经OGTT普查人群代谢综合征患病率及胰岛素抵抗指标的评估

目的调查北京某单位21~78岁人群(n=1022)代谢综合征(MS)的患病率及相关危险因素,比较用腰围、体重指数(BMI)评估MS和高胰岛素血症的临床意义。方法使用预定的流行病学调查表,由专业人员询问调查人群的既往史,统一行口服葡萄糖耐量(OGTT)试验评估糖代谢情况(测定空腹和餐后2h血糖、血胰岛素水平),另检测血脂、血尿酸、肝肾功能,并测量身高、体重、腰围、血压,计算BMI值,分别以腰围和BMI值来定义肥胖,分析不同定义的肥胖合并其他2项代谢异常(IDF定义)时人群的患病率及其高胰岛素血症的检出率。结果按腰围和BMI值计算肥胖患病率分别为20.6%和41.5%(P<0.01),且随年龄的增长而增加。糖代谢异常、高胰岛素血症、高血压、高甘油三酯血症、低高密度脂蛋白血症、MS(IDF定义)检出率分别为8.51%、8.10%、39.60%、30.20%、0.49%、9.00%。按腰围和BMI计算:肥胖合并其他2项代谢异常的检出率分别为9.0%、14.0%(P<0.01),其检出敏感性分别为40.9%、63.6%,特异性分别为85.1%、64.7%;肥胖合并其他2项代谢异常人群高胰岛素血症的检出率分别为6.64%、7.55%,分别占总调查人群的1.37%、3.13%,两者比较差异有显著性(P<0.01)。结论北京某单位成年人中MS及相关代谢疾病非常常见。与BMI相比,腰围对肥胖合并其他2项代谢异常的检出敏感性低、特异性高。对高胰岛素血症患者的检出将有助于识别非肥胖人群合并有2项代谢异常者。

Evaluation on the prevalence of metabolic syndrome and index of insulin resistance in the population screened by oral glucose tolerance test (OGTT)

Objective To investigate the prevalence of metabolic syndrome (MS) and its risk factors in the population of age between 21 to 78 years in Beijing, and to study the clinical significance of evaluation of MS and hyperinsulinaemia by the use of waist circumference and body mass index (BMI). Methods A standard questionnaire and 75g oral glucose tolerance test (OGTT) were used in the investigation. All the data, including plasma glucose (fasting blood glucose level and postprandial glucose level), blood levels of insulin, blood lipid, blood uric acid, and creatinine, as well as height, weight, waist circumference (WC), blood pressure, body mass, were determined or measured. Obesity was defined by WC and BMI value. The incidence of obesity complicated with two abnormal metabolic disorders (IDF), as well as hyperinsulinaemia in these subjects, were analyzed. Results The prevalence of obesity as determined by WC and BMI were 20.6% and 41.5%, respectively, in the said popalation of Beijing (P<0.01). The prevalence rose with increasing age. The incidence of glucose metabolic disorder, hyperinsulinaemia, hypertension, hypertriglyceridemia, hypo-and high-density lipoproteinemia and metabolic syndrome were 8.51%, 8.10%, 39.6%, 30.20%, 0.49% and 9.00%, respectively. The incidence of obesity complicated with two of metabolic disorders as determined by WC and BMI criteria were 9.0% and 14.0%, respectively (P<0.01). The detection sensitivity of WC and BMI criteria for obesity complicated with two other metabolic disorders was 40.9% and 63.6%, and the specificity was 85.1% and 64.7%, respectively. The prevalence of hyperinsulinaemia was 6.64% and 7.55% (P>0.05) in subjects of obesity complicated with two other metabolic abnormality as defined by WC and BMI criteria, accounting for 1.37% and 3.13% of the whole investigated population (P<0.01). Conclusion Metabolic syndrome and its related diseases are very common in the elderly Beijing population. Compared with BMI, WC had lower sensitivity and higher specificity in identifying subjects with two other metabolic disorders, and it might miss 5% of the population. The detection of hyperinsulinaemia detection will be helpful to detect non-obesity patients with two metabolic abnormalities.