三种代谢综合征诊断标准在锡林浩特市人群中应用的比较

A Comparison of Three Diagnostic Criterions for Metabolic Syndrome Applied in Population of Xilinhaote City

目的比较三种代谢综合征(MS)诊断标准在内蒙古锡林郭勒盟人群中应用的差异。方法2006年9月—2007年3月,对在内蒙古锡林郭勒盟医院体检的企事业单位20岁以上职工进行流行病学调查(1060人),分别采用国际糖尿病联盟(IDF,2005)、美国国家胆固醇教育计划成人组第三次报告(NCEP-ATPⅢ,2005)和中华医学会糖尿病分会(CDS,2004)标准计算MS患病率,比较三种标准在锡盟人群应用中的一致性和差异。结果IDF、ATPⅢ和CDS三种标准下,锡盟人群MS标化患病率分别为25.0%,27.9%和22.5%。IDF与ATPⅢ诊断一致性最高,Kappa值为0.929,IDF与CDS、ATPⅢ与CDS的Kappa值分别为0.726,0.763,基本一致。与ATPⅢ比较,IDF、CDS诊断的非MS人群中分别有4.3%和10.8%的人具有3种及以上代谢异常组分。蒙古族男性腰围90cm,女性BMI≥25kg/m2时,灵敏度及特异度较好,ROC曲线距离最短,预测MS危险因素聚集的能力相对最好;而汉族则以男性BMI≥25kg/m2、女性腰围80cm时相对最好。结论三种MS诊断标准中,ATPⅢ标准对MS及危险因素聚集个体的检出率最高,最适合心脑血管病高危人群的筛查。IDF与ATPⅢ的腰围标准较适合锡盟蒙古族男性,而CDS的标准较适合汉族男性,提示肥胖评价指标应联合采用腰围和BMI。

Objective To compare the differences of three diagnostic criterions for metabolic syndrome （MS） proposed by the International Diabetes Federation （IDF） in 2005, the Third Report of National Cholesterol Education Progam-Adult Treatment Panel Ⅲ （NCEP-ATP Ⅲ ） in 2005 and Chinese Diabetes Society （CDS）in 2004 in population of Xilingnole city in inner mongolia. Methods 1 060 employees aged more than 20 yrs in enterprises taken health examination in Xilinguole hospital were investigated by epidemiological survey and the prevalence rates of MS and its components were calculated according to these three definitions respectively, and compared the agreement rates and difference between these definitions. Results The age-adjusted MS prevalence rates were 25.0%, 27.9% and 22.5% according to IDF （2005）, ATP Ⅲ （2005） and CDS （2004） respectively. The agreement rate of diagnosis between IDF and ATP Ⅲ was the highest, and the Kappa value was 0.929. The kappa values between IDF and CDS,ATPⅢ and CDS were 0.726 and 0.763, respectively. There were 4.3% and 10.8% subjects respectively without MS diagnosed by IDF and CDS criterion presented at least 3 risk factors respectively. For Mongolia nationality people, when the waist circumference was 90cm in male and BMI was 25kg/m^2 in female, the sensitivity and specificity were relative better, and the distance of ROC curve was the shortest, but for Han nationality, BMI ≥ 25 kg/m^2 in male and waist circumference ≥ 80 cm was better. Conclusion ATP Ⅲ definition can screen out the highest prevalence of MS and risk factors aggregation among three definitions, and it＇s best for screening for the high risk population of cardio-cerebrovascutar diseases. The cutoff value of waist circumference （WC） in IDF and ATP Ⅲ seems better for Mongolia nationality men; while the cutoff value in CDS was better for Han nationality men. We should combine waist circumference and body mass index to judge the condition of obesity.