腰围适宜切割点分析在山东省中西部地区农村居民糖尿病筛检中的应用

目的 探讨利用腰围筛检糖尿病的价值及最佳腰围切割点.方法 按多阶段随机抽样原则,对16 341人测量身高、体重、腰围及空腹血糖,空腹血糖在6.1～7.0 mmol/L间复做口服葡萄糖耐量试验;糖尿病诊断采用WHO 1999年糖尿病诊断标准.采用受试者工作特征(ROC)曲线计算曲线下面积(AUC)和不同切割点下筛检糖尿病的灵敏度、特异度及约登指数,以约登指数最大的点为最佳切割点.结果山东省中西部地区农村居民男、女性糖尿病患病率随腰围增加而升高(趋势检验x2=72.01、122.65,P＜0.01),特别是男性腰围≥85 cm、女性腰围≥80 cm,糖尿病患病率升高明显.男、女性AUC分别为0.639和0.655,差异均有统计学意义(t=7.22、11.07,P＜0.01).男女性间AUC大小差异无统计学意义(t=0.70,P＞0.05).男性腰围以85 cm、女性以80 cm为切割点时筛检糖尿病的约登指数最大,分别为24.90%和24.39%;男性筛检的灵敏度和特异度分别为58.04%和66.86%,女性筛检的灵敏度和特异度分别为67.08%和57.31%.结论腰围对糖尿病具有较好的筛检价值,男性腰围85 cm、女性腰围80 cm可作为山东省中西部农村居民筛检糖尿病和确定高危人群的切割点.

Application of ''waist circumference cutoff point'' in screening diabetes mellitus among rural residents in mid-western area of Shandong province,China

Objective To determine the value and the optimal cutoff point of waist circumference (WC) in screening diabetes mellitus (DM) and to provide evidence for DM prevention and identifying population at risk in mid-western rural areas of Shandong province.Methods A sample consisting 16 341 rural residents was selected and studied.All participants were physically examined on height,weight,WC and fasting plasma glucose (FPG).Oral glucose tolerance test (OGTT) was performed for subjects with FPG valued from 6.1 to 7.0 mmol/L.DM was defined according to the criteria set by WHO in 1999.Area under the curve (AUC),sensitivity,specificity and Youden index were computed based on the receiver operating characteristic (ROC) curve analysis.Optimal cutoff point was determined by the maximum of Youden index.Results The prevalence rates of DM for males and females increased along with the rise of WC (trend test X2=72.01,122.65,P＜0.01 ).It appeared significantly higher in those with WC 85 cm in females and≥80 cm in males,with those WC ＜85 cm for females and ＜80 cm for males,in particular.AUCs were 0.639 and 0.655 for males and females respectively and both had significant differences (t=7.22,11.07,P ＜0.01 ).However,the AUCs did not show significant difference (t=0.70,P ＞ 0.05) between males and females.The Youden index reached maximum when WC approached 85 cm for females (24.90%) and 80 cm for males (24.39%).The sensitivity and specificity were 58.04%and 66.86%for males,and 67.08%and 57.31%for females.Conclusion WC seemed to be an effective indicator for screening the DM.The optimal cutoff point of WC would be 85 cm for females and 80 cm for males in screening DM and defining the population at risk in this area.