颈围、腰围、腰臀比对2型糖尿病患者超重、肥胖及代谢综合征评价作用的比较研究

Function of Neck Circumference,Waist Circumference and Waist-hip Ratio in Evaluating Overweight,Obesity and Metabolic Syndrome: A Comparative Study

目的比较颈围、腰围、腰臀比对2型糖尿病患者超重、肥胖及代谢综合征的评价作用。方法选取北京三级甲等医院与15个城区社区联合开展糖尿病纵向管理项目的基线数据库中3 176例2型糖尿病患者(即2008年8月—2009年7月在北京市5个城区随机整群抽取的15个社区卫生服务中心所管辖的社区居民3 176例,均已诊断为2型糖尿病)。以BMI≥24/29 kg/m2分别作为超重/肥胖的诊断标准。代谢综合征的诊断依据中华医学会糖尿病学分会的诊断标准。采用SPSS 11.5统计软件绘制颈围、腰围、腰臀比评价超重、肥胖及代谢综合征的受试者工作特征(ROC)曲线,计算曲线下面积(AUC),并采用Med Calc软件中的Z检验进行比较分析。结果 3 176例2型糖尿病患者中,男1 291例(40.65%),女1 885例(59.35%);颈围为(36.6±3.7)cm;腰围为(89.0±9.4)cm;腰臀比为(0.89±0.06)。不同性别2型糖尿病患者年龄间差异无统计学意义(P>0.05);而颈围、腰围、腰臀比间差异有统计学意义(P<0.05)。颈围、腰围、腰臀比评价男性患者超重的AUC分别为0.721、0.833、0.677,评价女性患者超重的AUC分别为0.728、0.838、0.639;其中腰围、腰臀比评价男、女患者超重的AUC与颈围比较,差异均有统计学意义(P<0.05);腰臀比评价男、女患者超重的AUC与腰围比较,差异亦均有统计学意义(P<0.05)。颈围、腰围、腰臀比评价男性患者肥胖的AUC分别为0.779、0.870、0.703,评价女性患者肥胖的AUC分别为0.735、0.849、0.629;其中腰围、腰臀比评价男、女患者肥胖的AUC与颈围比较,差异均有统计学意义(P<0.05);腰臀比评价男、女患者肥胖的AUC与腰围比较,差异亦均有统计学意义(P<0.05)。颈围、腰围、腰臀比评价男性患者代谢综合征的AUC分别为0.667、0.772、0.629,评价女性患者代谢综合征的AUC分别为0.661、0.746、0.621;其中腰围评价男、女患者代谢综合征的AUC与颈围比较,差异均有统计学意义(P<0.05);腰臀比评价男、女患者代谢综合征的AUC与腰围比较,差异亦均有统计学意义(P<0.05)。结论评价超重、肥胖、代谢综合征时腰围优于颈围和腰臀比,颈围优于或与腰臀比相当。颈围可以替代腰臀比用于评价超重、肥胖及代谢综合征。

Objective To compare the function of neck circumference（NC）,waist circumference（WC） and waist-hip ratio（ WHR） in the evaluation of overweight, obesity and metabolic syndrome of patients with type 2 diabetes mellitus（T2DM）. Methods From the baseline database of the longitudinal diabetes management project jointly carried out by Grade A Class Three hospitals and 15 urban communities in Beijing,we selected 3 176 T2 DM patients（ community residents under the administration of 15 community health service centers in 5 city districts who were diagnosed with T2 DM and were enrolled by random cluster sampling from August 2008 to July 2009）. BMI ≥ 24 /29 kg / m2 was taken as the diagnostic criterion for overweight / obesity. The diagnostic criterion of the Chinese Diabetes Society of Chinese Medical Association was used as a reference for the diagnosis of metabolic syndrome. SPSS 11. 5 software was used to draw the ROC curves of NC,WC and WHR evaluating overweight, obesity and metabolic syndrome, and AUC was calculated and analyzed by Z test of Med Calc software. Results Among the 3 176 T2 DM patients,there were 1 291（40. 65%） males and 1 885（59. 35%） females; the mean NC,WC and WHR were（ 36. 6 ± 3. 7） cm,（ 89. 0 ± 9. 4） cm and（ 0. 89 ± 0. 06） respectively. No significant difference existed in age between male and female T2 DM patients（ P〈0. 05）,while significant differences existed in NC,WC and WHR（ P〈0. 05）. AUC values of NC,WC and WHR evaluating the overweight of male patients were 0. 721,0. 833 and0. 677 respectively,and those evaluating the overweight of female patients were 0. 728,0. 838 and 0. 639; the AUC of WC and WHR evaluating the overweight of male and female patients was significantly different from the AUC of NC evaluating their overweight（ P〈0. 05）; the AUC of WHR evaluating the overweight of male and female patients was significantly different from the AUC of WC evaluating their overweight（ P〈0. 05）. The AUC values of NC,WC and WHR evaluating the obesity of male patients were 0. 779,0. 870 and 0. 703 respectively,and those evaluating the obesity of female patients were 0. 735,0. 849 and0. 629; the AUC of WC and WHR evaluating the obesity of male and female patients was significantly different from the AUC of NC evaluating their obesity（ P〈0. 05）; the AUC of WHR evaluating the obesity of male and female patients was significantly different from the AUC of WC evaluating their obesity（ P〈0. 05）. The AUC values of NC, WC and WHR evaluating the metabolic syndrome of male patients were 0. 667,0. 772 and 0. 629 respectively,and those evaluating the metabolic syndrome of female patients were 0. 661,0. 746 and 0. 621; the AUC of WC evaluating the metabolic syndrome of male and female patients was significantly different from the AUC of NC evaluating their metabolic syndrome（ P〈0. 05）; the AUC of WHR evaluating the metabolic syndrome of male and female patients was significantly different from the AUC of WC evaluating their metabolic syndrome（ P〈0. 05）. Conclusion WC is superior to NC and WHR in the evaluation of overweight,obesity and metabolic syndrome,and NC is superior to or equal with WHR. NC can replace WHR in the evaluation of overweight, obesity and metabolic syndrome.