三种代谢综合征诊断标准在北京某国有企业体检员工中应用的比较

目的探讨三种代谢综合征（MS）诊断标准在北京某国有企业体检员工中应用的异同比较并提出建议。方法对1039例23～62岁的办公室人员进行现况调查，分别采用国际糖尿病联盟（IDF，2005）、美国国家胆固醇教育计划成人组第三次报告（ATPHI，2005）和中华医学会糖尿病分会（CDS，2004）标准计算MS患病率，比较三种标准在该人群中应用的一致性和差异。结果ATPm、IDF、CDS三种标准诊断的MS患病率依次为：14．8％、14．2％、10．7％。IDF与ATPⅢ标准一致性很高（Kappa=0．977）。CDS与IDF、CDS与ATPⅢ标准的一致性均一般，Kappa值分别为0．697、0．694。CDS标准诊断的非MS的人中有5．7％存在危险因素聚集。ATPⅢ、IDF标准诊断的MS者常见的表现形式为：中心性肥胖＋高三酰甘油（TG）血症＋血压异常和中心性肥胖＋高TG血症＋低高密度脂蛋白（HDL-C）血症；CDS标准常见的表现形式为中心性肥胖＋高TG血症＋高血压和中心性肥胖＋高TG血症＋血糖异常。结论三种MS诊断标准中，ATPⅢ标准对MS及危险因素聚集个体的检出率最高。IDF与ATPⅢ标准一致性高于IDF、ATPⅢ与CDS的一致性，但前两者仍存在不一致。CDS各组分的诊断标准有待于进一步改进。建议采用三种诊断标准，或两种诊断标准CDS与ATPⅢ或CDS与IDF比较，提高筛检的灵敏度，达到较好的干预效果。

Use of different diagnostic criteria of metabolic syndrome in health check-up receivers from one state-owned enterprise in Beijing

Objective To compare the diagnostic criteria of metabolic syndrome （MS） developed by the International Diabetes Federation （IDF） in 2005, the 3th Report of National Cholesterol Education Program-Aduh Treatment PanelⅢ （NCEP-ATPⅢ） in 2005, and the Chinese Diabetes Society （CDS） in 2004. Methods A total of 1039 adults aged 23 to 62 year-old were enrolled in this epidemiological investigation to assess the prevalence of MS by above three definitions. Results The MS prevalence rate was 14. 8% ,14. 2% and 10.7% in ATP Ⅲ ,IDF, and CDS, respectively. The diagnoses agreement of IDF with ATP Ⅲ was stronger （ Kappa = 0. 912） than IDF with CDS （ Kappa = 0. 466） and ATP m with CDS （ Kappa =0. 504）. CDS definition found 5.7% of non-MS individuals had risk factor accumulation. Those defined by ATP Ⅲ and IDF criteria were presented with central obesity ＋ hypertriglyceridemia ＋ abnormal blood pressure and central obesity ＋ hypertriglyceridemia ＋ low high-density lipoprotein hyperlipidemia. However, those defined by CDS criterion were commonly presented with obesity ＋ hypertriglyceridemia ＋ abnormal blood pressure or obesity ＋ hypertriglyceridemia ＋ hyperglycemia Conclusions The agreement of IDF and ATP Ⅲ definition was relatively stronger. For better screening sensitivity, those three criteria, or CDS and IDF criteria,or CDS and ATPⅢ criteria should be used together.