不同诊断标准对云南省6县(区)居民代谢综合征的流行率诊断结果比较分析

目的比较4种代谢综合征(MS)诊断标准在云南省6县(区)城乡居民中对流行率诊断的差异及一致性。方法 2010年10—12月,采用多阶段分层随机抽样的方法对云南省6个疾病监测点≥18岁常住居民进行慢病危险因素调查,分别采用美国国家胆固醇教育计划成人组第3次报告[NCEP-ATPⅢ(2005年修订)]、国际糖尿病联盟(IDF,2005)、中华医学会糖尿病分会(CDS,2004)和《中国成人血脂异常防治指南》(GCADP,2007)4种不同MS诊断标准分析MS流行特征、结果一致性和危险因素聚集状况,用ROC曲线下面积(AUC)比较4个诊断标准的诊断效率。结果该次调查有效样本3 600例,其中男性1 726例,女性1 874例,平均年龄(41.98±15.34)岁;ATPⅢ、IDF、CDS和GCADP诊断标准下MS流行粗率(标化率)依次为17.2%(16.6%)、13.5%(13.1%)、10.4%(10.0%)和15.5%(15.0%),4种标准诊断的流行率经Cochran Q检验,P<0.01;4种标准下≥3个危险因素检出率ATPⅢ/IDF最高(均为22.8%),GCADP次之(15.5%),CDS最低(13.6%)(P<0.01);ATPⅢ与IDF一致性最高,Kappa值为0.857,GCADP与CDS和ATPⅢ的Kappa值分别为0.670、0.676,一致性好,其余两两一致性一般;男性腰围切点>90 cm,女性>85 cm时,ROC曲线下面积分别为0.698、0.668,灵敏度及特异度较好,预测MS危险因素聚集的能力相对较好。结论4种诊断标准MS流行率存在差异;ATPⅢ标准对MS及≥3个危险因素的检出率最高;ATPⅢ与IDF一致性最好;适宜的最佳腰围切点为男性>90 cm、女性>85 cm。

Differences of four diagnostic criteria for the prevalence of metabolic syndrome in inhabitants of six counties in Yunnan Province

Objective To compare the differences and consistency of four metabolic syndrome （MS） diagnostic criteria for MS prevalence rates in urban and rural inhabitants of six counties in Yunnan Province. Methods Multistage stratified random sampling was performed in inhabitants aged over 18 years old in six disease surveillance sites in Yunnan Province. The different prevalence and risk factors aggrega- tion of MS under ATPIII （2005）, IDF （2005）, CDS （2004） and GCADP （2007） were calculated re- spectively to find the differences and consistency. Meanwhile, the diagnosis efficieney of four diagnostic criteria was compared by area under ROC curve （AUC）. Results A total of 3 600 inhabitants （ 1 726 male, 1 874 female, mean age 41.98 ±15.34 years） were selected. The prevalence rates （ standardized rate） of MSwere 17.2% （16.6%）, 13.5% （13.1%）, 10.4% （10.0%）, 15.5% （15.0%） accord- ing to ATPIII, IDF, CDS, and GCADP definitions, respectively, （P 〈 0. 01 by Coehran Q tests）. ATP III and IDF definition can screen out the highest prevalence of I〉3 risk factors （22. 8% ） , then GCADP deft-nitions can screen out 15.5% and CDS definitions （ 13.6% ） was lowest. The consistency of diagnosis be- tween IDF and ATP III was the highest, and the Kappa value was 0. 857. The Kappa values between CDS and GCADP, ATPIII and GCADP were 0. 670,0. 676. When the waist circumference was 90 cm in male and 85 cm in female, the ROC area under curve was 0. 698 and 0. 668 respectively, and the sensitivity and specificity were relative better. Conclusion There were differences for four MS diagnostic criteria to diag- nose MS prevalence rates. The consistency of diagnosis between IDF and ATP III was the highest. ATP III definition can screen out the highest prevalence of MS and ≥3 risk factors. The appropriate cut-off points of waist circumference were 〉 90 cm in male and 〉 85 cm in female, respectively.