首页 >>2014年06期
四种代谢综合征诊断标准在浙江省城市人群中应用情况的比较
作者:胡浙芳 章荣华 黄李春 周标 贺登花 丁钢强

摘要:

目的  利用4种代谢综合征(MS)诊断标准对浙江省城市地区18岁以上人群进行诊断,并分析比较4种诊断标准MS检出率情况。方法  按照多阶段分层与人口成比例(PPS)的整群随机抽样原则,分别于2009年和2010年采用随机数字法在杭州市下城区、江干区,宁波市江东区,金华市婺城区抽取了320户家庭的18周岁以上非孕妇和非乳母人群共计3 417名。采用标准方法测量其身高、体重、腰围、血压、FBG、餐后2 h血糖(2h–PBG)、TG和HDL–C,分别用中华医学会糖尿病学分会(CDS)标准、中国成人血脂异常防治指南制订联合会(JCDCG)标准、2005年美国国家胆固醇教育计划成人治疗方案第三次报告(ATPⅢ)标准、国际糖尿病联盟(IDF)标准对3 417名研究对象进行MS诊断,分析比较4种诊断标准下MS检出率情况。结果  ATPⅢ标准MS检出率最高,为21.6%(737/3 417),CDS标准最低,为9.8%(335/3 417),JCDCG标准MS检出率为15.0%(513/3 417),IDF标准MS检出率为18.5%(632/3 417),4种诊断标准MS检出率差异有统计学意义(χ2=192.1,P<0.05);ATPⅢ标准与IDF标准、JCDCG标准一致性较高,一致率分别为96.9%、92.9%,Kappa值均为0.75;MS异常组分检出结果表明,MS人群中ATPⅢ标准检出≥3个危险因素聚集比例最高,为100.0%,非MS人群中ATPⅢ检出≥3个危险因素聚集比例最低,为0.8%。结论  4种诊断标准对浙江省城市地区18岁以上人群MS检出情况有差异,其中以ATPⅢ标准筛检MS及其异常组分效果较好。

关键词:代谢综合征X;参考值;肥胖症;诊断标准;横断面研究

Abstract:

Objective  To compare the applicative effect of four diagnostic criteria of metabolic syndrome (MS) among the urban adult population of Zhejiang Province.Methods  According to multi-stage stratified and proportional to size, cluster, random sampling principle, 3 417 adults population at urban areas were extracted by random number method from 320 families of Shangcheng and Jianggan community in Hangzhou, Jiangdong community in Ningbo and Wucheng community in Jinhua in 2009 and 2010 respectively, which excluded pregnant, wet nurse, children, and those who were at least 18 years of age. Height, weight, waist, blood pressure, fasting plasma glucose (FBG), 2-hour postprandial blood glucose (2h-PBG), TG and HDL-C of all the subjects were measured by standard method. MS was diagnosed and compared according to four diagnostic criteria: Chinese Medical Association Diabetic Society (CDS), Joint Committee for Developing Chinese Guidelines (JCDCG), American National Cholesterol Education Program Adult Treatment PaneⅢ in 2005 (ATPⅢ) and International Diabetes Federation (IDF), respectively.Results  The high prevalence of MS diagnosed by the criteria of ATPⅢ was 21.6% (737/3 417), while the lowest prevalence diagnosed by CDS was 9.8% (335/3 417), the result of consistency check demonstrated the MS diagnostic criteria of ATPⅢ and IDF, ATPⅢ and JCDCG were in strong and the same accordance with the concordance rate, Kappa value was 0.75, while the consistency of the criteria of ATP Ⅲ and CDS were in relatively weak agreement, Kappa value was 0.53; the detection result of MS abnormal components showed the highest proportion of having ≥3 risk factors was presented by ATPⅢ among subjects diagnosed as MS (100.0%), meanwhile, the lowest proportion of having ≥3 risk factors was also found by ATPⅢ among those MS-free (0.8%).Conclusions  The criteria of ATPⅢ may have more sensitivity when screening MS and its abnormal components. However, it′s limited to extrapolate the results from the cross-sectional survey to the total population.

