颈围对2型糖尿病患者心血管疾病及血脂异常的初步评价作用：北京社区糖尿病研究15

Neck circumference in assessment of cardiovascular disease and dyslipidemia risk in Chinese type 2 diabetes： Beijing Community Diabetes Study （BCDS-15）

目的探讨颈围对2型糖尿病患者心血管疾病（高血压、冠心病、脑卒中）及血脂异常的评价作用。方法以2008年8月至2009年7月北京三甲医院与15个城区社区中心联合开展糖尿病纵向管理项目基线数据库中3176例2型糖尿病患者为研究对象。其中男性1291例（40．7％），女性1885例（59．3％）。糖尿病病程（9±7）年。合并高血压者2103例（66．2％）、血脂异常2903例（91．4％）、冠心病616例（19．4％）、脑卒中398例（12．5％）。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，对患者进行体格检查及相关的实验室检查。采用受试者操作特征（ItOC）曲线计算颈围、腰围、腰臀比评价患心血管疾病及血脂异常曲线下面积（AUC）。结果①3176例2型糖尿病患者平均颈围（36．6±3．7）em，腰围（89．4±9．4）cm，腰臀比（0．89±0．06）。男性颈围、腰围、腰臀比均高于女性[分别为颈围（38．4±3．6）比（35．4±3．3）cm、腰围（91．6±8．7）比（87．9±9．6）em，腰臀比（0．91±0．06）比（0．88±0．06），t值分别为24．251、11．148和14．249，P均〈0．01]。男性的糖化血红蛋白（HhAlc）（7．3±1．7）％略高于女性（7．2±1．5）％（t=2．089，P=0．037），而男性TC、LDL—c、HDL—c水平低于女性[分别为TC（5．0±1．3）比（5．3±1．2）mmol／L，LDL—c（2．9±0．9）比（3．0±0．9）mmol／L，HDL—C（1．3±0．5）比（1．4±0．5）mmolZL，t值分另0为-5．837、-3．562、-6．788，P均〈0．01]。②腰围、颈围、腰臀比评价患高血压AUC男性分别为0．599、0．557、0．563，颈围AUC低于腰围（Z=2．486，P=0．013），颈围与腰臀比的AUC差异无统计学意义（z=0．273，P：0．785）；女性AUC分别为0．578、0．576、0．540，腰臀比AUC低于腰围（Z=3．021，P=0．003），颈围与腰围、颈围与腰臀比的AUC差异无统计学意义（分别为Z=0．181，P=0．857；z=1．983，P=0．057）。③评价血脂异常、脑卒中、冠心病时腰围、颈围、腰臀比AUC差异无统计学意义。④评价2种、3种以上疾病（高血压、冠心病、脑卒中、血脂异常）时，腰围、颈围、腰臀比AUC相近。结论与腰围、腰臀比相比，颈围是中等效能评价2型糖尿病患者高血压、血脂异常、脑卒中、冠心病以及多种心血管疾病指标。

Objective To evaluate the detecting power of neck circumference （NC） for cardiovascular disease and dyslipidemia in type 2 diabetes among the Chinese population. Methods Total 3 176 subjects aged 20 -80 years with type 2 diabetes, including 1 291 （40.7%） males and 1 885 （59.3%） females, were recruited from 15 community health centers in Beijing using a multi-stage random sampling approach. The duration of diabetes was （ 9 ＋ 7 ） years. Among all subjects there were 2 103 （66. 2% ） with hypertension, 2 903 （91.4%） with dyslipidemia, 616 （ 19.4% ） with coronary heart disease and 398 （ 12. 5% ） with stroke. An anthropometrie study, including neck and waist circumference （NC and WC） measurements, was conducted. ROC analyses were used to compare the association between different anthropometrie indicators with cardiovascular risk factors. 1 291 （40. 7% ） were male and 1 885 （59.3%） were female. The duration of diabetes was （9 ±7） years. There were 2103 people （66. 2% ） with hypertension, 2 903 people （91.4%） with dyslipidemia, 616 people （ 19. 4% ） had coronary heart disease and 398 people （12.5%） with stroke. Results The mean NC was （36.6 ±3.7） cm, WC was （89. 4 ±9. 4） cm, waist-to-hip ratio （WHR） was 0. 89 ±0. 06. NC, WC and WHR in males were higher than those in females [NC（38.4±3.6） vs. （35.4±3.3）em, WC （91.6＋8.7） vs. （87.9±9.6）cm, WHR （0. 91 ＋0. 06） vs. （0. 88 ±0. 06）, t =24. 251, 11. 148, 14. 249, all P 〈0. 001 ]. HbAle value in males was higher than that in females [ （7.3 ±1.7% ） vs. （7.2 ± 1.5 ） %, t = 2. 089, P = 0. 0371. There were statistically significant differences in TC, LDL-C and HDL-C between the sex groups [ TC （5.0 ± 1.3 ） mmol/L vs. （5.3 ± 1.2） retool/L, LDL-C（2. 9 e0. 9） vs. （3.0±0. 9） mmoL/L, HDL-C（ 1.3 ±0. 5） vs. （ 1.4 ± 0. 5） mmol/L, t = - 5. 837, - 3. 562, - 6. 788, all P 〈 0. 001 ]. The area under curve （AUC） of NC, WC and WHR in detection of hypertension in males were 0. 599, 0. 557, and 0. 563 （ NC vs. WC, Z = 2. 486, P =0. 013, NC vs. WHR, Z =0. 273, P =0. 785 ）. The AUC of NC, WC and WHR in detection of hypertension in females were 0. 578, 0. 576, and 0. 540 （ WC vs. WHR, Z = 3. 021, P = 0. 003,WC vs. NC, Z=0. 181 ,P=0. 857, NC vs. WHR, Z= 1. 983,P=0. 057）. There was no statistically significant in the AUC of NC, WC and WHR in detection of dyslipidemia, stroke, and coronary heart disease. The AUC of NC, WC and WHR in detection of two or more diseases （ hypertension, coronary heart disease, stroke and dyslipidemia） were not statistically significant. Conclusion Compared to WC and WHR, NC, an operable anthropometric index, might be used to identify hypertension, dyslipidemia, stroke, coronary heart disease with medium effieiency in the Chinese diabetie population.