两种青少年代谢综合征诊断标准在台湾地区12～19岁人群中的应用比较

目的 比较两种青少年代谢综合征(MS)诊断标准在中国台湾地区12～19岁人群MS及其组分的检出情况,为进一步制定相应的预防和治疗措施提供依据.方法 选择2005年1月～2006年12月首次参加美兆健康体检的12～19岁人群1629名进行横断面研究,应用分别由Cook(标准Ⅰ)和de Ferranti(标准Ⅱ)推荐的两种标准诊断MS,使用χ2检验比较不同性别、不同体重人群MS检出率、MS各组分检出率及MS组分数只构成的性别差异,应用Kappa值评价两种标准在台湾地区青少年中应用的一致性.结果 (1)标准Ⅰ MS检出率为4.05%(男5.84%,女1.98%),标准Ⅱ为8.35%(男10.42%,女5.95%);体重正常、高危和超重二组人中MS标准Ⅰ检出率分别为0.94%、14.20%和36.59%,标准Ⅱ检出率分别为3.61%、25.93%和53.66%;(2)标准Ⅰ的5种组分检出率为9.09%(低高密度脂蛋白胆固醇)～16.39%(高血压),标准Ⅱ的5种组分检出率0.98%(高血糖)～27.13%(高腰围);(3)满足≥3个异常组分的人中,标准Ⅰ具有3项、4项和5项MS组分组合的比例分别为2.76%、1.04%和0.25%,标准Ⅱ分别为6.69%、1.60%和0.34%;(4)MS患者异常组分最常见组合,标准Ⅰ为"肥胖+低HDL-C+高BP",标准Ⅱ为"肥胖+低HDL-C+高甘油三酯";(5)标准Ⅰ和Ⅱ诊断的一致率为94.35%,Kappa值为0.518.结论 采用两种MS诊断标准获得的12～19岁人群检出率和异常组分聚集情况差异较大,结果的高估与低估与标准推荐使用的各组分的切点值高度相关,建议制定具本国特异性切点值的儿童青少年MS诊断标准.

Comparison of two diagnostic criteria for metabolic syndrome applied in health check-up population aged 12-19 years in Taiwan

Objective To compare the differences of two recommended diagnostic criteria for metabolic syndrome (MS) in a health check-up population aged 12 -19 years in Taiwan province. Method The study data were supplied by the MJ Health Screening Center, which is a private membership chain clinic with 4 health screening centers around the Taiwan Island and provides periodic health examination to its members. The database included a self-administered questionnaire for health history, asking about demographic, socioeconomic, medical, and lifestyle information, and clinical and laboratory measures for every member. A total of 1629 members (873 boys and 756 girls, respectively) received a health check-up first time at MJ centers were recruited from 2005 to 2006. MS detection rate and agreement rate was calculated according to two definitions, respectively. The distributions of MS components and the aggregation of risk factors were further analyzed. Result (1) The range of age-adjusted detection rate of MS for two definitions were 4.05% (5.84% for boys, 1.98% for girls) and 8. 35% (10.42% for boys, 5.95% for girls), respectively. It was 0.94%, 14.20% and 36.59% for criterion Ⅰ among adolescents who were overweight (BMI over 95th percentile), at risk of overweight ( BMI between 85th and 95th percentile) and normal weight ( BMI below the 85th percentile), respectively; while 3.61%, 25. 93% and 53.66% for criterion Ⅱ. (2) The range of five MS components were 9.09% (low-HDL-C)-16.39% ( high blood pressure) for definition Ⅰ, while 0. 98% (high FBG)-27.13% (high WC) for definition Ⅱ. (3) Of the total subjects, 2.76%, 1.04% and 0.25% were presented with three, four and five MS risk factors for definition Ⅰ ; while 6.69%, 1.60% and 0.34% for definition Ⅱ, separately. (4) The most common DOI : 10. 3760/cma. j. issn. 0578-1310. 2009.06.002clinical symptom complex of MS was "obesity, hypertension and low-HDL-C" for criterion Ⅰ, "high TG, obesity and Iow-HDL-C" for criterion Ⅱ. (5) The MS diagnostic criterions of Ⅰ and Ⅱ were in moderate accordance with agreement rate of 94.35%, Kappa index was 0.518. Conclusion Our findings reveal that there were relatively large differences in detection and aggregation of risk components on MS when using two recommended definitions, the detection rate of MS in adolescents depends strongly on the parameters chosen and their respective cut-off points. In order to avoid possible relevant under- or over-estimation of the prevalence, it seems advisable that the use of unversally specific cut-off values seems to be more appropriate to give more reliable results.