Key words: Metabolic syndrome X;Reference values;Obesity;Diagnostic criteria;Cross-sectional study

发表日期:2014/6

引用本文:

图/表:

  • 10.3760/cma.j.issn.0253-9624.2014.06.016.T001:表1 采用4种诊断标准时不同性别和年龄人群的MS检出率[%(例)]

    10.3760/cma.j.issn.0253-9624.2014.06.016.T001:表1 采用4种诊断标准时不同性别和年龄人群的MS检出率[%(例)]

  • 10.3760/cma.j.issn.0253-9624.2014.06.016.T002:表2 不同MS诊断标准的一致性

    10.3760/cma.j.issn.0253-9624.2014.06.016.T002:表2 不同MS诊断标准的一致性

  • 10.3760/cma.j.issn.0253-9624.2014.06.016.T003:表3 采用4种诊断标准时MS各异常组分检出率[%(例)]

    10.3760/cma.j.issn.0253-9624.2014.06.016.T003:表3 采用4种诊断标准时MS各异常组分检出率[%(例)]

参考文献:

[1]GrundySM, CleemanJI, DanielsSR, et al. Diagnosis and management of the metabolic syndrome:an American Heart Association/National Heart, Lung, and Blood Institute scientific statement:Executive Summary[J]. Crit Pathw Cardiol, 2005, 4(4):198–203.
[2]中华医学会糖尿病学分会代谢综合征研究协作组. 中华医学会糖尿病学分会关于代谢综合征的建议[J]. 中华糖尿病杂志, 2004, 12(3):156–161.
[3]中国成人血脂异常防治指南制订联合委员会. 中国成人血脂异常防治指南[J]. 中华心血管病杂志, 2007, 35(5):390–419.
[4]AlbertiKG, ZimmetP, ShawJ, et al. The metabolic syndrome––a new worldwide definition[J]. Lancet, 2005, 366(9491):1059–1062.
[5]马晓静, 胡承, 周健, 等. 2型糖尿病家系一级亲人群代谢综合征患病情况及与肥胖相关指标的关系[J]. 中华内分泌代谢杂志, 2009, 25(3):286–290.
[6]周慧, 胡晓抒, 郭志荣, 等. 三种代谢综合症诊断标准在江苏人群中适应性研究[J]. 中华预防医学杂志, 2009, 43(2):117–121.
[7]孙凤, 陶秋山, 詹思延. 中国台湾35~74岁体检人群中代谢综合征五种诊断标准的对比研究[J]. 中华流行病学杂志, 2008, 29(9):925–929.
[8]蒋升, 张莉, 邵亮, 等. 新疆维吾尔族30~80 岁人群代谢综合征调查及三种诊断标准的对比研究[J]. 中华流行病学杂志, 2011, 32(8):756–759.
[9]塔吉古丽·木沙, 姚晓光, 张德莲. 2010年新疆和田地区维吾尔族人群代谢综合征患病状况[J]. 中华预防医学杂志, 2013, 47(2):186–187.
[10]李莹, 李淑环, 高孟, 等. 三种诊断标准下的代谢综合症的适用性比较[J]. 中华疾病控制杂志, 2012, 16(5):392–395.
[11]朱旅云, 胡丽叶, 李晓玲, 等. 体重指数和腰围与代谢综合征发生风险的比较研究[J]. 中华内分泌代谢杂志, 2009, 25(5):515–518.
[12]LeeJ, MaS, HengD, et al. Should central obesity be an optional or essential component of the metabolic syndrome?Ischemic heart disease risk in the Singapore Cardiovascular Cohort Study[J]. Diabetes Care, 2007, 30(2):343–347.
[13]AlbertiKG, EckelRH, GrundySM, et al. Harmonizing the metabolic syndrome:a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention;National Heart, Lung, and Blood Institute;American Heart Association;World Heart Federation;International Atherosclerosis Society;and International Association for the Study of Obesityj[J]. Circulation, 2009, 120(16):1640–1645.

用户评论 0条

用户名: 密码: 登陆 注册
 
  • 9
  • 3
  •  4 : 页次:0/0页 共0条记录 5条/每页
    关于我们 | 专家风采 | 会员注册 | 继续教育
    地 址:北京市西城区东河沿街69号正弘大厦511室 邮 编:100052
    电话:010-51322302
    版权所有 中华医学会及中华预防医学杂志编辑部
    京ICP备 07035254 号