C反应蛋白水平与代谢综合征及其组分患病风险的研究

目的探讨C反应蛋白（CRP）水平的变化与代谢综合征（MS）及其相关组分的患病风险。方法取自1998～2001年上海华阳、曹杨社区代谢综合征及其相关疾病的流行病学基线调查资料,5502例（男2379例,女3123例）20岁以上人群,具有完整的体脂参数、血压、血脂、胰岛素及CRP的资料者纳入本次分析。代谢综合征及其相关组分的诊断标准采用1999年WHO代谢综合征的工作定义。超敏C反应蛋白测定采用速率散射比浊法。结果（1）该社区人群中代谢综合征及其各组分的患病率分别为高血糖21．63％（糖尿病9．21％,糖调节异常12．41％）,高血压32．95％,高甘油三酯（TG）／低高密度脂蛋白胆固醇（HDL—C）血症46．04％,中心性肥胖40．68％,代谢综合征13．98％。（2）CRP水平均随年龄增加而升高（趋势分析P〈0．01）。（3）1—2项代谢异常亚组及MS亚组的CRP水平显著增高于无代谢异常亚组（P〈0．01）,MS亚组的CRP水平显著高于1～2项代谢异常亚组明显增加（P〈0．01）。代谢综合征的发生随CRP水平的升高而递增（趋势分析P〈0．001）。（4）把男、女人群的CRP值分或4分位数,以ms各组分及ms为应变量,CRP各分布位点为自变量进行Logistic回归分析。与CRP处于下114位点人群比较,CRP位于上114位点者各代谢异常风险增加的幅度为：男性高血糖3．8倍、高血压2．8倍、高TG 1．3倍、低HDL—C 1．5倍、中心性肥胖5．5倍及MS10．0倍,女性高血糖7．7倍、高血压6．1倍、高TG 3．6倍、低HDL—C1．1倍、中心性肥胖2．2倍及MS8．6倍。结论（1）CRP水平与增龄有关,年龄越大,CRP水平越高;（2）同一个体所聚集的代谢异常的数目越多,CRP水平越高;（3）代谢综合征的发生频率随CRP水平升高而递增;男性CRP水平大于2．11mg/L及女性CRP水平大于2．22mg/L者,出现高血糖、血脂紊乱、高血压、中心性肥胖及代谢综合征的风险显著增加。

Association between C-reactive protein level and metabolic syndrome and components thereof

Objective To investigate the relationship between serum C-reactive protein (CRP) and metabolic disorders in individuals in Shanghai communities and to assess the value of CRP level on the risk of metabolic disorders. Methods A total of 5502 individuals (males 2379 , females 3123 ) aged over 20 years with complete baseline data on metabolic syndrome ( MS) and serum CRP from 1998 to 2001 in two communities of Shanghai were included. Highly sensitive CRP was tested by kinetics nephelometry. Quartiles of concentration of CRP were computed. Hyperglycemia ( diabetes or impaired glucose regulation) , hypertension, dyslipidemia, centra] obesity and MS were defined by WHO ( 1999) working definition of MS. Logistic regression model was used to estimate the relation between CRP level and relative risks of metabolic disorders. Results (1 ) In this two communities based population the prevalences of metabolic syndrome and its components were as follow: hyperglycemia 21. 63% ( diabetes 9. 21% , impaired glucose regulation 12. 41% ) , hypertesion 32. 95% , high triglyceride (TG) / low high-density lipoprotein cholesterol (HDL- C) 46.04%, central obesity 40.68% and metabolic syndrome 13.98% . (2) Serum CRP level was gradually elevated with the increment of ages in both men and women ( P < 0. 01 ). (3 ) Serum CRP level was increased with the increment of the components of metabolic disorders(P <0. 01 ). In individuals with MS, CRP level was higher than in those with 1 or 2 components of metabolic disorders ( P < 0. 01 ) . (4) The highest quartile of CRP was 2.11 mg/L in men and 2. 22 mg/L in women. (5 ) Compared with those in the lowest quartile, men in the highest quartile had increased relative risk of hyperglycemia (3.8 times), central obesity (5. 5 times) , hypertension (2. 8 times) , hypertriglyceride (1.3 times) , low HDL-C ( 1. 5 times) and MS (10 times) . Similarly, women in the highest quartile had increased relative risk of hyperglycemia (7.7 times), central obesity (12.2 times), hypertension (6.1 times), hypertriglyceride (5.6 times) , low HDL-C (1.1 times) and MS (8.5 times). Conclusion ( 1 ) CRP level was related to the increment of age. (2) Individuals with more components of metabolic syndrome had higher serum CRP level. ( 3 ) The incidence of metabolic syndrome was increased with the increment of CRP level. The risk of metabolic disorders including hyperglycemia, hypertension, dyslipidemia, central obesity and metabolic syndrome was significantly elevated in men with CRP level over 2. 11 mg/L and women with CRP level over 2. 22 mg/L.