三种代谢综合征诊断标准在江苏人群中的适用性研究

A comparison of applicability in three diagnostic criteria of metabolic syndrome in Jiangsu population

目的比较国际糖尿病联盟（IDF）、美国胆固醇教育计划成人治疗专家组（NCEP—ATPⅢ）和中华医学会糖尿病学分会（CDS）3个既便于操作又有中国人肥胖指标的代谢综合征（MS）诊断标准在江苏人群中的适用性。方法采用“江苏省多代谢异常和MS综合防治研究”队列资料（1971例），用IDF、ATP111和CDS标准诊断MS，通过计算敏感度、特异度和ROC曲线距离，比较检出心血管疾病（CVD）和2型糖尿病（T2DM）假阳性和假阴性率均较低的MS诊断标准；并通过Cox回归分析，比较发生CVD和T2DM的相对危险度（95％可信区间）[RaY（95％CI）]。结果三标准中，虽然CDS标准检出CVD、T2DM的特异度最高[IDF、ATP11I、CDS检出CVD、T2DM的特异度分别为83．52％、76．36％、89．57％和85．02％、78．67％、92．28％]；但是其检出CVD、T2DM的敏感度太低（40．82％，29．47％），此标准将会漏诊大于50％的患者；无论是对于检出CVD或T2DM，ROC曲线最短距离相应的诊断标准均为ATP111（0．4369；0．5777），表明ATPⅢ诊断标准检出CVD或T2DM的假阳性率和假阴性率相对较低。进一步分析发现，与ATPⅢ-／IDF-组相对照，ATPⅢ＋／IDF-组比ATPⅢ＋／IDF＋组MS的CVD[RR（95％CI）：5．59（2．62～11．92 vs 2．90（1．41～5．93）]、T2DM[3．36（1．92～5．79）vs1．97（1．16—3．34）]发生风险高，证明ATPⅢ＋／IDF-组这部分人群应纳入MS中。结论对于这3个MS标准，本研究认为ATPm标准在江苏人群中适用性最好。

Objective To compare the applicability of the three diagnostic criteria for metabolic syndrome （MS） proposed by the International Diabetes Federation（IDF） in 2005 ,Adult Treatment Panel m of National Cholesterol Education Program （ NCEP-ATP Ⅲ ） in 2005 and Chinese Diabetes Socie （CDS） in 2004. Methods Based on the findings of cohort study of multiple metabolic disorders and metabolic syndrome （1971 cases） in Jiangsu province, MS was diagnosed according to these three definitions respectively,and by calculating the sensitivity, specificity, and ROC curve distance, those with lower false positive and false negative rates were identified as to detecting cardio vascular diseases（CVD） and type 2 diabetes mellitus （T2DM）. While, through Cox regression analysis, to compare their relative risk （RR） and 95% confidential interval （CI）was wade. Results Among three diagnostic criteria, the specificity by CDS of MS was higher than the other criteria （ 83.52%, 76. 36%, 89. 57% ; 85. 02%, 78. 67%, 92. 28% ）, however the sensitivity of CDS of MS was low （40. 82%, 29.47% ）. When using CDS, over 50 percent of diagnosis might be missed. ATP Ⅲ definition corresponded to the shortest distance in ROC curve, namely, at the diagnostic criteria, the rates of false positive and false negative for identifying clustering of CVD and T2DM were minimum（0. 4369; 0. 5777 ）. The incidence of CVD[5.59 （2. 62 - 11.92） vs 2. 90（ 1.41 -5.93）],T2DM [3.36（1.92 -5.79） vs 1.97 （1.16 -3.34） ] was significantly higher in cases of ATPⅢ ＋/IDF- than ATPⅢ ＋/IDF ＋, as compared with ATP Ⅲ -/IDF -. Conclusion Among three diagnostic criteria,the ATP Ⅲ definition of the MS should be the most applicable diagnostic criteria for MS in Jiangsu population.