四种代谢综合征诊断标准在老年人中的适用性比较

蔡瑞雪; 巢健茜; 孔令燕; 王滢鹏

doi:10.16462/j.cnki.zhjbkz.2019.02.005

四种代谢综合征诊断标准在老年人中的适用性比较

doi: 10.16462/j.cnki.zhjbkz.2019.02.005

210009 南京, 东南大学公共卫生学院医疗保险系

基金项目:

国家自然科学基金 81872711

江苏省研究生科研与实践创新计划项目 SJCX18_0076

详细信息

通讯作者:
巢健茜, E-mail: chaoseu@163.com

中图分类号: R181
计量
- 文章访问数: 372
- HTML全文浏览量: 241
- PDF下载量: 53
- 被引次数: 0
出版历程
- 收稿日期: 2018-09-27
- 修回日期: 2018-11-19
- 刊出日期: 2019-02-10

Comparison of four different metabolic syndrome diagnostic criteria among the elderly in Nanjing

Department of Medical Insurance, School of Public Health, Southeast University, Nanjing 210009, China

Funds:

National Natural Science Foundation of China 81872711

Postgraduate Research＆Practice Innovation Program of Jiangsu Province SJCX18_0076

More Information

Corresponding author: CHAO Jian-qian, E-mail: chaoseu@163.com

摘要

摘要: 目的比较2013年中华医学会糖尿病学分会（2013 Chinese diabetes society，CDS 2013）标准、2009年国际糖尿病联盟流行病预防工作组联合过渡声明（joint interim statement，JIS）标准、2005年国际糖尿病联盟（international diabetes federation，IDF）标准和2005年美国国家胆固醇教育计划成人治疗方案第三次报告（adult treatment panel Ⅲ，ATPⅢ）标准在南京市老年人中的应用。方法 2013年3月~12月采用整群随机抽样方法抽取南京市某社区1 832名60岁及以上的老年人作为研究对象，对其进行问卷调查、体格检查和实验室检测。采用四种诊断标准计算代谢综合征（metabolic syndrome，MS）的患病率，采用SPSS 19.0软件进行t检验、χ²检验和一致性检验，比较不同诊断标准下老年人MS的患病率及不同诊断标准的一致性。结果根据CDS 2013、JIS、IDF和ATPⅢ诊断标准，南京市老年人MS患病率分别为39.9%、58.2%、46.5%和54.5%。JIS标准和ATPⅢ标准诊断的一致性最高，符合率为96.1%（k=0.920）；其次是ATPⅢ标准和IDF标准，符合率为92.0%（k=0.841）。结论不同标准下南京市老年人MS患病率均较高，JIS标准和ATPⅢ标准对MS的检出率较高，有助于及早发现MS，降低其带来的心血管损害。
- 代谢综合征 /
- 诊断标准 /
- 患病率 /
- 老年人
Abstract: Objective To compare the application of the 2013 Chinese Diabetes Society (CDS 2013) criteria, the 2009 joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention(JIS)criteria, the 2005 International Diabetes Federation(IDF)criteria and the 2005 US National Cholesterol Education Program Adult Treatment PanelⅢ (ATPⅢ) criteria among the elderly in Nanjing. Methods A total of 1 832 elderly (≥ 60 years old) were recruited in Nanjing using cluster random sampling and were surveyed with questionnaires, physical examination, and laboratory test between March and December 2013. The different prevalence under CDS 2013, JIS, IDF and ATPⅢ criteria were calculated respectively. SPSS 19.0 was used to conduct t test, chi-square test and kappa test to compare the prevalence of metabolic syndrome and the consistency of four diagnostic criteria in the elderly. Results According to CDS 2013, JIS, IDF, and ATPⅢ, prevalence of MS in the elderly in Nanjing was 39.9%, 58.2%, 46.5%, and 54.5%, respectively. The highest value of kappa was 0.920 between JIS and ATPⅢ, with a compliance rate of 96.1%.The value of kappa was 0.841 between ATPⅢ and IDF, with a compliance rate of 92.0%. Conclusions The prevalence of metabolic syndrome among the elderly in Nanjing is relatively high under different criteria. The higher detection rate of MS by the JIS standard and ATPⅢ standard can help to find MS earlier and reduce the cardiovascular damage.
- Metabolic syndrome /
- Diagnostic criteria /
- Prevalence /
- Elderly

