两种儿童青少年代谢综合征定义的临床应用比较

Comparison of clinical application of two definitions of metabolic syndrome in children and adolescents

目的：比较2012年中国儿童青少年代谢综合征（MetS）定义和2007年国际糖尿病联盟（IDF）定义在肥胖儿童青少年中的临床应用情况，并评价其适用性。方法：对2006年7月至2012年12月593名10～16岁肥胖儿童青少年的住院检查资料进行分析，比较两种定义诊断MetS及其组分的一致性，以及检出胰岛素抵抗、早期血管病变的敏感性和特异性。结果：两种定义对研究对象的MetS诊断一致性较好（K=0．626），对各组分异常率的诊断一致性由高到低依次为中心性肥胖、高甘油三脂血症、高血糖、胆固醇代谢异常、高血压，其K值分别为1．000、0．803、0．780、0．734和0．594。两种定义对胰岛素抵抗和早期血管病变的检出率均随着MetS组分异常数的增多而显著升高（尸〈0．05）；对胰岛素抵抗的检出，中国定义的敏感度和特异度分别为54．5％和65．7％，IDF定义分别为36．1％和83．1％；对早期血管病变的检出，中国定义的敏感度和特异度分别为58．3％和55．8％，IDF定义分别为37．3％和70．8％。校正年龄和性别因素后，相较于非MetS儿童，中国定义的MetS儿童发生胰岛素抵抗和早期血管病变的OR值分别为2．166（P〈0．001）和1．771（P=0．008），而根据IDF定义，MetS儿童发生胰岛素抵抗和早期血管病变的OR值分别为2．618（P〈0．001）和1．357（P=0．190）。结论：中国定义和IDF定义在国内肥胖儿童青少年MetS诊断上具有较好的一致性，中国定义诊断高血压、高血糖、高非高密度脂蛋白胆固醇血症的敏感度较高，能较早发现肥胖儿童青少年的胰岛素抵抗和早期血管病变。

Objective： To compare and evaluate clinical applications of two definitions of metabolic syndrome in children and adolescents, which was developed by Pediatric Academy of Chinese Medical Association in 2012 （Chinese definition ） and by International Diabetes Federation in 2007 （IDF definition）, respectively. Methods： 593 obese children and adolescents aged 10 - 16 y from July 2006 to December 2012 were enrolled in the study. The diagnostic concordance of two definitions for metabolic syndrome and individual components was estimated, and their sensitivity and specificity for detecting insulin resistance and early macrovascular complications were compared. Results： The concordance between two definitions for diagnosing metabolic syndrome was good （kappa = O. 626） ; as for detecting the individual components ,the Kappa concordance index were 1. 000,0.803,0. 780,0. 734 and O. 594 for hypertriglyceridemia, hyperglycemia, cholesterol abnormality and hypertension, respectively. The incidence of insulin resistance and early macrovascular complications, detected by the two definitions, were both increased with increasing number of abnormal components. The sensitivity and specificity for detecting insulin resistance in children with metabolic syndrome were 54.5% and 65.7% by Chinese definition, and 36. 1% and 83. 1% by IDF definition; while the sensitivity and specificity for detecting early macrovascular complications were 58.3% and 55.8% by Chinese definition,and 37.3% and 70.8% by IDF definition. After adjusting for age and sex, compared to the obese children and adolescents without metabolic syndrome, the odds ratios of insulin resistance and early macrovascular complications were 2. 166 （P 〈 0.001 ） and 1. 771 （P = 0.008 ） for children with metabolic syndrome diagnosed by Chinese definition,and the odds ratio of insulin resistance and early macrovascular complications were 2. 618 （P 〈0.001） and 1. 357 （P =0. 190） by IDF definition. Conclusions： The concordance between Chinese and IDF definitions for diagnosing metabolic syndrome in Chinese obese children and adolescents is good. Compared to IDF definition, Chinese definition is more sensitive for hypertension, hyperglycemia and hypercholesterolemia, thus it can more effectively detect insulin resistance and early macrovascular complication.