不同代谢综合征诊断标准运用于四川地区人群的比较分析  

Comparison of Different Diagnostic Criteria for Metabolic Syndrome in Sichuan Population

作　　者：费扬帆[1] 王椿[1] 刘关键[2,3] 高赟[1] 陈涛[1] 田浩明[1] 冉兴无[1] 

机构地区：[1]四川大学华西医院内分泌代谢科糖尿病足诊治中心,成都610041 [2]四川大学华西医院 [3]中国循证医学中心.中国Cochrane中心,成都610041

出　　处：《四川大学学报（医学版）》2012年第4期547-552,共6页Journal of Sichuan University(Medical Sciences)

基　　金：国家自然科学基金(No.81170776)资助

摘　　要：目的探讨世界卫生组织1999年〔WHO(1999)〕、美国第三次胆固醇教育计划2005年〔ATPⅢ(2005)〕、中华医学会糖尿病学分会2004年〔CDS(2004)〕,以及国际糖尿病联盟2005年〔IDF(2005)〕对代谢综合征(MS)作出的诊断标准的一致性,寻求适合于四川地区人群的MS诊断标准。方法对四川地区20岁以上人群行多级整群抽样流行病学调查,共3511例对象纳入研究中。对研究对象同时行问卷调查、体格检查和实验室检查,包括口服葡萄糖耐量试验(OGTT)和血脂谱。结果 4种诊断标准中,ATPⅢ(2005)标准诊断MS粗患病率及年龄校正后患病率最高,分别为22.4%和19.8%。MS的患病率根据WHO(1999)和CDS(2004)标准诊断为男性高于女性(P<0.05),而根据IDF(2005)标准诊断为女性高于男性(P<0.05),根据ATPⅢ(2005)标准诊断则在两性中没有差异(P>0.05)。4种定义诊断MS的患病率在汉、彝两族人群中差异均无统计学意义(P>0.05)。4种标准的总体诊断符合率为81.17%;其中IDF(2005)与ATPⅢ(2005)定义的诊断符合率最高为95.70%,Kappa值为0.867(P=0.000);4种标准诊断为MS者心肌梗死和脑卒中的患病率之间差异无统计学意义(P=0.556),但均高于无MS者(P<0.05)。CDS(2004)标准较WHO(1999)标准简便易行,可操作性强,同IDF(2005)及ATPⅢ(2005)相比其诊断MS的患病率更低,更加经济。结论 ATPⅢ(2005)标准较另外3种标准严格。4种诊断标准运用于四川地区人群在预测心脑血管事件方面有相同价值,而CDS(2004)标准更适用于四川地区人群。Objective To evaluate the consistency of the diagnostic criteria for metabolic syndrome（MS） proposed by World Health Organization 1999（WHO1999）,National Cholesterol Education Program Adult Treatment Panel Ⅲ 2005（ATP Ⅲ 2005）,Chinese Diabetes Society 2004（CDS2004）,and International Diabetes Federation 2005（IDF2005）,and to identify a more applicable one for people in Sichuan.Methods A cross-sectional survey on MS was conducted in Sichuan.A total of 3511 participants were recruited through multistage cluster random sampling.A questionnaire was administered to the participants,along with physical examinations and laboratory tests involving oral glucose tolerance test and lipid profiles.The MS patients were identified by the above-mentioned diagnostic criteria.Results According to the ATPⅢ（2005）,the prevalence and age-adjusted prevalence of MS were 22.4% and 19.8% in Sichuan population respectively,significantly higher than those identified by the other 3 diagnostic criteria.The prevalence of MS increased with age.Men had higher prevalence of MS than women（P〈0.05） according to the CDS（2004） and WHO（1999）.But women had higher prevalence of MS than men according to the IDF（2005） and no gender difference in the prevalence of MS existed according to the ATPⅢ（2005）.No significant difference was found in the prevalence of MS between the Han ethnicity and the Yi ethnicity regardless which diagnostic criteria were adopted.The 4 MS diagnostic criteria reached a consistency of 81.17%.The highest consistency（95.70%） occurred between the IDF（2005） and the ATPⅢ（2005）,with a kappa coefficient of 0.867（P=0.000）.Significantly higher morbidity of myocardial infarction（MI） and/or cerebral stroke was found in MS patients regardless which criteria applied.The morbidity of MI and cerebral stroke in MS patients identified by the 4 criteria showed no difference（P=0.556）.Conclusion ATPⅢ（2005） has stricter criteria for MS than the others.The prevalence of MS

关 键 词：代谢综合征 诊断标准 一致性 

分 类 号：R589[医药卫生—内分泌]