HTML全文

表 1 调查对象的基本特征(x±s)

Table 1. Characteristics of the subjects(x±s)

变量	男性(n=907)	女性(n=925)	P值
年龄(岁)	69.47±6.49	68.81±6.44	0.030
体质指数(kg/m²)	23.69±3.03	23.65±3.32	0.787
腰围(cm)	88.29±9.39	85.23±9.95	<0.001
收缩压(mmHg)	136.17±18.53	134.26±18.43	0.027
舒张压(mmHg)	80.21±11.22	77.06±11.49	<0.001
空腹血糖(mmol/L)	6.08±1.64	6.01±1.38	0.302
甘油三酯(mmol/L)	1.66±1.03	1.71±0.91	0.263
高密度脂蛋白胆固醇(mmol/L)	1.19±0.45	1.35±0.43	<0.001

下载: 导出CSV

表 2 四种标准诊断老年人MS患病率的比较[n(%)]

Table 2. Comparison of MS prevalence under 4 different criteria[n(%)]

性别	例数	CDS标准	JIS标准	IDF标准	ATPⅢ标准
总体	1 832	731(39.9)	1 067(58.2)	852(46.5)	999(54.5)
男	907	378(41.7)	499(55.0)	330(36.4)	431(47.5)
女	925	353(38.2)	568(61.4)	522(56.4)	568(61.4)
P值		0.125	0.006	<0.001	<0.001

下载: 导出CSV

表 3 四种标准对代谢综合征各组分检出率情况[n(%)]

Table 3. Prevalence of components of metabolic syndrome detected by 4 criteria[n(%)]

组分	CDS标准		JIS标准		IDF标准		ATPⅢ标准
组分	MS	Non-MS	MS	Non-MS	MS	Non-MS	MS	Non-MS
中心性肥胖	581(79.5)	311(28.2)	973(91.2)	312(40.8)	852(100.0)	266(27.1)	85(85.3)	266(31.9)
高血压	676(92.5)	678(61.6)	944(88.5)	410(53.6)	754(88.5)	600(61.2)	88(88.9)	466(55.9)
高血糖	451(61.7)	185(16.8)	796(74.6)	218(28.5)	628(73.7)	386(39.4)	74(74.4)	271(32.5)
高甘油三酯	499(68.3)	16(15.0)	601(56.3)	63(8.2)	467(54.8)	197(20.1)	58(59.0)	75(9.0)
低高密度脂蛋白胆固醇	393(53.8)	95(8.6)	636(59.6)	96(12.5)	512(60.1)	220(22.4)	62(62.2)	111(13.3)

