2型糖尿病家系一级亲人群代谢综合征患病情况及与肥胖相关指标的关系

Prevalence of metabolic syndrome and its relationship with obesity-related indicators in first-degree relatives of familial type 2 diabetes pedigrees

目的比较美国国家胆固醇教育计划成人治疗方案第三次报告（ATPⅢ）2005年、国际糖尿病联盟（IDF）2005年、中华医学会糖尿病学分会（CDS）2004年和《中国成人血脂异常防治指南》制定联合委员会（JCDCG）2007年建议的代谢综合征（MS）工作定义中不同的肥胖标准在2型糖尿病家系一级亲人群中应用的差异及与肥胖相关指标的关系。方法对715个2型糖尿病家系中有完整血压、血脂及血糖资料的2372名一级亲成员，分别用ATPⅢ、IDF、CDS和JCDCG定义诊断MS及肥胖。结果（1）四种定义诊断的一级亲MS患病平分别为45．40％、38．74％、25．08％和39．29％，按ATPHI、IDF定义诊断时，女性MS患病率明显高于男性（均P〈0．01）；（2）除CDS定义在女性中最常见的组合是血脂紊乱＋高血压＋高血糖外，其余定义下MS的常见异常组合均表现为四种代谢异常同时存在；（3）四种定义诊断的一级亲中具备肥胖组分的比例分别为58．18％、58．18％、33．90％和42．96％；肥胖患者中分别有66．59％、66．59％、54．85％和68．99％伴有MS；（4）应用ATPⅢ／IDF以及JCDCG定义中腹型肥胖的诊断切割点，分别有28．58％及16．78％个体表现为体重指数（BMI）〈25kg／m^2，但已呈腹型肥胖，其中女性的比例明显高于男性（38．90％vs15．02％，21．01％vs11．22％，均P〈0．01）。结论（1）MS及肥胖的发病有明湿家族聚集倾向，2型糖尿病家系一级亲人群是其高危人群；（2）采用腰围作为MS中肥胖组分的判别指标，较BMI可能更有助于临床早期识别和防治MS。

Objective To compare the differences of metabolic syndrome （MS） prevalence by using four working definitions and their relationship with obesity-related indicators in first-degree relatives of type 2 diabetes mellitus pedigrees. Methods Totally, 2 372 first-degree relatives from 715 type 2 diabetic pedigrees were selected in this study. Complete laboratory data, including blood pressure, lipid profile and plasma glucose, were collected. The prevalence rates of MS and obesity of four definitions, as defined by National Cholesterol Education Program Adult Treatment Panel Ⅲ （ATPⅢ） in 2005, International Diabetes Federation （IDF） in 2005, Chinese Diabetes Society （CDS） in 2004 and Joint Committec for Developing Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Aduhs （JCDCG） in 2007,were analyzed. Results （ 1 ）The prevalence rates of MS were 45.40% ,38.74% ,25.08% and 39.29% according to four definitions respectively. The prevalence rates of MS were higher in females than in males by using ATP Ⅲ and IDF definitions （ both P〈0.01 ）. （2） The common combinations of metabolic abnormality was dyslipidemia, hypertension, obesity and hyperglycemia by using four definitions, except in females by using CDS definition. （3）The prevalence rates of obesity were 58.18% ,58.18% , 33.90% and 42.96% according to the four definitions respectively. The prevalence rates of MS in obese subjects were 66.59% ,66.59% ,54.85% and 68.99% according to four definitions respectively. （4） Applying the cutoff point for abdominal obesity according to ATP Ⅲ, IDF and JCDCG definitions, the prevalence rates of abdominal obesity in subjects with body mass index （BMI）〈25 kg,/m^2 were respectively 28.58% and 16.78% ,being higher in females than in males（38.90% vs 15.02%,21.01% vs 11.22% ,both P〈0.01）. Conclusion （1）There is significant familial aggregation of MS and obesity,and the first-degree relatives of type 2 diabetic patients are high risk populations. （2）Waist circumference rather than BMI taken as a discriminating component of obesity in MS seems to be clinically more helpful to the early identification and prevention of MS.