常用人体测量指标对高血糖的筛查价值探讨

Screen value of anthropometric indices for hyperglycemia

目的探讨体质指数(BMI)、腰围(WC)、腰臀比(WHR)、腰围身高比(WHtR)、腰腿比(WTR)与高血糖的关系及其对高血糖的筛查价值。方法 2010年8月整群抽取在北京世纪坛医院健康体检中心体检的某机关工作人员1280名,测量其身高、体重、腰围、臀围、腿围、血压与空腹血糖及生化指标等。结果①此人群空腹高血糖检出率为40.16%,且随着年龄增长高血糖检出率亦增加;高血糖组的WC、BMI、WHtR、WHR、WTR、SBP、DBP、AST、TC、TG、CRE、UA水平均显著高于血糖正常组,而HDL-C水平低于血糖正常组,同时高血糖组脂肪肝的检出率也显著高于血糖正常组。②对于高血糖,WTR的受试者工作特征曲线(ROC)下面积(AUC)为0.716,高于WHtR(0.690)(P<0.001)、WHR(0.682)(P<0.001)、WC(0.682)(P<0.001)、BMI(0.665)(P<0.001);按性别分层后,在男性中,对于高血糖WTR的AUC(0.648)高于WHtR(0.611)(P<0.001)、WHR(0.614)(P<0.001)、WC(0.598)(P<0.001)和BMI(0.587)(P<0.001);在女性中,WTR对于高血糖的AUC为0.758,低于WHtR(0.774)(P<0.001)和WC(0.761)(P<0.001),但高于BMI(0.738)(P<0.001)和WHR(0.732)(P<0.001);在年龄≥35岁的女性中,WTR对于高血糖的AUC为0.725,高于WHtR(0.716)(P<0.001)、WC(0.705)(P<0.001)、WHR(0.676)(P<0.001)和BMI(0.665)(P<0.001);③在调整年龄和性别后,WTR与高血糖的相关性最强(OR=1.70,95%CI 1.37～2.11,每1 SD增量)。结论该机关工作人员空腹高血糖问题较为严重,WTR比其他4个指标能更好地筛查男性高血糖,在年龄大于35岁的女性中,WTR比其他四个能更好地筛查高血糖。

Objective The study was to examine whether waist-to-thigh ratio（WTR） performed better than waist-to-height ratio（WHtR）,waist-to-hip ratio（WHR）,waist circumference（WC）,or body mass index（BMI） in relation to hyperglycemia（fasting plasma glucose≥5.6 mmol/L） among government employee.Methods A cluster sampling was conducted in Beijing ShiJitan Hospital in August 2010.1280 government employee were examined on height,weight,WC,hip circumference,thigh circumference,fasting glucose and so on.Results ①The rate of hyperglycemia was 40.16%,increasing along with age.The level of WC、BMI、WHtR、WHR、WTR、SBP、DBP、AST、TC、TG、CRE、UA in hyperglycemia group was significantly higher than that of normal glucose group（P0.001）,but the level of HDL-C is lower than normal glucose group.Meanwhile,the prevalence rate of fat liver in hyperglycemia group was significantly higher than that of normal glucose group.② Receiver operating characteristic（ROC）curve analysis was used to measure the predictive hyperglycemia performance of each anthropometric measurement based on the area under the curve（AUC）.AUC of WTR（0.716） was larger than that of WHtR（0.690）（P0.001）,WHR（0.682）（P0.001）,WC（0.682）（P0.001）,and BMI（0.665）（P0.001） for hyperglycemia.In men,AUC of WTR（0.648） was larger than that of WHtR（0.611）（P0.001）,WHR（0.614）（P0.001）,WC（0.598）（P0.001）,and BMI（0.587）（P0.001） for hyperglycemia.In women,the AUC of WTR（0.758）was smaller than that of WHtR（0.774）（P0.001）,and WC（0.761）（P0.001）,but larger than that of BMI（0.738）（P0.001）and WHR（0.732）（P0.001） for hyperglycemia.Stratified by age,in women who age ≥35 years,the AUC of WTR（0.725） was larger than that of WHtR（0.716）（P0.001）、WC（0.705）（P0.001）、WHR（0.676）（P0.001）and BMI（0.665）（P0.001）.③After adjustment for age and gender,logistic regression analyses showed that WTR have the strongest association with hyperglycemia（OR=1.70,95% CI 1.37-2.11;per 1 SD increment）.Conclusion Hyperglycemia is a serious health problem in government employee.WTR performed better than other four indices in all men and in women age≥35 for the association with hyperglycemia.