应用体脂测量代替简易人体参数评估福州成人代谢综合征的危险度

Use body fat determination instead of simple body composition parameters evaluate the risk of metabolic syndrome in Fuzhou adults

目的 筛选出较适合福州成人的代谢综合征（MS）定义,进一步评价体脂测量对MS患病危险的估测是否优于简易人体参数.方法 在福建医科大学附属第一医院体检成人818名,男472名,女346名,测量简易人体参数,包括体质指数（BMI）、腰围、腰臀比（WHR）等,双能X线骨密度仪检测总体脂肪含量（BF）、躯干脂肪含量（TF）.BF、TF不同取值下MS的检出率分析用四分位法,疾病危险度多因素分析用Logistic回归,BF、TF和简易人体参数临界点及诊断可靠性估测用ROC工作曲线.结果 （1）按2005年国际糖尿病联盟（IDF2005）定义,BF、TF≥P50时MS检出率显著增高（P＜0.01）,对应的BMI为24 kg/m^2;2001年美国胆固醇教育计划成人治疗指南Ⅲ（NCEP ATP Ⅲ 2001）定义,BF、TF≥P75时MS检出率亦显著增高（P＜0.01）,对应的BMI均为26 kg/m2.IDF2005定义的MS患者BF、TF低于ATPⅢ2001定义（均P＜0.05）.（2）按IDF2005定义,BF、TF为MS的独立危险因素,男性MS患病OR值分别为1.952和3.276,女性为2.644和3.085,BMI、WHR未进入方程.（3）BF、TF估测MS存在的ROC曲线下面积均大于0.9,且灵敏度和特异度均高于BMI和WHR;MS最佳的BF切点为25%（男）、35%（女）,TF为30%（男）、38%（女）.结论 ATPⅢ2001定义易漏诊体脂肪含量已明显增加或存在脂肪分布异常的MS高危患者,IDF2005定义在本研究人群中适用性较好.与简易体脂参数相比,人体脂含量增加及分布异常是MS更为重要的危险因素,体脂测量可作为MS评估更有价值的指标.

Objective To compare the application of two different definitions of MS （IDF2005 and ATP Ⅲ 2001）in this study population.Accroding to IDF2005.evaluate the impact of body fat content and its distribution for the risk of metabolic syndrome.Methods The sample of 818 subiects maseaure the simple anthropometric parameters including body mass index（BMI）,waist circumference,waist-hip ratio （WHR）,and so on. Body fat mass and distribution were measured by dual-energy X-ray abosorbtiometry （DEXA）.Quatile method is used to analyse the relevance ratio of MS in different value of BF and TF.ROC curve is used in evaluating of tipping point of BF,TF,simple body composition parameters and reliability of diagnosis.The risk of MS were analyzed by logistic regression.Results According to IDF2005,when BF,TF≥P50.the relevance ratio of MS has a remarkable increasing（P〈0.01）,its matching BMI is 24 and 23 kg/m2,according to NCEP ATPⅢ2001,when BF、TF≥P75,the relevance ratio of MS has a remarkable increasing,too（P〈0.01）,its matching BMI value is 26 kg/m^2,BF and TF of MS patients which diagnosed by IDF2005 are lower than ATPⅢ2001（P〈0.05）.For each additional level of BF,the odds ratios of MS prevalence were 1.952（male） and 2.644（female）;for each additional level of TF,the odds ratios of MS prevalence were 3.276（male） and 3.058（female）,BMI,WHR were not into the equation.The AUCROC which used to evaluate the exist of MS by BF and TF is larger than 0.9.and has better performance in sensitivity and specificity than BMI and WHR;the best point of contact of MS in BF is 25%（male）,35% （female）,in TF is 30%（male）,38%（female）.Conclusion ATPⅢ standards may have been mi8Sed MS patients with normal high fasting blood glucose value and abdominal obesity.The applicaton of IDF2005 standards was proved better in this populatin.Compared with simple anthropometric parameters,the accmulation of body fat,especially trunk fat even more harmful,to is better to identify the risk of MS in Fuzhou adults population.