Association Of Chronic Subclinical Inflammation With Metabolic Syndrome And Its Target Organ Damage

【Objective】To investigate the association of inflammatory markers high sensitivity C-reactive protein (hs-CRP), soluble intercellular adhesion molecule-1 (sICAM-1), fibrinogen (Fg), white blood cell (WBC) with metabolic syndrome (MS) and its target organ damage, and explore the role of chronic subclinical inflammation play in the development of metabolic syndrome and its target organ damage.【Methods】160 subjects were enrolled, including 130 in-patients from Department of Endocrinology, Cardiology and 30 health examinees. Baseline clinical measures includeed systolic blood pressure (SBP), diastolic pressure (DBP), waist circumference (WC), body mass index (BMI, kg/m2) was calculated based on weight and height. Plasma lipids, fasting blood glucose (FPG), fasting insulin, uric acid (UA), and the blood levels of hs-CRP, sICAM-1, Fg, WBC were also measured respectively. Urinary albumin to creatinine ratio (ACR) was calculated on the basis of the first morning urine sample, the carotid arteries intimal-media thickness (IMT) was detected by two dimensional echocardiography and left ventricular mass was evaluated by M-B mode echocardiography in all patients. The detection rate of MS and its target organ damage by IDF criteria and CDS criteria were compared, association of the four inflammatory markers with MS components and its target organ damage were also analyzed.【Results】(1) The detection rate of MS by IDF was significantly higher than that by CDS criteria (P=0.008), accompanying with obesity(P=0.006), hypertension(P=0.001), elevated FPG(P<0.001) and reduced HDL-C(P<0.001). (2) The detection rate of MS in women was significantly higher than that of men by IDF criteria (P=0.015). However, there was no significant sex difference in the detection rate of MS by CDS criteria (P=0.631). (3) The MS criteria of IDF and that of CDS were in good accordance, the accordance rate was 81.88%. There was also no significant difference in the detection rate of target organ damage by the two criteria. (4) The blood level of hs-CRP, sICAM-1,Fg in patients with MS were higher than that of subjects without MS(P< 0.001).(5)Four inflammatory markers were associated with WC, BMI, HOMA- IR, FPG,TG, SBP, DBP, UA, IMT, ACR and LVMI positively, and HDL-C negatively. hs-CRP showed a stronger association with MS components and its target organ damage than other three inflammatory markers. Multiple stepwise regression analysis showed that inflammatory markers were independent influencing factors for MS and its target organ damage. (6)The level of hs-CRP, sICAM-1,Fg were elevated in accordance with the number of MS components count. (7)Elevated hs-CRP level was a independent risk factor for MS.Patients with hs-CRP level≥3mg/L had a relative risk of developing MS 2.255 times that of those with hs-CRP level< 1mg/L (P<0.001). (8)The incidence rate of MS target organ damage increased with elevated levels of inflamma- tory markers. (9) hs-CRP was associated with sICAM-1, Fg and WBC positively; Fg was associated with sICAM-1 and WBC positively. In multiple regression analysis, Fg (P<0.001) and sICAM-1 (P=0.016) were independently related to hs-CRP; hs-CRP (P=0.003) and Fg (P=0.043) were independently related to sICAM-1; hs-CRP (P<0.001) and WBC (P=0.049) were independently related to Fg; Fg was independently related to WBC (P<0.001) after adjustment for potential compounders.【Conclusions】1.The MS criteria of IDF and that of CDS were in good accordance.Both were suitable for Chinese. 2. MS may be underestimated by the CDS criteria, the IDF criteria may be more helpful in the early detection of MS. 3.The levels of inflammatory markers in patients with MS were higher than that of subjects without MS. Inflammatory markers were correlated to insulin resistance, several components of MS, and its target organ damage. hs-CRP showed a stronger correlation with MS components and its target organ damage than other three inflammatory markers. It was a strong predictor for MS. 4. Inflammatory markers were influenced by each other in the occurrence and development of MS. 5.Chronic subclinical inflammation may aggravate the development of MS and its target organ damage through insulin resistance, endothelial dysfunction, and glycometabolic and lipid metabolic disorders.