人体测量学指标和三酰甘油葡萄糖乘积指数对代谢综合征的诊断价值比较

背景　代谢综合征（MS）与冠心病、糖尿病等慢性病密切相关，其患病率逐年升高，但目前诊断标准不统一，诊断条件复杂，基层医务人员操作困难。目的　比较中国人群中人体测量学指标〔腰高比（WHtR）、腰臀比（WHR）、腰围（WC）、体质指数（BMI）〕及三酰甘油葡萄糖乘积（TyG）指数、TyG指数与BMI的乘积（TyG-BMI）、TyG指数与WC的乘积（TyG-WC）与MS相关性的差异及其对MS的诊断价值，确定MS的简易筛查指标。方法　选取北京市通州区觅子店社区2 972例参加健康体检人员，分别进行问卷调查、体格检查及实验室检查，计算WHtR、WHR、BMI及TyG指数、TyG-BMI、TyG-WC。依据中华医学会糖尿病学分会（CDS）诊断标准确定MS患者。采用SPSS 18.0统计软件绘制上述各项指标诊断MS的受试者工作特征（ROC）曲线，计算曲线下面积（AUC），并采用MedCalc 16.8软件进行AUC比较。结果　男性和女性的MS患病率无统计学差异〔206/1 044比368/1 928，P>0.05〕。同性别MS患者的WHtR、WHR、WC、BMI、TyG指数、TyG-BMI、TyG-WC均高于非MS者（P<0.05）。BMI、WHtR、WHR、WC诊断男性MS的AUC分别为0.81、0.77、0.68、0.77，诊断女性MS的AUC分别为0.78、0.76、0.66、0.76，BMI诊断男性MS和女性MS的AUC均高于其他3项指标（P<0.05）。BMI诊断男性和女性MS的切点分别为25.00、25.30 kg/m2。TyG指数、TyG-BMI、TyG-WC诊断男性MS的AUC分别为0.88、0.89、0.88，诊断女性MS的AUC分别为0.88、0.88、0.87，TyG指数诊断男性MS和女性MS的AUC与其他2项指标比较无统计学差异（P>0.05）。TyG指数诊断男性和女性MS的切点分别为8.87、8.80。TyG指数诊断男性MS和女性MS的AUC高于BMI（P<0.05）。结论　人体测量学指标、TyG指数及其相关指数与MS均明显相关。BMI同MS的相关性优于其他人体测量学指标，可用于MS的大规模人群初步筛查；TyG指数的诊断价值优于BMI，可作为基层医务人员判断MS风险的简易指标。

Comparison of the Value of Anthropometric Indicators and Triglycerides Glucose Index in the Diagnosis of Metabolic Syndrome

Background　Metabolic syndrome（MS） is significantly associated with chronic diseases such as coronary heart disease and diabetes with an increasing prevalence year by year.However，the diagnostic criteria of MS are not uniform and the diagnostic conditions are complicated currently difficult for grassroots medical staff to operate.Objective　To compare the difference between the correlation of anthropometric indicators〔waist-to-height ratio（WHtR），waist-hip ratio（WHR），waist circumference（WC），and body mass index（BMI）〕，triglycerides glucose（TyG）index，triglyceride glucose-body mass index（TyG-BMI），and triglyceride glucose-waist circumference（TyG-WC） and MS，and its value in the diagnosis of MS in Chinese population，in order to determine the simple screening indicators of MS.Methods　The study was carried out with the participation of 2 972 adults who took the regular health check from Maizidian Village in Tongzhou District of Beijing.The questionnaire survey，physical examination，and blood examination were conducted to get their WHtR，WHR，BMI，TyG index，TyG-BMI and TyG-WC.MS patients were identified according to diagnostic criteria set by Chinese Diabetes Society（CDS）.SPSS 18.0 software was used to draw the ROC curves of the above indicators and calculate the AUC.The comparisons of AUCs were performed by MedCalc 16.8 software.Results　There was no significant difference in the prevalence of MS between different genders〔206/1 044 vs. 368/1 928，P>0.05〕.WHtR，WHR，WC，BMI，TyG index，TyG-BMI and TyG-WC were higher in patients with MS than those without（P<0.05）.The AUCs of BMI，WHtR，WHR and WC for male patients with MS were 0.81，0.77，0.68 and 0.77，and those for female patients with MS were 0.78，0.76，0.66 and 0.76.Comparing with WHtR，WHR and WC，the difference of AUC of BMI in diagnosing male and female patients with MS was higher（P<0.05）.The cut-off point of BMI for MS diagnosis was 25.00 kg/m2 for males and 25.30 kg/m2 for females.The AUCs of TyG index，TyG-BMI and TyG-WC in diagnosing male patients with MS were 0.88，0.89 and 0.88，and those for female patients with MS were 0.88，0.88 and 0.87.There was no significant difference in AUCs of TyG index and other two indexes in diagnosing MS（P>0.05）.The cut-off point of TyG index for MS diagnosis was 8.87 for males and 8.80 for females.The AUC of TyG index in male and female MS was higher than BMI（P<0.05）.Conclusion　Anthropometric indicators and TyG index and its related indicators are significantly associated with MS.BMI has a better correlation with MS than other anthropometric indicators which can be used to screen large-scale population for MS preliminarily.TyG index is better than BMI in the diagnosis of MS which can be used as a simple indicator for primary medical staff to identify risks of MS.