肥胖测量指标结合糖尿病家族史识别血糖异常的效能评价

Efficacy evaluation of obesity measurement indicators combined with family history of diabetes in pathoglycemia identification

目的:比较肥胖测量指标在糖尿病家族史(FHD^+)和无糖尿病家族史(FHD^-)人群中识别血糖异常的效能。方法:对温州市4个社区进行横断面调查,入选40岁及以上人群4 867人,其中FHD^+组979人,FHD^-组3 878人,利用Pearson相关分析对体质量指数(BMI)、腰围(WC)、腰臀比(WHR)、腰围身高比(WHt R)与血糖指标,包括空腹血糖(FPG)、餐后2 h血糖(2h PG)、糖化血红蛋白(Hb A1c)进行分析,比较4项指标在识别血糖异常的ROC曲线下面积,确定最佳切点值。结果:BMI、WC、WHR、WHt R均与4项血糖指标相关(r=0.114~0.253,P<0.05)。对FHD进行分层,FHD^+组血糖异常的发生率明显高于FHD^-组,差异有统计学意义(P<0.05)。WHt R在FHD^+组和FHD^-组筛检血糖异常的最佳切点分别为0.54和0.56,BMI分别为23.5 kg/m^2和24.8 kg/m^2,WC分别为86.1 cm和88.2 cm,WHR均为0.89,ROC曲线分析显示WHt R的曲线下面积为最大(均为0.65)。结论:肥胖测量指标在FHD^+组识别血糖异常的切点值低于FHD^-组,建议对于FHD^+人群,应制定更加严格的筛查切点。2组人群中,WHt R均是识别血糖异常的最佳指标。

Objective： To compare the effectiveness of obesity measurement index in identifying abnormal blood glucose （prediabetes and diabetes） in populations with family history of diabetes （FHD＋） and those with non-diabetic family history （FHD-）. Methods： A cross-sectional study was carried out in four communities of Wenzhou city. A total of 4 867 people aged above 40 years old were included in the study, among whom, 979 people were FHD＋ group and 3 878 people in FHD- group. A correlation analysis was made of body mass index （BMI）, waist circumference （WC）, waist-hip ratio （WHR）, waist-to-height ratio （WHtR） and blood glucose level （fasting plasma glucose, 2-hour postprandial blood glucose and hemoglobin Alc） using Pearson correlation. Ar- eas under the working characteristic curve of four indexes in identifying subjects with abnormal blood glucose were compared and the optimal cut-off value was determined. Results： BMI, WC, WHR, WHtR, were all related to blood glucose indexes （r=0.114-0.253, P〈0.05）. FHD was layered, and the incidence of abnormal blood glucose in FHD＋ group was significantly higher than that in FHD- group （P〈0.05）. The optimal cut-off value of WHt2, in screening glucose abnormality in FHD＋ group and FHD- group was 0.54 mad 0.56 respectively; that of BMI was 23.5 kg/m2 and 24.8 kg/m2 respectively; that of WC was 86.1 cm and 88.2 cm respectively; that of WHR was both 0.89; ROC curve mmlysis showed that the area under curve of waist-to-height ratio was the larg- est （both 0.65）. Conclusion： The cut-off value of obesity measurement indexes in identifying glucose abnormal- ity in FHD＋ group is lower than that in FHD- group. It is suggested that stricter cut-off value should be given for FHD＋ population. Of the two groups, WHt2, is the best index to identify glucose abnormality.