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目的 了解2型糖尿病(T2DM)合并代谢综合征(MS)患者发生心脑血管疾病的风险.方法 2008年在北京市新街口社区中心就诊的T2DM患者376例,其中单纯T2DM患者118例(单纯T2DM组),糖尿病合并MS患者258例(68.6％,T2DM合并MS组),T2DM合并MS患者的BMI、腰围、臀围、收缩压、舒张压、空腹血糖、糖化血红蛋白(HbA1c)、TG、TC、HDL-C、血尿酸水平,高于单纯T2DM患者,差异有统计学意义(均P＜0.05).所有患者均继续入组前三甲医院确定的药物干预方案进行治疗,在社区进行健康教育与随访的糖尿病管理方案,即每6个月随访1次,检测BMI、血压、血脂、空腹血糖、餐后2h血糖、HbA1c水平及肝肾功能、心脑血管疾病发生情况,共随访6年.结果 ①随访结束时,T2DM合并MS组的BMI、腰围、臀围、颈围、收缩压、餐后血糖、HDL-C比单纯T2DM组水平高,差异均有统计学意义(t值分别为-7.42、-6.63、-5.09、-3.02、-2.88、-3.60和2.33,均P＜0.05),其中T2DM合并MS组的收缩压下降2.99 mmHg(1 mmHg =0.133 kPa)、HbA1c下降0.43％、LHL-C水平下降0.50 mmol/L,单纯T2DM组收缩压下降1.58 mmHg、HbA1c下降0.01％、LHL-C水平下降0.68 mmol/L,两组干预前后的收缩压、HbA1c、LHL-C差值比较差异均有统计学意义(t值分别为2.34、2.28、1.98,均P＜0.05);②单纯T2DM组发生心脑血管疾病6例(5.1％,6/118),T2DM合并MS组发生34例(13.2％,34/258);Kaplan-Merier分析,两组患者心脑血管疾病累积风险的差异有统计学意义(x2=3.877,P=0.049);③Cox回归分析显示,T2DM合并MS组发生心脑血管疾病风险比(HR)是单纯T2DM组的2.21倍(95％ CI:1.02 ～4.73);调整性别、年龄、教育程度的影响后,T2DM合并MS组发生心脑血管疾病风险比是单纯T2DM组的2.31倍(95％CI:1.01～5.28).结论 T2DM患者合并MS增加心脑血管疾病发生的风险,社区T2DM患者的管理要加强对MS的干预.

Objective To investigate the risk factors of cardiocerebrovascular events in type 2 diabetic (T2DM) patients with metabolic syndrome (MS).Methods Total 376 patients with type 2 diabetes,including 258 cases with metabolic syndrome and 118 cases without metabolic syndrome,entered in community diabetes management program in 2008 and followed up for 6 years.The body mass index (BMI),blood pressure,blood lipids,fasting blood glucose,postprandial 2 h blood glucose,glycated hemoglobin (HbA1 c),the incidence of liver and kidney function and other indicators were measured in a 6-month interval,the cardiovascular events were documented.Results At the end of follow-up:BMI,waist circumference,hip circumference,systolic blood pressure,postprandial blood glucose,high density lipoprotein levels of T2DM patients with MS were higher than those of T2DM patients (P ＜ 0.05).The systolic pressure,HbA1c and low density lipoprotein levels of T2DM with MS patients were decreased by 2.99 mmHg(1 mmHg=0.133 kPa),0.43％,and 0.50 mmol/L,respectively (P ＜0.05);those of T2DM patients were decreased by 1.58 mmHg,0.01％ and 0.68 mmol/L,respectively (P ＜ 0.05).The incidence rate of cardiocerebrovascular events in T2DM group was 5.1％ (6/118),that in T2DM with MS was 13.2％ (34/258),Kaplan-Merier analysis showed that Cum Hazard rate of cardiovascular diseases between two groups was significantly different (x2 =3.877,P =0.049).The Cox surv ival analysis showed that the risk rate of cardiocerebrovascular events in T2DM with MS patients was 2.21 times higher (95％ CI:1.02-4.73) than diabetic group.After adjustment of gender,age,education level,metabolic syndrome,the risk was 2.31 times (95％ CI:1.01-5.28) higher than diabetic group.Conclusion The diabetic patients with metabolic syndrome increase the risk of cardiocerebrovascular events,and the management of T2DM with MS patients need to be strengthened.