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目的分析非ST段抬高急性冠脉综合征(NSTE ACS)中代谢综合征患者的临床特征和住院期间预后。方法SUNDAY注册研究(TheStrategiesforUA NSTEMIandDelayofAngioplastYRegistry)回顾性登记了本院2000年1月至2002年12月三年间首次因不稳定性心绞痛(UA)或非ST段抬高心肌梗死(NSTEMI)在我院住院的患者1013例,比较合并代谢综合征患者与不伴代谢综合征的患者的临床特征和结果,并根据代谢综合征各组成数计算代谢综合征积分。结果有体重、身高及病史、生化检查记录完整的患者743例,其中符合我国代谢综合征定义的患者343人(46.2%),年龄较轻[(59.66±9.67)岁vs.(61.11±10.37)岁,P=0.052]。与不伴代谢综合征患者相比,合并代谢综合征患者除具有体重指数高、收缩压高、舒张压高、血糖高、血脂紊乱(P值均小于0.0001)的特点外,肌酐[(1.07±0.29)mg dlvs.(1.01±0.22)mg dl,P<0.0001]、白细胞总数[(7.05±1.81)Lvs.(6.75±1.98)L,P=0.039]均高于非代谢综合征的NSTE ACS患者。合并代谢综合征的患者的冠脉病变严重的比例较高,三支加左主干病变的比例明显高于不伴代谢综合征的患者(46.6%vs.32%,P<0.0001),住院天数明显延长(P=0.015),住院期间的费用明显增高(P=0.004)。应用Logistic分析发现心性事件和代谢综合征积分明显相关(P=0.017)并随代谢综合征积分的增加,患者有年轻化的趋势(P=0.03),代谢综合征的各组成成分也均有明显加重的趋势(P>0.05),而且严重冠脉病变(左主干+三支病变)的比例也明显增高(P=0.006),各组间不良心性事件的比例,差异也有显著性(P=0.039)。结论在NSTE ACS患者中,合并代谢综合征的比例较高,并有年轻化的特点。不良心性事件和代谢综合征积分明显正相关,即合并代谢综合征的成分越多,肥胖、糖尿病、高血压和血脂紊乱的严重程度越明显,冠脉病变越严重,不良心性事件的比例也越高。
Objective To analyze the clinical characteristics and prognosis of patients with metabolic syndrome in non-ST-elevation acute coronary syndrome (NSTE ACS). Methods The Strategy for UA NSTEMI and Delay of AngioplastY Registry was retrospectively registered for the first time in our hospital from January 2000 to December 2002 for UA or non-ST-elevation myocardial infarction (NSTEMI) A total of 1013 patients were enrolled in this study. The clinical features and outcomes of patients with and without Metabolic Syndrome were compared. Metabolic syndrome scores were calculated based on the number of Metabolic syndromes. RESULTS: There were 743 patients with complete body weight, height and medical history and biochemical records, of whom 343 (46.2%) were eligible for metabolic syndrome and younger (59.66 ± 9.67) vs. (61.11 ± 10.37) Year old, P = 0.052]. Compared with patients without metabolic syndrome, patients with metabolic syndrome had the following characteristics: high body mass index, high systolic blood pressure, high diastolic blood pressure, high blood sugar and dyslipidemia (P <0.0001) (1.05 ± 1.81) L vs (6.75 ± 1.98) L, P = 0.039] were higher than those in non-metabolic syndrome patients with NSTE ACS (0.29 mg dlvs. 1.01 ± 0.22 mg dl, P <0.0001) . Patients with metabolic syndrome had a significantly higher rate of coronary lesions, a significantly higher proportion of three patients with left main disease than those without metabolic syndrome (46.6% vs.32%, P <0.0001), and significant hospital stay (P = 0.015), the cost of hospitalization was significantly higher (P = 0.004). Logistic analysis showed that there was a significant correlation between cardiac events and metabolic syndrome scores (P = 0.017). With the increase of metabolic syndrome scores, patients had a younger trend (P = 0.03), and the components of metabolic syndrome were also significantly higher (P = 0.006). There was also a significant difference in the proportion of adverse cardiac events between the two groups (P = 0.039) ). Conclusions NSTE ACS patients have a higher proportion of metabolic syndrome and are younger. There was a significant positive correlation between adverse cardiac events and metabolic syndrome scores, that is, the more components with metabolic syndrome, the more serious the severity of obesity, diabetes, hypertension and dyslipidemia, the more severe coronary artery disease, the worse the proportion of non-cardiac events high.