目的：探讨中老年人群代谢综合征（ MS）与颈动脉斑块的关联性及其性别差异。方法在2011年6月—2013年12月某企业首次参加体检且年龄≥45岁的职工中，按每5岁一个年龄段分层，在各层中按比例随机抽取中老年人2180例。最终选取符合纳入排除标准的中老年人1770例，其中男813例，女957例（包括已绝经者673例、未绝经者284例）。采用颈动脉超声检查颈动脉有无斑块。MS诊断采用2009年国际统一标准（其中腹型肥胖采用亚洲人标准）。结果1770例中老年人中， MS患病率为40.3%（714/1770），颈动脉斑块检出率为25.9%（459/1770）。有无MS中老年男性、女性及总人群颈动脉斑块检出率间差异均有统计学意义（ P﹤0.05）。随着MS组分数目的增加，中老年男性、女性及总人群的颈动脉斑块检出率均呈现增加趋势（ P﹤0.001）。调整年龄、BMI、吸烟指数、低密度脂蛋白胆固醇（ LDL-C ）、总胆固醇（ TC ）和血尿酸（ SUA ）后，中老年男性〔OR （95%CI ）＝1.53（1.04，2.23），P＝0.030〕和绝经后女性MS患者〔OR（95%CI）＝1.60（1.08，2.38），P＝0.020〕颈动脉斑块的检出风险增加。在中老年男性中，调整年龄、BMI、吸烟指数、LDL-C、TC、SUA后对颈动脉斑块检出影响较大的组分为血压升高〔OR（95%CI）＝1.65（1.14，2.37），P ＝0.008〕和血糖升高〔OR（95%CI）＝1.93（1.36，2.75），P﹤0.001〕；在中老年女性中，调整年龄、BMI、吸烟指数、LDL-C、TC、SUA和是否绝经后对颈动脉斑块检出影响较大的组分为血压升高〔OR（95%CI）＝1.82（1.25，2.65），P＝0.002〕。结论 MS是中老年男性和绝经后女性颈动脉斑块检出的独立危险因素；对不同性别中老年人颈动脉斑块检出产生主要影响的MS组分不同。%Objective To investigate correlation between metabolic syndrome and carotid plaque of middle-aged and aged people and its gender differences. Methods Staffs( aged≥45 )who participated in the physical examination for the first time in a company from June 2011 to December 2013 were stratified according to age groups of every 5 years,and 2 180 middle-aged and aged people were selected in proportion from each age group. According to inclusion and exclusion criteria,1 770 middle-aged and aged people were finally selected,813 were male and 957 were female( including 673 postmenopausal cases, 284 non-menopause cases). Carotid ultrasound was used to check whether there was plaque in carotid artery. The international unified standard in 2009 was applied by MS diagnosis(which abdominal obesity using Asian standards). Results Among 1 770 middle-aged and aged people,prevalence rate of MS was 40. 3%(714/1 770),detection rate of carotid artery plaque was 25. 9%(459/1 770). There was significant difference in the detection rate of carotid artery plaque among middle-aged and aged males and females and the total population with or without MS( P﹤0. 05 ) . With the increasing number of components in MS,the detection rate of carotid artery plaque in middle-aged and aged men and women as well as the total population showed an increasing trend ( P ﹤ 0. 001 ) . After adjustment of age, BMI, smoking index, low - density lipoprotein cholesterol ( LDL-C),total cholesterol( TC)and serum uric acid( SUA),the detection risk of carotid artery plaque of middle-aged and aged men〔OR(95%CI) =1. 53(1. 04,2. 23),P=0. 030〕and postmenopausal females〔OR(95%CI) =1. 60(1. 08, 2. 38),P=0. 020〕increased. Among middle-aged and aged men,blood pressure elevation〔OR(95%CI) =1. 65(1. 14, 2. 37),P=0. 008〕and blood glucose rising〔OR(95%CI) =1. 93(1. 36,2. 75),P﹤0. 001〕were the components that had great influence on detecting carotid artery plaque after adjustment of age,BMI,smoking index,LDL-C,TC and SUA;among middle-aged and aged women,after adjusting age,BMI,smoking index,LDL-C,TC and SUA and menopause or not,the component that had great effect on detecting carotid artery plaque was blood pressure elevation〔OR(95%CI) =1. 82 (1. 25,2. 65),P=0. 002〕. Conclusion MS is an independent risk factor of detecting carotid artery plaque in middle-aged and aged men and postmenopausal women;the detection of carotid artery plaque among middle-aged and aged people of different genders was mainly influenced by different components of MS.
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