Prevalence and risk factors of metabolic syndrome in adults with congenital heart disease
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摘要: 目的 调查我国成人先天性心脏病(adult congenital heart disease，ACHD)患者发生代谢综合征(metabolic syndrome，MS)的现状及其影响因素，为制订相关防治策略提供有力的理论依据。方法 选取2020年1月—2022年1月就诊于武汉科技大学附属武汉亚洲心脏病医院的1 833例ACHD患者作为研究对象，根据国际糖尿病联盟(IDF)MS诊断标准将患者分为MS组和非MS组，比较不同种类、性别、年龄患者MS患病情况，采用单因素分析和多因素logistic回归分析ACHD患者发生MS的危险因素。结果 1 833例ACHD患者中共265例发生MS，MS的总体患病率为14.5%，轻度和中重度ACHD患者患病率分别为15.6%和11.8%，男性患病率为17.8%，女性患病率12.9%，两者随着年龄增长患病率逐渐增加，老年阶段患病率最高，为27.4%。MS中单一指标异常率最高，其中高密度脂蛋白胆固醇降低和中心性肥胖患病率较高，分别为33.2%、31.5%。多因素logistic回归分析结果显示男性、体重指数增高、腰围增加、收缩压升高、空腹血糖升高、甘油三酯升高、肾小球滤过率下降、天门冬氨酸转移酶增高以及肺动脉高压是ACHD患者发生MS的独立危险因素(P < 0.05)。结论 MS在ACHD患者中的患病率较普通人群高，应加强ACHD患者MS的筛查和预防性健康宣教。Abstract: Objective To investigate the current situation and influencing factors of metabolic syndrome(MS) in adult patients with congenital heart disease(ACHD) in China, and to provide a strong theoretical basis for formulating relevant prevention and treatment strategies.Methods A total of 1833 ACHD patients who visited Wuhan Asia Heart Hospital Affiliated to Wuhan University of Science and Technology from January 2020 to January 2022 were selected as the study subjects. The patients were divided into MS group and non-MS group according to the International Diabetes Federation(IDF) MS diagnostic criteria. The prevalence of MS in patients with different types, genders and ages was compared. Univariate analysis and multivariate logistic regression were used to analyze the risk factors of MS in ACHD patients.Results A total of 265 of 1833 ACHD patients developed MS. The overall prevalence of MS was 14.5%, and the prevalence was 15.6% and 11.8% in mild and moderate to severe ACHD patients, 17.8% in males and 12.9% in females, respectively, both of which gradually increased with age, with the highest prevalence of 27.4% in the elderly. The abnormal rate of single index was the highest in MS, and the prevalence of decreased high-density lipoprotein cholesterol and central obesity was high, 33.2% and 31.5%, respectively. Multivariate logistic regression analysis showed that male gender, increased body mass index, increased waist circumference, increased systolic blood pressure, increased fasting blood glucose, increased triglycerides, decreased glomerular filtration rate, increased aspartate transferase, and pulmonary hypertension were independent risk factors for MS in ACHD patients(P < 0.05).Conclusion The prevalence of MS in ACHD patients is higher than that in the general population, and MS screening and preventive health education in ACHD patients should be strengthened.
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Key words:
- adult congenital heart disease /
- metabolic syndrome /
- prevalence /
- risk factors
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表 1 MS在不同种类ACHD患者中的患病率
Table 1. Prevalence of MS in patients with different types of ACHD
疾病分型 总例数/例 MS患病数/例 MS患病率/% 房间隔缺损 961 148 15.4 室间隔缺损 193 19 9.8 房室间隔缺损 10 1 10 卵圆孔未闭 394 72 18.3 动脉导管未闭 128 12 9.4 主动脉弓异常 22 3 13.6 主动脉狭窄 9 1 11.1 肺动脉狭窄 12 2 16.7 法洛四联症 5 0 0 心室双出口 14 2 14.3 单心室 8 0 0 房间隔膨胀瘤合并缺损 13 2 15.4 室间隔膜部瘤合并缺损 15 1 6.7 先天性肺动静脉瘘 7 0 0 先天性主动脉窦动脉瘤 5 0 0 其他 37 2 5.4 合计 1 833 265 14.5 
