中国台湾35～74岁体检人群中代谢综合征五种诊断标准的对比研究

Comparison of five different diagnostic criteria on metabolic syndrome applied during physical check-up programs among population aged 35-74, in Taiwan

目的比较国际糖尿病联盟（IDF）、美国国家胆固醇教育计划成年人治疗方案第三次报告（NCEP—ATPⅢ）、美国心脏协会（AHA）、中华医学会糖尿病学分会（CDS）和台湾健康局（TAIWAN）建议的代谢综合征（MS）诊断标准在台湾人群中应用的差异。方法选择2005—2006年首次参加美兆健康体检的35～74岁人群28408人，分别应用五种标准计算该人群MS的患病率，分析不同标准时MS异常组分及危险因素聚集的检出情况，比较五种标准在台湾体检人群中应用的一致性和差异。结果（1）五种标准标化患病率范围为10．6％（CDS）～23．6％（AHA），其中男性13．4％（CDS）～27．6％（AHA），女性8．0％（CDS）～20．5％（IDF）。（2）五种MS组分（IDF标准判断）异常率为22．5％（低高密度脂蛋白胆固醇）～39．7％（高空腹血糖），其中聚集≥3个危险组分者占22．3％；五个标准下判断为非MS者中有三个及以上危险因素聚集的比例分别为：0％（AHA）、6．7％（TAIWAN）、6．9％（ATPⅢ）、8．9％（IDF）、14．9％（CDS）。（3）满足≥3个危险组分的人中，具有5项、4项和3项MS组分组合的比例分别为8．0％、29．5％和62．5％；MS危险组分最常见组合为“肥胖＋高血压＋高血糖”。（4）ATPⅢ、AHA与TAIWAN三个标准诊断的一致性较好，Kappa值为0．81～0．98；CDS、IDF与其他标准的一致性均不高，Kappa值在0．35～0．62之间。结论五种MS诊断标准在台湾体检人群中获得的患病率和危险组分聚集情况差异较大，标准的选用要充分考虑这种差异可能造成的偏倚，并需要通过队列研究对不同MS诊断标准的实际应用价值进行评估。

Objective To compare the differences of five diagnostic criteria used for metabolic syndrome （MS）, issued by International Diabetes Federation （IDF）, the National Cholesterol Education Program （ATPⅢ）, America-Heart-Association （AHA）, Chinese Medical Association Diabetes Branch （CDS） and The Taiwan Health Bureau （TAIWAN）, during a physical check-up program among population aged 35-74 years, in Taiwan. Methods A total number of 28 408 people who had received physical checkup program first time at the MJ centers, were recruited from 2005 to 2007. The prevalence of MS and the degree of agreement were both calculated according to the five definitions and the results of MS components. Distributions and risk factor aggregation of the results were also analyzed. Results According to the five definitions （1）The range of age-adjusted prevalence of MS appeared to be 10.6% （CDS）- 23.6%（AHA）, and were 13.4% （CDS）-27.6% （AHA）and 8.0% （CDS）-20.5% （IDF） for men and women respectively. （2） The range of five MS components were 22.5% （low-HDL-C）-39.7% （high FPG）, with 22.3 % of the total subjects presented at least 3 risk factors. In addition, 0 % （AHA）, 6.7 % （TAIWAN）, 6.9% （ATPⅢ）, 8.9% （IDF） and 14.9% （CDS） of the subjects diagnosed as MS-free, by the five criterions, also appeared of having ≥ 3 risk factors. （3） Among all the MS subjects, the proportions of clinical symptom complex, having 5,4 and 3 MS components were 8.0%, 29.5% and 62.5 % respectively. The most common clinical symptoms complex of MS were obesity, hypertension and high FPG. （4） The MS diagnostic criteria of ATPⅢ, AHA and TAIWAN were in good accordance with Kappa index, showing 0.81-0.98 for the three criteria. CDS and IDF were in relatively weak agreement when comparing with other definitions with Kappa index showed as 0.35 and 0.62. Conclusion Our findings revealed big differences in the prevalence and aggregation of risk components on MS, when using the five definitions. We suggested that prospective cohort studies be planned to investigate the impact on cardiovascular disease morbidity and mortality so as to verify whies criterion might be suitable to the population in Taiwan, considering the possible bias.