三种代谢综合征诊断标准在2型糖尿病家系人群中应用比较

目的 比较2005年美国国家胆固醇教育计划成人治疗方案第3次报告(ATPⅢ)、2005年国际糖尿病联盟(IDF)和2004年中华医学会糖尿病学分会(CDS)建议的代谢综合征(MS)诊断标准在2型糖尿病家系人群中应用的差异.方法 对715个2型糖尿病家系中有完整血压、血脂及血糖资料的4468名成员(包括配偶),由专门小组调查并采血样后,分别用ATPⅢ、IDF和CDS标准诊断MS,并比较MS患病率及诊断的一致性.结果 ATPⅢ、IDF和CDS标准诊断出的家系成员MS患病率分别为44.94%(2008/4468)、37.87%(1692/4468)、23.86%(1066/4468),均呈二级亲、配偶、一级亲、先证者逐渐升高的趋势[ATP Ⅲ标准诊断MS患病率分别为23.78%(117/492)、35.77%(318/889)、45.40%(1077/2372)、69.37%(496/715);IDF标准诊断MS患病率分别为20.53%(101/492)、31.61%(281/889)、38.74%(919/2372)、54.69%(391/715);CDS标准诊断MS患病率分别为8.94%(44/492)、16.99%(151/889)、25.08%(595/2372)、38.60%(276/715);ATPⅢ:X2趋势=266.359;IDF:X2趋势=155.950;CDS:X2趋势=165.087;P值均<0.01].用ATPⅢ、IDF诊断时,MS患病率女性明显高于男性[ATPⅢ:47.47%(1156/2435)、41.91%(852/2033);IDF:43.00%(1047/2435)、31.73%(645/2033);X2>值分别为13.871、60.169,P值均<0.01],而用CDS标准诊断时女性低于男性(分别为22.38%、25.63%,X2=6.423,P=0.011).ATPⅢ与IDF、ATPⅢ与CDS、IDF与CDS标准两两间的一致检出率分别为92.93%、75.56%和77.21%,其Kappa值分别为0.855、0.484和0.478(P值均<0.01).结论 在2型糖尿病家系人群中,ATPⅢ标准诊断的MS患病率及检出危险因素聚集的比例最高,更能反映该人群MS及其组分的特点.

Comparison of the application of three diagnostic criteria of metabolic syndrome in familial type 2 diabetic pedigrees

Objective To compare the significance of the application of three diagnostic criteria of metabolic syndrome (MS),issued by the National Cholesterol Education Program Adult Treament Panel Ⅲ ( ATPⅢ) in 2005 ,International Diabetes Federation (IDF) in 2005 and Chinese Diabetes Society (CDS) in 2004,in type 2 diabetes mellitus pedigrees. Methods Totally,4468 subjects (including spouses) from 715 type 2 diabetic pedigrees were selected in this study. Complete laboratory data, including blood pressure, lipid profile and plasma glucose, were collected. The prevalence rates of MS and the unity of three criteria were analyzed. Results The prevalence rates of MS were 44.94% (2008/4468), 37.87% (1692/4468) and 23.86% (1066/4468) according to the ATPⅢ ,IDF and CDS criteria respectively. It subsequently increased in second-degree relatives, spouses, first-degree relatives and probands ( ATPⅢ: 23.78% (117/492), 35.77% (318/889) ,45.40% (1077/2372) and 69.37% (496/715) ; IDF: 20. 53% (101/492) ,31.61% (281/889) ,38.74% (919/2372) and 54.69% (391/715) ; CDS: 8.94% (44/492) ,16.99% (151/889), 25.08% (595/2372) and 38.60% (276/715) ; ATP Ⅲ : X<'2> = 266.359, IDF:X<'2>= 155.950, EDS : X2 =165.087 ,respectively,P <0.01). The prevalence rates of MS, as defined by the ATP Ⅲ and IDF criteria, were higher in females than in males ( ATP Ⅲ: 47.47% (1156/2435) and 41.91% (852/2033) ; IDF: 43.00% (1047/2435) and 31.73% (645/2033) ; X2=13.871 and 60.169, respectively, P <0.01), and was lower in females than in males as defined by the CDS criterion (22.38% and 25.63% ,respectively, X2= 6.423,P = 0.011). The agreement in the diagnosis of MS using ATP Ⅲ and IDF, ATP Ⅲ and CDS, IDF and CDS was 92.93%, 75.56% and 77.21% respectively. Kappa index were 0.855,0.484 and 0.478 respectively (P<0.01 ). Conclusion ATP Ⅲ criterion showed the highest prevalence of MS and the percent of risk factor aggregation which best reflected the characteristics of MS in familial type 2 diabetic pedigrees.