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表 2 不同年龄、性别ACHD患者MS患病率的比较
Table 2. Comparison of MS prevalence in ACHD patients of different ages and genders
例(%) 年龄分组 调查数/例(男/女) 男性MS患病 女性MS患病 合计 P 青年 770(262/508) 29(11.1) 30(5.9) 59(7.7) 0.011 中年 833(253/580) 58(22.9) 85(14.7) 143(17.2) 0.004 老年 230(65/165) 16(24.6) 47(28.5) 63(27.4) 0.554 合计 1833(580/1253) 103(17.8) 162(12.9) 265(14.5) 0.006 P — 0.001 < 0.001 < 0.001 ﹣
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表 3 ACHD患者不同性别MS各指标检出率及不同指标组合异常率比较
Table 3. Comparison of MS detection rates of different genders
例(%) 诊断指标 男性MS 女性MS 合计 P 中心性肥胖 222(38.3) 356(28.4) 578(31.5) < 0.001 血压增高 218(37.6) 344(27.5) 562(30.7) < 0.001 FPG增高 152(26.2) 256(20.4) 408(22.3) 0.006 TG增高 149(25.7) 249(19.9) 398(21.7) 0.005 HDL-C降低 129(22.2) 479(38.2) 608(33.2) < 0.001 0项异常 146(25.2) 357(28.5) 503(27.4) 1项异常 174(30.0) 413(33.0) 587(32.0) 2项异常 131(22.6) 258(20.6) 389(21.2) 0.197 3项异常 90(15.5) 157(12.5) 247(13.5) 4项异常 31(5.3) 56(4.5) 87(4.7) 5项异常 8(1.4) 12(1.0) 20(1.1)
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表 4 ACHD患者发生MS危险因素的单因素分析
Table 4. Univariate analysis of risk factors for MS in ACHD patients
例(%), M(P25, P75) 变量 MS组(265例) 非MS组(1568例) χ2/Z P 年龄/岁 51(40，59) 42(31，53) -8.133 < 0.001 女性 162(61.1) 1091(69.6) 7.478 0.006 BMI/(kg/m2) 27.0(25.4，28.4) 21.9(19.8，23.9) -21.466 < 0.001 腰围/cm 83(81，91) 68(64，76) -21.01 < 0.001 收缩压/mmHg 130(120，142) 115(106，125) -12.63 < 0.001 舒张压/mmHg 76(70，85) 70(64，77) -8.759 < 0.001 吸烟史 25(9.4) 95(6.1) 4.221 0.04 饮酒史 19(7.2) 79(5.0) 2.035 0.154 冠心病 48(18.1) 143(9.1) 19.642 < 0.001 瓣膜病 43(16.2) 380(24.2) 8.19 0.004 心力衰竭 9(3.4) 46(2.9) 0.167 0.683 心功能分级 0.770 0.380 1~3 246(92.8) 1430(91.2) 4~5 19(7.2) 138(8.8) 紫绀 5(1.9) 48(3.1) 1.114 0.291 肺动脉高压 44(16.8) 472(30.1) 15.129 0.002 先心病严重程度 4.393 0.036 轻度 202(76.2) 1096(69.9) 中重度 63(23.8) 472(30.1) GFR/(mL/min) 101(87，111) 105(93，117) -4.809 < 0.001 UA/(μmol/L) 324(273，398) 299(249，366) -2.611 0.009 CR/(μmol/L) 68(60，75) 65(57，73) -2.837 0.005 Urea /(mmol/L) 5.12(4.26，6.12) 4.84(4.12，5.90) -2.611 0.009 AST/(U/L) 19.8(17.4，24.0) 18.7(16.6，23.5) -2.896 0.004 LDH/(U/L) 162(146，181) 158(137，183) -1.970 0.049 FPG/(mmol/L) 5.27(4.82，6.05) 4.84(4.12，5.90) -6.861 < 0.001 TG/(mmol/L) 1.72(1.23，1.96) 1.18(082，1.43) -13.004 < 0.001 TC/(mmol/L) 3.85(2.97，4.70) 3.24(2.53，4.05) -6.757 < 0.001 HDL-C/(mmol/L) 1.11(0.95，1.39) 1.37(1.17，1.62) -9.921 < 0.001 LDL-C/(mmol/L) 2.58(2.17，3.01) 2.41(2.13，2.67) -5.632 < 0.001 超敏C反应蛋白/(mg/L) 0.87(0.53，1.67) 0.64(0.30，1.32) -6.039 < 0.001 注：若有单元格的理论频数T < 5且T≥1，采用连续性校正的卡方检验；若T < 1，采用确切概率法。
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表 5 ACHD患者发生MS危险因素的多因素分析
Table 5. Multivariate analysis of risk factors for MS in ACHD patients
变量 B SE Wald χ2 P OR 95%CI 下限 上限 男性 5.039 0.540 87.101 < 0.001 154.271 53.546 444.470 BMI 0.016 0.038 9.575 0.002 1.123 1.043 1.209 腰围 0.136 0.015 77.746 < 0.001 1.146 1.112 1.181 收缩压 0.014 0.005 8.027 0.005 1.014 1.004 1.023 FPG 0.163 0.068 5.806 0.016 1.178 1.031 1.345 GFR -0.098 0.006 248.139 < 0.001 0.906 0.891 0.921 TG 0.876 0.115 58.236 < 0.001 2.402 1.918 3.008 AST 0.017 0.009 4.029 0.045 1.017 1.001 1.035 肺动脉高压 0.650 0.174 13.892 < 0.001 1.916 1.361 2.697
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