颈动脉内中膜厚度及斑块稳定性与代谢综合征的相关性

摘要

目的 研究颈动脉内中膜厚度(IMT)及斑块稳定性与代谢综合征的相关性.方法 收集2011年3月至2012年12月于北京安贞医院健康体检中心进行颈动脉超声检查患者2 292例,根据斑块检出情况分为无斑块组(1 582例)和斑块组(710例),依据颈动脉超声检查斑块回声特征,斑块组分为稳定斑块亚组(301例)和不稳定斑块亚组(425例).结果 超重和/或肥胖(662例)、糖尿病(713例)、高血压(742例)、血脂紊乱(624例)的患者IMT分别为(1.36±0.35)、(1.49±0.41)、(1.43±0.38)、(1.51±0.48) mm,明显高于无超重和/或肥胖(737例)、糖尿病(686例)、高血压(657例)、血脂紊乱(775例)患者的(1.16 ±0.24)、(1.18±0.22)、(1.09 ±0.19)、(1.05 ±0.13) mm(P ＜0.05).超重和/或肥胖、糖尿病、高血压、血脂紊乱的患者颈动脉斑块检出率分别为55.1％(365/662)、58.6％ (418/713)、60.5％ (449/742)、68.1％(425/624),明显高于无超重和/或肥胖、糖尿病、高血压、血脂紊乱患者的46.8％(345/737)、42.6％(292/686)、39.7％ (261/657)、36.8％(285/775)(P＜0.05).具备1、2、3个代谢综合征组分患者的IMT分别为(1.31±0.24)、(1.46±0.35)、(1.66 ±0.39) mm,颈动脉斑块检出率分别为38.2％(233/610)、54.7％(223/408)、66.7％(254/381),IMT厚度及颈动脉斑块检出率均随着代谢综合征组分数目增加而增加(P＜0.05).收缩压[比值比(OR) =3.212,95％置信区间(CI):1.542～ 5.295]、空腹血糖(OR =3.082,95％ CI:1.416 ～4.985)、低密度脂蛋白胆固醇(OR=3.087,95％CI:1.654 ～7.395)、代谢综合征(OR =4.624,95％CI:1.654 ～ 7.295)是颈动脉斑块形成的独立危险因素(P＜0.05),高密度脂蛋白胆固醇(OR =0.735,95％CI:0.449 ～0.952)是颈动脉斑块形成保护因素(P＜0.05).空腹血糖(OR=2.156,95％ CI:1.424 ～5.249)、总胆固醇(OR=1.895,95％ CI:1.169 ～3.195)、代谢综合征(OR =3.652,95％ CI:1.752 ～8.985)是颈动脉不稳定斑块的独立危险因素(P＜0.05),高密度脂蛋白胆固醇(OR =0.758,95％CI:0.424～0.946)是颈动脉斑块稳定保护因素(P＜0.05).结论 代谢综合征及代谢综合征组分可增加颈动脉粥样硬化发生风险,并且与IMT增厚、斑块形成及斑块不稳定型密切相关,颈动脉超声检查有助于早期预防心血管事件发生.%Objective To study the correlation between carotid artery intima-media thickness (IMT) and plaque stability in metabolic syndrome (MS).Methods From March 2011 to December 2012 at Beijing Anzhen Hospital,carotid of 2 292 patients was examined using ultrasonography ; carotid intima-media thickness and plaque detection rate were collected.The patients were divided into none-plaque group (1 582 cases) and plaque group (710 cases) ; based on the results of carotid plaque ultrasound echo characteristics,plaque group was divided into subgroups of stable (301 cases) plaque and unstable plaque (425 cases).Results IMT of overweight and/or obesity (662 cases),diabetes (713 cases),hypertension (742cases) and dyslipidemia (624 cases) was significantly higher than that of no overweight / or obesity (737 cases),no diabetes (686cases),no hypertension (657 cases) and no dyslipidemia(775cases) [(1.36 ± 0.35),(1.49±0.41),(1.43 ± 0.38),(1.51±0.48)mmvs(1.16 ± 0.24),(1.18 ± 0.22),(1.09 ± 0.19),(1.05 ± 0.13) mm,P＜0.05].Dyslipidemiacarotid detection rate was 55.1％ (365/662),58.6％ (418/713),60.5％ (449/742),68.1％ (425/624)respectively.Carotid detection rate was 46.8％ (345/737),42.6％ (292/686),39.7％ (261/657) and 36.8％ (285/775) (P ＜ 0.05).With 1,2,3 MS components,IMT was (1.31 ± 0.24) mm,(1.46 ± 0.35) mm and (1.66±0.39) mm; carotid artery plaque detection rate was 38.2％ (233/610),54.7％ (223/408) and 66.7％ (254/381).Systolic blood pressure (OR =3.212,95％ CI:1.542-5.295),fasting plasma glucose (FPG) (OR =3.082,95％ CI:1.416-4.985),low-density lipoprotein cholesterol (LDL-C) (OR =3.087,95 ％ CI:1.654-7.395) and metabolic syndrome (OR =4.624,95％ CI:1.654-7.295) were independent risk factors of carotid artery plaque formation (P ＜ 0.05).High-density lipoprotein cholesterol (HDL-C) (OR =0.735,95 ％ CI:0.449-0.952) was a protective factor of carotid plaque (P ＜ 0.05).FPG(OR =2.156,95 ％ CI:1.424-5.249),TC (OR =1.895,95 ％ CI:1.169-3.195),MS(OR =3.652,95％ CI:1.752-8.985) and unstable carotid artery plaques were independent risk factors (P ＜ 0.05) ; HDL-C (OR =0.758,95％ CI:0.424-0.946) was a protective factor (P ＜ 0.05).Conclusions MS and MS components increase carotid atherosclerosis risk and they are closely related to the IMT thickening,plaque formation and plaque unstable ; carotid ultrasonography contributes to early prevention of cardiovascular events.