代谢综合征三种诊断标准在2型糖尿病中的比较研究  

Comparison of the three proposed definitions for diagnosing metabolic syndrome in type 2 diabetes

作　　者：谭少珍[1] 周智广[1] 唐炜立[1] 陈小燕[1] 颜湘[1] 汤佳珍[1] 彭健[1] 黄干[1] 冯琼[1] 刘玉华[1] 

机构地区：[1]中南大学湘雅二医院内分泌科,代谢内分泌研究所,长沙410011

出　　处：《中华糖尿病杂志（1006-6187）》2005年第3期187-189,共3页

基　　金：国家"十五"科技攻关项目(2001BA702B04和2001BA702B01);湖南省科技厅项目(02SSY3065)

摘　　要：目的比较WHO、美国国家胆固醇教育计划成人治疗组第三次指南(NCEPATPⅢ)及中华糖尿病学会(CDS)代谢综合征(MS)诊断标准在2型糖尿病(T2DM)中的应用。方法选择251例病程未超过1年、无临床心脑血管疾病的T2DM患者,比较三种标准的诊断差异,并比较稳态模型评估的胰岛素抵抗(IR)及大血管超声异常率与MS间的关系。结果采用WHO、CDS及ATPⅢ标准MS患病率分别为61.4%、61.8%及48.2%(P<0.01);中心性肥胖的诊断率分别为59.3%、59.8%及13.5%(P<0.01);WHO与CDS标准符合率为99.6%。应用ATPⅢ标准,有MS者其IR、空腹胰岛素及餐后2h胰岛素水平皆显著高于无MS者(P<0.05)。结论(1)三种标准诊断MS其差异有显著性;ATPⅢ标准诊断率低于另两者;WHO标准与CDS标准在中国T2DM人群可以通用。(2)ATPⅢ标准诊断中心性肥胖更严格,且可见IR与MS关系密切。Objective To compare the prevalences of the metabolic syndrome (MS) in type 2 ~diabetic (T2DM) patients using three definitions proposed by WHO,1999, NCEP-ATPⅢ,2001 and the Chinese Diabetes Society (CDS), 2003 respectively. Methods We screened 251 T2DM patients with less than one-year duration of diabetes and without the histories of coronary heart disease and stroke. The homeostasis model assessment was used to evaluate insulin resistance (HOMA-IR). The three definitions for dignosis of MS were compared in T2DM. HOMA-IR and the prevalences of ultrasonic macrovascular abnormalities were compared between the patients with and without MS. Results (1)The prevalences of the MS by the WHO, the CDS and the ATPⅢ criterium were 61.4%, 61.8% and 48.2%(P<0.01) respectively. The prevalence using the ATPⅢ criterium was lower than that using the other two criterium (P<0.01).(2)99.6% of the participants were similarly classified by the WHO and the CDS criterium.(3)The prevalences of central obesity by the criterium of WHO, CDS and ATPⅢ were 59.3%, 59.8% and 13.5%(P<0.01) respectively.(4)Using the ATPⅢ criterium, the levels of HOMA-IR, FIns and 2 hIns between the participants with and without MS were 5.2(3.4～8.3) vs 4.3(2.8～6.8) (P<0.05), 16.0(12.0～23.5) vs 14.0(10.0～20.0) mU/L(P<0.01), 48.0(33.0～77.0) vs 40.0(25.5～57.0) mU/L(P<0.01) respectively. Conclusions (1)The prevalences of MS using the three criterium were significantly different in the participants. The prevalence using the ATPⅢ criterium was lower than that by the other two criterium. The WHO and CDS criterium may be mutually applied in T2DM in Chinese. (2)It is more stringent in diagnosing central obesity using the ATPⅢ criterium. Close relationships between HOMA-IR and MS may be found using the ATPⅢ criterium in T2DM.

关 键 词：代谢综合征 诊断标准 2型糖尿病 MS 胰岛素抵抗 

分 类 号：R587.1[医药卫生—内分泌] R589[医药卫生—内科学]