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目的了解代谢综合征(MS)合并糖尿病(DM)与心血管病(CVD)的关系,为预防和控制CVD的发病提供参考依据。方法采用前瞻性研究方法,于1999年4月—2004年6月对在江苏省分层整群抽取的8 685名≥35岁居民进行基线调查,并于2006年3月—2007年10月对基线调查满5年并符合本研究标准的3 887名居民进行随访,分析并比较MS各组分和DM与CVD的关系。结果随访期间3 887名居民中新发CVD 116例,发病率为2.98%;调整基线调查时年龄、性别及其他CVD危险因素和MS组分后,仅高血压(RR=2.58,95%CI=1.55~4.29)和DM(RR=3.54,95%CI=2.28~4.96)与CVD有联系;正常组、患MS但无DM组、患DM但无MS组和MS合并DM组CVD累计发病率分别为1.53%、4.47%、9.17%和13.30%;调整基线调查时性别、年龄及其他CVD危险因素后,患MS但无DM组、患DM但无MS组和MS合并DM组CVD的发病风险分别为正常组的1.96、4.11和7.10倍;调整性别、年龄和其他危险因素后,MS患者中患DM者相对于未患DM者发生CVD的RR值及其95%CI为2.23(1.65~3.29),而DM患者中患MS者相对于未患MS者发生CVD的RR值及其95%CI为1.36(0.85~2.03);高血压组基线为DM者和非DM者随访CVD累计发病率分别为16.0%和4.0%;血压正常组基线为DM者和非DM者随访CVD累计发病率分别为7.5%和1.1%;调整基线调查时年龄、性别及其他CVD危险因素和MS组分后,高血压组DM者随访期间患CVD的风险是非DM者的3.31倍,血压正常组DM者随访期间患CVD的风险是非DM者的6.02倍。结论 MS合并DM患者更易患CVD,控制DM可降低MS患者CVD的发病风险。
Objective To understand the relationship between metabolic syndrome (MS) with diabetes mellitus (DM) and cardiovascular disease (CVD) and provide a reference for the prevention and control of CVD. Methods A prospective study was conducted to investigate the prevalence of 8 685 residents aged 35 years and older in the stratified cluster in Jiangsu Province from April 1999 to June 2004. The data were collected from March 2006 to October 2007 A total of 3,887 residents who were baseline surveyed for 5 years and met the criteria of this study were followed up to analyze and compare the relationship between MS components and DM and CVD. Results Of the 3 887 residents who were followed up, 116 were newly diagnosed with CVD, with an incidence rate of 2.98%. After adjustment for age, sex and other CVD risk factors and MS components in the baseline survey, only hypertension (RR = 2.58, 95% CI = 1.55 ~ 4.29) and DM (RR = 3.54, 95% CI = 2.28 ~ 4.96) were associated with CVD; normal group, suffering from MS but no DM group, but no MS group and MS combined DM group cumulative incidence of CVD Were 1.53%, 4.47%, 9.17% and 13.30%, respectively. After adjustment for gender, age and other CVD risk factors at baseline, the risk of developing CVD was higher in MS patients without MS than in MS patients Were 1.96, 4.11 and 7.10 times of those in the normal control group. After adjusting for gender, age and other risk factors, the RR of CVD and the 95% CI of 2.23 (1.65-3.39) , While the RR of CVD and the 95% CI of MS with MS in DM patients were 1.36 (0.85-2.03). The cumulative incidence of follow-up CVD in hypertensive patients with DM and non-DM was 16.0% and 4.0% respectively. The cumulative incidence of follow-up CVD was 7.5% and 1.1%, respectively, in patients with normotensive subjects who were baseline DM and non-DM follow-up. After adjustment for age, gender and other CVD risk factors and MS components at baseline, 3.31 times the risk of those non-DM DM patients were followed up during the CVD, normotensive DM were followed up by 6.02 times the risk of suffering from non-DM during CVD. Conclusion MS patients with DM are more susceptible to CVD and DM may reduce the risk of CVD in patients with MS.