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目的了解药物综合干预代谢综合征(MS)是否可以改变发生心脑血管事件的风险。方法采用随机整群抽样南宁市两个社区的1215人符合纳入标准为本次综合干预治疗的研究对象,随机分为强化干预组和对照组。强化干预组人群按照是否患有MS及其相关疾病、疾病前状态(包括高血压、血压前期、肥胖、超重、糖尿病、糖耐量减退、血脂异常)等分别采取不同的强化治疗方案进行干预;对照组人员维持志愿就诊和志愿服药的正常医疗状态,每年随访1次,按WHO-MONICA方案心血管病事件(CVD)的诊断标准登记本年度发生的CVD和死亡事件。结果前瞻性随访研究43.5个月后:①经比较对照组中MS亚组与非MS亚组,MS患者发生心脑血管事件比非MS显著增高(P=0.02);②经比较干预组中MS亚组与非MS亚组,干预后MS心脑血管事件下降明显,MS患者发生心脑血管事件与非MS相比无差异(P>0.05);③经比较干预和对照两组MS亚组之间心脑血管事件的发生率,干预组为2.7%,对照组为10.1%,差异显著(P=0.03,OR值=4.01,95%CL:1.07-15.10);两组非MS亚组之间心脑血管事件的发生率分别为2.3%和4.2%,无显著性差异(P=0.12)。结论药物综合干预代谢综合征(MS)可以改变发生心脑血管事件的风险,与对照相比干预后风险降低了约4倍。
Objectives To understand whether drug-induced metabolic syndrome (MS) can alter the risk of cardiovascular events. Methods A randomized cohort of 1215 people from two communities in Nanning City was enrolled in this study. The subjects were randomly divided into intensive intervention group and control group. Intensive intervention group intervention according to whether they have MS and related diseases, pre-disease status (including hypertension, prehypertension, obesity, overweight, diabetes, impaired glucose tolerance, dyslipidemia), respectively, to take different intensive treatment intervention; control Group members to maintain voluntary medical care and voluntary medical treatment of the normal state of health, follow-up once a year, according to the WHO-MONICA program cardiovascular disease (CVD) diagnostic criteria for the registration of CVD and deaths this year. Results 43.5 months after the prospective follow-up study: (1) Compared with non-MS patients, the occurrence of cardiovascular and cerebrovascular events in MS patients and non-MS patients and MS patients was significantly higher than that in non-MS patients (P = 0.02) Subgroups and non-MS subgroups showed a significant decrease in cardiovascular and cerebrovascular events after MS intervention. There was no difference in cardiovascular and cerebrovascular events between MS patients and non-MS patients (P> 0.05). ③Compared with the MS subgroups The incidence of cardiovascular and cerebrovascular events was 2.7% in the intervention group and 10.1% in the control group (P = 0.03, OR = 4.01, 95% CL: 1.07-15.10) The incidence of cardiovascular and cerebrovascular events were 2.3% and 4.2%, respectively, with no significant difference (P = 0.12). Conclusion The combination of drug-induced metabolic syndrome (MS) can change the risk of cardiovascular and cerebrovascular events, and the risk is reduced about 4-fold after intervention compared with the control.