依据我国成人体重判定行业标准评价现行代谢综合征诊断标准在中老年人群中的应用

Study on evaluation of current diagnostic criteria for metabolic syndrome applied in middle-to-old-aged residents according to the criteria of weight for adults

目的 ：依据我国成人体重判定行业标准,评价现行代谢综合征（MS）3种诊断标准在合肥市中老年人群中的应用。方法：采用整群随机抽样方法,对合肥市某社区内40岁及以上常住居民进行问卷调查、体格检查和实验室检查。按照中华医学会糖尿病分会（CDS）诊断标准、国际糖尿病联盟（IDF）诊断标准和美国国家胆固醇教育计划成人治疗方案第3次报告（NCEP-ATPⅢ）分别计算MS的患病率,依据我国成人体重判定行业标准,修订现行CDS标准作为参考标准,评价上述3种标准及修订后的IDF和ATPⅢ在实际疾病筛查中的意义。结果：共调查2 860名居民,男1 093名（占38.22%）,女1 767名（占61.78%）,平均年龄（56.38±10.8）岁。按照CDS、IDF、ATPⅢ和参考标准,调查对象MS患病率分别为23.39%、34.55%、37.20%和26.71%,标化患病率分别为22.18%、33.73%、36.28%和25.33%。CDS与参考标准诊断时,男女间患病率无统计学差异,60-69岁年龄段MS患病率最高。IDF与ATPⅢ标准诊断时,50-59岁年龄段MS患病率最高,女性MS患病率高于男性。相同年龄段、相同性别人群均表现出CDS标准诊断MS患病率最低,ATPⅢ标准诊断MS患病率最高,差异有统计学意义。参照参考标准,现行CDS、IDF和ATPⅢ的灵敏度分别为87.57%、80.10%和84.29%,特异度分别为100.00%、82.06%和79.96%,阳性预测值分别为100.00%、61.94%和60.53%。修订后的IDF和ATPⅢ标准MS患病率分别为27.31%和32.76%,特异度分别为88.31%和84.40%,阳性预测值分别为68.63%和65.10%。结论：调查对象MS患病率较高,现行3种诊断标准中CDS标准诊断MS患病率最低,ATPⅢ标准诊断最高,参照成人体重判定修订现行标准,可提高CDS标准下MS患病率、IDF和ATPⅢ标准诊断的特异度和阳性预测值,在实际筛查工作中应结合调查对象的实际情况灵活选择诊断标准。

Objective To evaluate the application of current three metabolic syndrome（MS） diagnostic criteria in elderly people in Hefei based on the criteria of weight for adults. Methods Stratified cluster random sampling was used to select residents aged 40 years. Questionnaire survey, physician check-up and laboratory test were performed. The MS prevalence rate was calculated according to the diagnostic criteria of Chinese Diabetes Society（CDS）, International Diabetes Federation（IDF）, and the National Cholesterol Education Program（NCEP） Adult Treatment Panel-Ⅲ（ATP Ⅲ）,respectively. The revised CDS criteria based on the criteria of weight for adults was considered as the reference standards for evaluating the significance of the three MS diagnostic criteria and the revised IDF and ATP Ⅲ in actual disease screening. Results A total of 2 860 residents were interviewed with questionnaire including 1 093 men（38.22%）and 1 767women（61.78%）. The average age was（56.38±10.83） years. The MS prevalence rates were 23.39%, 34.55%, 37.20% and26.71% according to CDS, IDF, ATP Ⅲ and reference standards, respectively. The standardized prevalence rates of MS were 22.18%, 33.73%, 36.28% and 25.33%, respectively. In accordance with CDS and reference standards, no statistically significant difference was found between male and female prevalence rates, the highest prevalence rate of MS was found in60-69 age group. In IDF and ATPⅢ, the highest prevalence rate of MS was in 50-59 age group; MS prevalence rate of female was higher than male. The highest MS prevalence was found on ATP Ⅲ while the lowest rate was found on CDS in the same gender and age group. Referring to the reference standards, the sensitivity of current CDS, IDF and ATP Ⅲ were87.57%, 80.10% and 84.29%, the specificity were 100.00%, 82.06% and 79.96%, the positive predictive value were100.00%, 61.94% and 60.53%, respectively. Based on the revised IDF and ATP Ⅲ, the MS prevalence rates were 27.31%and 32.76%, the specificity were 88.31% and 84.40%, the positive predictive value were 68.63% and 65.10%,respectively. Conclusions The MS prevalence rate was high in Hefei, and the MS prevalence rate was highest on ATP Ⅲand lowest on CDS among the current three diagnostic criteria. The MS prevalence rate on CDS, the specificity and positive predictive value on IDF and ATP Ⅲ could be improved by revising the current diagnostic criteria. In actual disease screening, appropriate diagnostic criteria could be selected and in combination with the actual situation of objects.