两种代谢综合征工作定义在上海地区人群中应用的比较

A comparison of the application of two working definitions of metabolic syndrome in Chinese population

目的 比较 1999年WHO及 2 0 0 1年美国第三次胆固醇教育计划 (ATPⅢ )中提出的两种代谢综合征 (MS)工作定义在中国人群中应用的价值。方法 由 1999～ 2 0 0 1年上海华阳和曹杨社区肥胖及其相关疾病基线调查资料中 ,取年龄为 2 0～ 74岁人群有完整血糖、血脂、血压、胰岛素、尿微量白蛋白、尿肌酐等资料者共 2 0 4 8人 (男性 896人 ,女性 115 2人 )。分别应用WHO(1999)及ATPⅢ的MS工作定义诊断MS ,并比较MS的患病率及其构成组分患病率的异同。结果 (1)WHO(1999)及ATPⅢ定义诊断出的MS患病率分别为 17 14 %和 10 95 % ,前者显著高于后者。 (2 )两种定义诊断MS的一致率为 4 5 17% ,另有 4 2 0 2 %的MS仅符合WHO(1999)定义 ,12 81%的MS仅符合ATPⅢ定义。 (3)WHO(1999)定义诊断出的高血糖及腹型肥胖是ATPⅢ (2 0 0 1)定义的 1 74及 4 38倍(16 74 %比 9 5 7% ,33 0 4 %比 7 5 4 % )。 (4)两种定义诊断的MS者的体重指数、腰围与臀围比、血压、血糖、胰岛素抵抗指数、尿白蛋白 /肌酐比值都显著高于非MS者。结论 用两种定义诊断的MS都能较好地反映MS者代谢异常集聚的程度 ;WHO(1999)较ATPⅢ工作定义更能反映中国人群MS及构成组分的特点 ,能诊断出更多的MS。

Objective To compare the significance of the application of the working definition for metabolic syndrome (MS) proposed by the World Health Organization (WHO) in 1999 and the one proposed by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATPⅢ) in 2001. Methods Data of 2048 subjects, aged 20-74, 896 males and 1152 females, with complete laboratory data, including plasma glucose, lipid profile, blood pressure, serum insulin, urine albumin and creatinine, were gathered from the data of baseline survey on obesity and its co-morbidities conducted in Huayang and Caoyang communities, Shanghai, from 1999 to 2001. MS was diagnosed according to these two definitions respectively. Results (1) The age-adjusted MS prevalence rates were 17.14% and 10.95% according to the WHO (1999) and ATPⅢ(2001) respectively, the former being significantly higher than the latter. (2) A total of 445 subjects were diagnosed as having MS. The agreement in the diagnosis of MS using two definitions was about 45.17%. 42.02% of the subjects had MS only under the WHO (1999) definition, while 12.81% of the subjects had MS under the ATPⅢ(2001) definition. (3) The prevalence rate of hyperglycemia and central obesity as defined by WHO (1999) definition were 1.74 and 4.38 times higher than those defined by ATPⅢ (2001) definition (16.74% vs 9.57%, 33.04% vs 7.54% respectively). (4) In comparison with non-MS subjects, the body mass index, waist-to-hip ratio, blood pressure, blood glucose, insulin resistant index (HOMA-IR), and albumin-to-creatinine ratio were all significantly increased in MS subjects. Conclusion Both definitions for MS can reflect the clustering degree of risk factors of cerebrovascular and cardiovascular diseases. The WHO definition of MS can better reflect the characteristics of MS in Chinese than the definition proposed by ATPⅢ, however it needs more measurements and costs more. A simple method with high detection ability remains to be worked out.