江苏省成年人代谢综合征流行特征及其不同诊断标准的对比研究

Epidemiological characteristics of metabolic syndrome and comparison between its different diagnostic criteria in adults of Jiangsu Province

目的：了解江苏省成年人代谢综合征（MS）的流行特征,比较5种不同MS诊断标准应用的一致性和差异,探讨适宜成年人预测MS其他组分及危险因素聚集能力相对最好的最佳腰围或体质量指数（BMI）切点。方法：2010年在江苏省采用多阶段整群随机抽样方法抽取18岁及以上常住居民8400人,对调查对象进行体检和面对面问卷调查获取健康信息,分别采用2004年中华医学会糖尿病学分会（CDS）、2005年美国胆固醇教育计划成人治疗方案第三次报告（NCEP-ATPⅢ）、2005年国际糖尿病联盟（IDF）、2007年中国成人血脂异常防治指南制订联合委员会（JCDCG）和2009年国际联合暂定声明（JIS）标准诊断MS,描述各种标准MS的流行特征。分析不同标准对MS异常组分及危险因素聚集的检出情况,计算不同标准的符合率和Kappa值,比较MS不同诊断标准的一致性和差异。用受试者工作特征曲线（ROC）分析腰围及BMI切点预测MS各异常组分及危险因素聚集情况。结果：调查对象中CDS、ATPⅢ、IDF、JCDCG和JIS标准诊断的MS粗患病率（标化患病率）分别为18.4%（15.1%）、37.3%（31.0%）、29.5%（24.6%）、22.8%（19.4%）和38.9%（32.7%）。各种标准诊断的MS患病率在不同性别、年龄、文化程度、职业和父母是否患病高血压及糖尿病组中的分布比较差异均有统计学意义（P〈0.05）。采用CDS、ATPⅢ、IDF、JCDCG和JIS标准诊断为MS者中存在3种及3种以上危险因素聚集的比例分别为97.2%、96.7%、97.2%、98.7%和100.0%。ATPⅢ与JIS、ATPⅢ与IDF和IDF与JIS的符合率（Kappa值）分别为95.93%（0.91）、91.91%（0.82）和88.89%（0.76）,其他诊断标准的两两符合率为78%-82%,Kappa值为0.40-0.74。腰围切点男/女为85/80cm时,预测危险因素聚集的灵敏度、特异度和ROC曲线距离分别为88.29%、74.54%、0.28和85.97%、70.07%、0.33。结论：江苏省成年人MS患病率水平较高。CDS、ATPⅢ、IDF、JCDCG和JIS诊断标准在江苏省成年人群的适用性存在较大差异,ATPⅢ与JIS标准的一致性最好。适宜江苏省成年人群的最佳腰围切点男/女为85/80cm。

Objective To investigate the epidemiological characteristics of metabolic syndrome（MS）in adults of Jiangsu Province and compare the consistency and difference of the five diagnostic criteria for MS,and to explore the optimum cut-off points of waist circumference or body mass index（BMI）for forecasting other components and risk factors aggregation of MS in adults of Jiangsu Province.Methods A total of 8 400 residents aged 18 and older from Jiangsu Province were selected by multistage cluster randomly sampling method in 2010.Medical examination and face to face questionnaire survey were conducted to collect the health information for respondents.The prevalence and epidemiological characteristics of MS were calculated and described,diagnosed according to five diagnostic criteria,issued by the Chinese Medical Association Diabetes Branch（CDS）in 2004,Adult Treatment PanelⅢ of National Cholesterol Education Program（NCEP-ATP Ⅲ）in 2005,International Diabetes Federation（IDF）in 2005,Joint committee for Developing Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults（JCDDCG）in 2007 and International Joint Interim Statement（JIS）in 2009,respectively.The distribution of MS components and risk factors aggregation were analyzed,and the agreement rate and Kappa values of different diagnostic criteria were calculated to compare the consistency and difference of the five diagnostic criteria.Receiver operating characteristic（ROC）curve was conducted to forecast other components and risk factors aggregation of MS with cut-off points of waist circumference or BMI.Results The crude prevalence（standardized prevalence rate）of MS in the respondents was respectively 18.4%（15.1%）for CDS criterion,37.3%（31.0%）for ATPⅢ criterion,29.5%（24.6%）for IDF criterion,22.8%（19.4%）for JCDCG criterion and 38.9%（32.7%）for JIS criterion.There were statistically significant differences of the distribution of the prevalence of MS diagnosed by different criteria between different sex,age,education level,occupation,parents in hypertension and diabetes group（P〈0.05）.The proportions of at least three risk factors among the subjects with MS diagnosed by CDS,ATPⅢ,IDF,JCDCG and JIS criteria were respectively 97.2%,96.7%,97.2%,98.7%and 100%.The agreement rates（Kappa value）were respectively 95.93%（0.91）,91.91%（0.82）and 88.89%（0.76）between ATP Ⅲ and JIS,ATP Ⅲ and IDF,IDF and JIS.The agreement rate and Kappa value of other pairs were among 78%-82% and0.40-0.74,respectively.The sensitivity,specificity and shortest distance of receiver operating characteristic（ROC）curve for forecasting risk factors aggregation of MS were respectively 88.29%,74.54%,0.28 in male and85.97%,70.07%,0.33 in female when waist circumference was 85 cm in male and 80 cm in female.Conclusion The prevalence of MS is higher in the adults of Jiangsu Province.Among the five diagnostic criteria for MS,there is bigger difference in applicability for the adults of Jiangsu and a best consistency between the ATPⅢ and JIS.The optimum cut-off points of waist circumference for the adults in Jiangsu Province are respectively 85 cm for male and 80 cm for female.