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目的比较儿童青少年腰围与体重指数(BMI)在代谢综合征(MS)诊断中的实用价值。方法采用随机抽样的方法于2009年6月至2010年10月从南宁市14所中小学中抽取6～18岁儿童青少年7893人,分析腰围、BMI与MS各检测指标的相关性。以中华医学会糖尿病学分会(CDS)及国际糖尿病联盟(IDF)(2007)建议的MS标准应用受试者工作特征曲线(ROC),比较腰围及BMI的ROC曲线下面积,反映腰围及BMI诊断MS的准确性大小。结果 (1)除高密度脂蛋白胆固醇(HDL-C)均值随肥胖增加而降低外,MS的各检测指标均值比较除外空腹血糖(FBG)和天冬氨酸转移酶(AST)]均为肥胖组>超重组>正常组,3组间差异有统计学意义(P<0.05)。(2)腰围、BMI均与臀围、腰臀比、收缩压(SBP)、舒张压(DBP)、FBG、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)呈正相关,与HDL-C呈负相关,其中腰围与FBG、TG、HDL-C、FINS、HOMA-IR的相关程度较BMI密切。(3)腰围检出MS各组分异常的灵敏性明显高于BMI,阳性预测值(除外HDL-C异常)均相对好于BMI。(4)腰围及BMI的ROC曲线下面积在CDS标准下分别为0.949和0.951;在IDF标准下分别为0.941和0.921。结论儿童青少年MS的诊断中,腰围较BMI更具诊断价值,腰围测量有助于儿童青少年MS的筛查。

Comparison of the value of waist circumference with that of body mass index in diagnosing metabolic syndrome in children and adolescents.

??Objective To evaluate the practical value of waist circumference and body mass index??BMI??in diagnosing metabolic syndrome??MS?? in children and adolescents. Methods A random sampling method was used to select 7893 children and adolescents aged 6 to 18 years from 14 schools in Nanning City from June 2009 to October 2010.They were surveyed to analyze the correlation among waist circumference??BMI and MS detection indicators. Based on MS diagnostic criteria proposed by CDS and IDF??2007????receiver operating characteristic curve??ROC??was used to compare waist circumference’s area under ROC curve and body mass index??BMI??’s for reflecting the accuracy of diagnosis of MS. Results ??1??Average value of MS detection indicators??except for fasting blood glucose??FBG??and aspartate aminotransferase??AST????was significantly different among the three groups?? except that the mean of HDL-C decreased with the increase of obesity.These indexes in obesity group were higher than other two groups??P??0.05??.??2??Waist circumference and BMI were positively correlated with hip?? waist-hip ratio?? SBP??DBP??FBG??TG??LDL-C??FINS and HOMA-IR??but were negatively correlated with HDL-C.??3??Waist circumference predicted each component of MS more sensitively than BMI. In addition??waist circumference positive predictive value ??except for HDL-C??was relatively better than BMI.??4?? According to standard CDS??the area under ROC curve of waist circumference and BMI were 0.949 and 0.951??respectively. According to IDF??2007????their area were 0.941 and 0.921.Conclusion Waist circumference has more diagnostic value than BMI in children and adolescents with MS. The waist measurement may be helpful for MS screening in children and adolescents.