两种代谢综合征诊断标准在非酒精性脂肪性肝病中的应用比较

非酒精性脂肪性肝病（NAFLD）与代谢综合征（MS）密切相关，目前MS诊断标准众多且各有不同。目的：比较2005年国际糖尿病联盟（IDF）和2007年亚太地区修订版成人治疗组第三次指南（修订版ATP-Ⅲ）的MS诊断标准在NAFLD患者中的适用性和异同。方法：选取NAFLD患者148例，检测血压、腰围、体重指数、尿酸（UA）、血脂、空腹血糖（FBG）、空腹胰岛素、胰岛素抵抗指数（HOMA-IR）等，分析两种诊断标准下NAFLD患者的MS患病率和患者特征，评估MS组分评分与HOMA．IR的关系。结果：符合IDF和修订版ATP．Ⅲ诊断标准的MS患者分别为54例（36．5％）和83例（56．1％），两者诊断符合率达65．1％。两种诊断标准下MS患者的年龄、腰围、血压异常率、三酰甘油（TG）、FBG水平和HOMA-IR显著高于非MS患者（P〈0．05），HDL水平显著低于非MS患者（P〈0．01），总胆固醇（TC）、低密度脂蛋白（LDL）和UA水平与非MS患者相比无明显差异。修订版ATP-Ⅲ标准诊断的MS患者的MS组分评分与HOMA-IR呈正相关。结论：修订版ATP-Ⅲ诊断标准下的MS患者覆盖了IDF标准下的MS患者。对我国NAFLD患者而言，修订版ATP-Ⅲ诊断标准更易筛查出MS高危人群，利于干预。

Evaluation of Application of Two Diagnostic Criteria of Metabolic Syndrome in Patients with Non-alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease （NAFLD） is significantly correlated with metabolic syndrome （MS）. Up to present, there are many diagnostic criteria of MS with dissimilarities. Aims： To compare the applicability and differences of the two MS diagnostic criteria, the International Diabetes Federation （IDF） 2005 and the revised Adult Treatment Panel Ⅲ for the Asia-Pacific Study （revised ATP-Ⅲ） 2007 in patients with NAFLD. Methods： Blood pressure, waist circumference, body mass index, uric acid （UA）, lipid profile, fast blood glucose （FBG）, fast insulin and homeostasis model assessment of insulin resistance （HOMA-IR） were determined in 148 NAFLD patients. The prevalence rate of MS and characteristics of NAFLD patients with the two diagnostic criteria were analyzed, the relationship between MS score and HOMA-IR was evaluated. Results： Fifty-four （36.5%） MS patients were diagnosed by IDF while 83 （56.1%） by revised ATP-Ⅲ. The concordant diagnosis rate of the two criteria was 65.1%. Compared with non-MS patients, the age, waist circumference, abnormality rate of blood pressure, levels of triglyeride （TG）, FBG and HOMA-IR of MS patients diagnosed by the two criteria were significantly increased （P〈0.05）, HDL level was significantly decreased （P〈0.01）, and no statistically significant differences were found in levels of total cholesterol （TC）, low density lipoprotein （LDL） and UA. MS score of MS patients diagnosed by revised ATP-Ⅲ criteria was positively correlated with HOMA-IR. Conclusions： MS patients diagnosed by revised ATP-Ⅲ cover all those diagnosed by IDF. Revised ATP-Ⅲ criteria is more suitable to find out high-risk group of patients with NAFLD in China, which is beneficial for intervention.