中国成人代谢综合征腰围切点的研究

The cut-off point of waist circumference for identifying metabolic syndrome in Chinese adults

目的 根据中国成人较近期的调查数据 ,分析代谢综合征中腰围的适宜切点。方法 利用国家“九五”科技攻关课题 1998年在 15组人群进行心血管病危险因素调查 13732例 35～ 5 9岁成人的数据库 ,分析男性和女性不同腰围水平和代谢综合征其他成分聚集的关系 ,并寻找检出两个及以上危险成分假阳性和假阴性率均较低的腰围切点 ,作为成人腰围切点的建议。据此计算各性别年龄组代谢综合征的患病率 ,以及成分组合特点。结果 随腰围增大 ,代谢综合征成分聚集的OR值显著增高 ,以男性腰围≥ 85cm ,女性腰围≥ 80cm ,ROC曲线距离最短。以此为腰围切点中年男性人群代谢综合征患病率为 19 3% ,女性为 13 9% ,其中以腰围超标 ,血压升高和高甘油三酯三项的组合为最多。结论 建议男性腰围≥ 85cm ,女性腰围≥ 80cm ,收缩压≥ 130mmHg(1mmHg =0 133kPa)和 (或 )舒张压≥ 85mmHg ,血清甘油三酯≥ 1 6 9mmol/L ,高密度脂蛋白胆固醇 <1 0 3mmol/L ,空腹血糖≥ 6 1mmol/L ,5项中具备 3项及以上作为中国成人代谢综合征的临床检出标准。以上初步结果需要在有全国代表性的样本中进一步验证。

Objective Metabolic syndrome has attracted more attention from scientists of related areas due to its association with increased risk of cardiovascular disease and diabetes. The clinical identification criteria for metabolic syndrome issued by ATP Ⅲ of NECP indicate the enlarged waist as the first component using the cut-offs derived from Caucasians. The purpose of this study is to investigate the appropriate cut-offs of waist circumference for Chinese adults as a component of metabolic syndrome. Methods Database of 13732 Chinese adults with 35-59 years from the risk factor survey in 1998 (the 9~th Five Year National Project on trends and prediction of cardiovascular disease) was used to analyze the ORs of clustering of risk components by different strata of waist circumference. The sensitivity , specificity and distance in ROC curve by different cut-offs of waist circumference for identifying two or more risk components of metabolic syndrome were estimated to find the cut-off point for men and women with the shortest distance in ROC curve. Results The ORs of clustering of risk components increased significantly with the size of waist circumference. The waist circumference (≥85 cm for men, ≥80 cm for women) corresponded to the shortest distance in ROC curve, namely, at these cut-offs, the rates of false positive and false negative for identifying clustering of two or more risk components were the minimum. Conclusions If a person had three or more of the following components, metabolic syndrome could be defined : waist circumference≥85 cm in men or≥80 cm in women, SBP≥130 mm Hg or DBP≥85 mm Hg, TG≥1.69 mmol/L, HDL-C<1.03 mmol/L and fasting blood glucose ≥6.1 mmol/L. The prevalence of metabolic syndrome was 19.3% and 13.9% in middle-aged men and women respectively. In these patients the combination of enlarged waist, high blood pressure and high TG was the most frequent.This recommendation need further confirmed in representative sample of Chinese population.