代谢综合征对冠心病血运重建患者预后的影响

目的 探讨集中了5个心血管病危险因素(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1日至2004年9月30日在首都医科大学附属安贞医院接受血运重建治疗[经皮冠状动脉介入(PCI)或冠状动脉旁路移植术(CABG)]的2368例患者,选择其中身高、体重、血压、血糖和血脂等记录完整的患者共1911例,平均年龄(60±10)岁,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2005年美国胆固醇教育计划成人治疗专家组修订(NCEP ATP Ⅲ)的定义,以体重指数(BMI)≥25 kg/m2代替腹围指标.计量资料均值应用-x±s表示,两组间比较采用t检验,多组间比较采用方差分析,计数资料采用x2检验,不良事件与代谢综合征患者的相关性应用Logistic和Cox回归分析.结果 相应临床资料记录完整的患者1911例,其中男性1458例占76.3%.截至2007年底随访时间中位数为3.5年(293～1855 d).按照是否合并代谢综合征将患者分为2组,发现合并代谢综合征对住院期间和随访期间的死亡率没有影响,但明显增加随访期间主要不良心脑血管事件(MACCE)的发生率(P＜0.05).随访3.5年,合并代谢综合征患者增加的MACCE事件主要表现在:再次血运重建事件、脑卒中事件和再入院事件(P＜0.05);把性别、年龄、血脂等心血管危险因素放入Logistic模型中,比较影响总MACCE发生的危险因素,仅发现合并代谢综合征是影响总MACCE发生的惟一因素(OR 1.319,95%CI 1.020～1.706,P＜0.05).应用Logistic回归分析代谢综合征5个组成成分对随访MACCE的影响,发现糖代谢异常(OR 1.047,95% CI 1.005～1.091,P＜0.05)和低高密度脂蛋白胆固醇血症(OR 0.777,95%CI0.610～0.989,P＜0.05

Effect of metabolic syndrome on prognosis of revascularization in patients with coronary artery disease

Objective This study was conducted to assess the prevalence, characteristics, inhospital and long term prognosis of coronary artery disease (CAD) with metabolic syndrome(MS), and to determine the factors that influencing the CAD prognosis most. Methods The DESIRE (drug-eluting stent impact on revascularization) registry represents a database of 2368 patients with CAD between July 2003 and September 2004. Median long-term follow-up was 3.5 years(293-1855 days). The diagnosis of MS was based on the modified Adult Treatment Panel (ATP) Ⅲ Definition of the MS in 2005 ,using body mass index (BMI) instead of waist circumference. We tested the ability of MS and its components in predicting the incidence of major adverse cardiac and cerebral events (MACCE) in a large cohort of patients undergoing revascularization. Results Presence of MACCE was predicted only by MS (adjusted odds ratio (OR) =1.319,95% CI 1.020-1.706,P =0.035) but not other risk factors of cardiovascular (such as old age, male, smoking, high LDL cholesterol, CAD family history). MS was present in 45.6% (high FG 44.5%;high TG 45.0%; low HDL-C 50.8%; high BP 61.4%; high BMI 60.7%). After a follow-up of 3.5 ys,the ratio of MACCE in CAD patients with metabolic syndrome increased significantly (18.9% vs 15.6%, P =0.036). In multivariable model of five factors of MS, MACCE was predicted by high FG(fasting glucose)(OR = 1.047,95% CI 1.005-1.091, P ＜ 0.05) and low HDL-C (OR = 0.777, 95% CI 0.610-0.989, P ＜0.05). MS confers a higher risk of long-term MACCE in CAD patients with (OR = 1.258, 95% GI 1.010-1.607 , P ＜ 0.05) or without diabetes (OR = 1.139 , 95% CI 1.004-1.505 ,P ＜ 0.05) . Conclusions MShas primary predictive ability for MACCE in CAD patients, carried primarily by high FG and low HDL. MS confers a higher risk of long-term MACCE in CAD patients with or without diabetes.