中国11省市35～64岁人群应用不同代谢综合征诊断标准的比较

目的比较美国国家胆固醇教育计划成人治疗方案第三次报告(NCEP-ATPⅢ)、国际糖尿病联盟(IDF)和中华医学会糖尿病学分会(CDS)建议的代谢综合征(MS)诊断标准在中国35～64岁人群中应用的差异。方法1992年对中国11省市35～64岁人群共29 564人进行了心血管病危险因素基线调查,1996—1999年又入选了35～64岁男女两性共3129人,分别应用三种标准计算该人群MS的患病率,分析不同标准时MS异常组分及危险因素聚集的检出情况,比较三种标准在中国人群中应用的一致性和差异。结果(1)应用ATPⅢ、IDF和CDS标准计算中国人群MS的年龄标化患病率分别为18.7%、14.6%和9.0%。(2)ATPⅢ诊断MS中有77.8%的人有中心性肥胖,22.2%无中心性肥胖;IDF诊断为非MS者中还有4.6%的人有3个及以上危险因素聚集;CDS诊断为非MS者中还有11.2%的人有3个及以上危险因素聚集。(3)ATPⅢ和IDF诊断标准在中国人群中应用的一致性较好,男女两性的Kappa值分别为0.795和0.899;CDS诊断标准与另两种诊断标准的一致性不高。(4)男性腰围切点为85 cm,女性腰围切点为80 cm时,预测危险因素聚集的ROC曲线距离分别为0.40和0.34,其在所选择的切点中ROC曲线距离相对最短。结论在三种MS诊断标准中,ATPⅢ诊断中国人群MS的患病率及检出危险因素聚集的比例最高;适宜中国人群的最佳腰围切点为男性85 cm、女性80 cm。

A comparison of three diagnostic criterions for metabolic syndrome applied in a Chinese population aged 35-64 in l1 provinces

OBJECTIVE: To compare the differences of three diagnostic criterions for metabolic syndrome( MS), issued by the National Cholesterol Education Program(NECP), International Diabetes Federation(IDF) and CDS,in a Chinese population aged 35-64 years in 11 provinces. METHODS: A total of 29 564 Chinese resedents aged 35-64 years were recruited from 11 provinces and a survey on cardiovascular risk factors was conducted in 1992. Additionally,3129 participants were added into the study from 1996 to 1999. MS prevalence was calculated according to three definitions and results of MS components distributions and risk factor aggregation were analyzed. RESULTS: (1)The age-adjusted prevalence of MS in Chinese population were 18.7% for ATP III criterion, 14.6% for IDF criterion and 9.0% for CDS criterion,respectively. (2)Seventy-seven point eight percent of the subjects with MS diagnosed by ATP II criterion presented central obesity. Four point six percent of subjects without MS diagnosed by IDF criterion and 11.2% of subjects without MS diagnosed by CDS criterion presented at least 3 risk factors, respectively. (3)Kappa index showed 0.795 for ATPIII criterion and 0.899 for IDF criterion when applied in Chinese population. (4)The shortest distance in ROC curve for forecasting risk factor aggregation of MS was 0.40 in male and 0.34 in female when waist circumferences were 85 cm in males and 80 cm in females respectively. CONCLUSION: ATPIII definition could be used to detect the highest prevalence of MS and the percent of risk factor aggregation among three definitions. The appropriate cut-off points of waist circumference for Chinese were 85 cm for male and 80 cm for female respectively.