride 45.0%;low HDL 50.8%;high blood pressure 61.4%;high BMI 60.7%).Conclusion Among the traditional cardiovascular risk factors,only metabolic syndrome has a primary predictive ability for MACCE in CAD patients.