2型糖尿病患者颈围与血脂关系及其对血脂异常的预测作用——北京社区糖尿病研究（BCDS-10）

Association of neck circumference and lipid profile and its effect in predicting dyslipidemia in type 2diabetes： Beijing Community Diabetes Study （ BCDS-IO ）

目的了解2型糖尿病患者颈围与血脂谱问的关系。方法选择2008年8月至2009年7月北京三甲医院与15个城区社区联合开展糖尿病纵向管理项目基线数据库中2410例2型糖尿病患者。全体参与医师经过专门培训，按统一要求调查并填写调查表，同时对患者进行体格检查及相关的实验室检查，血脂异常的诊断根据2007年中国成人血脂异常防治指南。结果（1）2410例中男986例，女1424例。平均颈围为（36±4）cm。总胆固醇为（5．2±1．1）mmol／L；甘油三酯为（1．8±1．2）mmol／L；高密度脂蛋白胆固醇（HDL-C）为（1．3±0．4）mmol／L；低密度脂蛋白胆固醇（LDL-C）为（3．0±0．9）mmol／L；（2）男性、女性的颈围均与甘油三酯呈正相关（男性r=0．093，女性r=0．077，均P〈0．01），与HDL-C呈负相关（男性r=一0．144，女性r=一0．062，均P〈0．05）；（3）预测高甘油三酯血症最佳的颈围切点：男性为37em，女性为35em；预测HDL-C降低的颈围切点男性为40em，女性为35em；（4）预测高胆固醇血症受试者操作特征（ROC）曲线下面积男性组为0．511，女性组为0．480（P〉0．05）；预测LDL-C升高ROC曲线下面积男性为0．527；女性为0．519（P〉0．05）。结论2型糖尿病患者的颈围与血脂密切相关，尤其是甘油三酯和HDL-C；颈围可能做为筛查／评价2型糖尿病患者血脂异常的指标之一。

Objective To investigate the association between neck circumference and lipid profile in Chinese individuals with type 2 diabetes. Methods Total of 2410 subjects with type 2 diabetes （ age 20- 80 yrs） were recruited from 15 community health centers in Beijing using a multi-stage random sampling approach. Dyslipidemia was diagnosed according to 2007 Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults. Results （ 1 ） The study sample consisted of 986 men and 1424 women with a mean neck circumference of （ 36 ± 4） cm. Mean total cholesterol, triglyceride, high-density lipoprotein cholesteroland low-density lipoprotein cholesterol was （ 5.2 ± 1.1 ） mmol/L, （ 1.8 ± 1.2 ） retool/L, （ 1.3±0. 4 ） mmol/L and （ 3.0 ± 0. 9 ） mmol/L, respectively. （2） Neck circumference correlated positively with triglyeeride （ men （ r = 0. 093 ）, women（ r = 0. 077 ）, P 〈 0. 01 ）. Neck circumference correlated negatively with high-density lipoprotein cholesterol （ men （ r = - 0. 144 ）, women （ r = - 0. 062 ）, P 〈 0.05 ）. （ 3 ） Receiver operating characteristic analysis showed that a neck circumference of 37 cm for men and 35 cm for women was the best cutoff point for determining hypertriglyceridemia subjects. A neck circumference of 40 cm for men and 35 cm for women was the best cutoff point to determine subjects with decreased high-density lipoprotein cholesterol. （4）Receiver operating characteristic analysis showed that the area under the curve for neck circumference and hypercholeslerolcmia was 0. 511 for men and 0. 480 for women （ P 〉 0. 05 ） . Receiver operating characteristic analysis showed that the area under the curve for neck circumference and low-density lipoprotein cholesterol was 0. 527 for men and 0. 519 for women （ P 〉 0. 05 ）. Conclusion In the present study, neck circumference is related with lipid profile in Chinese individuals with type 2 diabetes, especially triglyceride and high-density lipoprotein cholesterol. Neck circumference might be used in a clinical setting as an indicator for screening or evaluating dyslipidemia in type 2 diabetic subiects.