下载: 导出CSV

表 4 四种诊断标准之间一致性分析

Table 4. Diagnosis accordance among 4 criteria

诊断标准	男性		女性		合计
诊断标准	例数	一致率(%)	例数	一致率(%)	例数	一致率(%)
CDS和JIS
一致(/--)	776	85.6	710	76.8	1486	81.1
CDS(+)JIS(-)	5	0.5	0	0.0	5	0.3
CDS(-)JIS(+)	126	13.9	215	23.2	341	18.6
Kappa值	0.716^a		0.559^a		0.634a
CDS和IDF
一致(/--)	787	86.8	706	76.3	1493	81.5
CDS(+)IDF(-)	84	9.2	25	2.7	109	5.9
CDS(-)IDF(+)	36	4.0	194	21.0	230	12.6
Kappa值	0.723^a		0.540^a		0.625^a
CDS和ATPⅢ
一致(/--)	844	93.1	710	76.8	1554	84.8
CDS(+)ATPⅢ(-)	5	0.5	0	0.0	5	0.3
CDS(-)ATPⅢ(+)	58	6.4	215	23.2	273	14.9
Kappa值	0.860^a		0.559^a		0.702^a
JIS和IDF
一致(/--)	738	81.4	879	95.0	1617	88.3
JIS(+)IDF(-)	169	18.6	46	5.0	215	11.7
JIS(-)IDF(+)	0	0.0	0	0.0	0	0.0
Kappa值	0.637^a		0.898^a		0.768^a
JIS和ATPⅢ
一致(/--)	835	92.1	925	100.0	1760	96.1
JIS(+)ATPⅢ(-)	70	7.7	0	0.0	70	3.8
JIS(-)ATPⅢ(+)	2	0.2	0	0.0	2	0.1
Kappa值	0.842^a		1.000^a		0.920^a
IDF和ATPⅢ
一致(/--)	806	88.9	879	95.0	1 685	92.0
IDF(+)ATPⅢ(-)	0	0.0	0	0.0	0	0.0
IDF(-)ATPⅢ(+)	101	11.1	46	5.0	147	8.0
Kappa值	0.774^a		0.898^a		0.841^a

下载: 导出CSV

参考文献(19)

[1]	Grundy SM. Metabolic syndrome pandemic[J]. Arterioscler Thromb Vasc Biol, 2008, 28(4): 629-636. DOI: 10.1161/ATVBAHA.107.151092.
[2]	Mottillo S, Filion KB, Genest J, et al. The metabolic syndrome and cardiovascular risk: a systematic review and meta-analysis[J]. J Am Coll Cardiol, 2010, 56(14): 1113-1132. DOI: 10.1016/j.jacc.2010.05.034.
[3]	张艳芬, 佟伟军, 刘洋, 等. 代谢综合征与心脑血管病及死亡前瞻性队列研究[J]. 中国公共卫生, 2013, 29(10): 1405-1409. doi: 10.11847/zgggws2013-29-10-01 KG2*3/4]Zhang YF, Tong WJ, Liu Y, et al. Association between MS and cardio-cerebrovascular disease and total mortality in Inner Mongolian population[J]. Chin J Public Health, 2013, 29(10): 1405-1409. DOI: 10.11847/zgggws2013-29-10-01.
[4]	李莹, 李淑环, 高孟, 等. 三种诊断标准下代谢综合征的适用性比较[J]. 中华疾病控制杂志, 2012, 16(5): 392-395. http://zhjbkz.ahmu.edu.cn/article/id/JBKZ201205009 KG2*3/4]Li Y, Li SH, Gao M, et al. Comparison of applicability of metabolic syndrome by three different criterion among community residents of Harbin[J]. Chin J Dis Control Prev, 2012, 16(5): 392-395. http://zhjbkz.ahmu.edu.cn/article/id/JBKZ201205009
[5]	孙焕珍, 金来润, 左翔, 等. 社区体检人群代谢综合征患病情况及相关影响因素的调查分析[J]. 中华疾病控制杂志, 2017, 21(5): 465-468. DOI: 10.16462/j.cnki.zhjbkz.2017.05.009.[KG2*3/4]Sun HZ, Jin LR, Zuo X, et al. Study on the prevalence of metabolic syndrome and its influencing factors in a community medical check-up crowd[J]. Chin J Dis Control Prev, 2017, 21(5): 465-468. DOI: 10.16462/j.cnki.zhjbkz.2017.05.009.
[6]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2013年版)[J]. 中华糖尿病杂志, 2014, 6(7): 447-498. DOI: 10.3760/cma.j.issn.1674-5809.2014.07.004.[KG2*3/4]Chinese Diabetes Society. China guideline for type 2 diabetes (2013)[J]. Chin J Diabetes Mellitus, 2014, 6(7): 447-498. DOI: 10.3760/cma.j.issn.1674-5809.2014.07.004.
[7]	Alberti KGMM, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiolo gy and prevention; national heart, lung, and blood institute; American heart association; world heart federation; international atherosclerosis society; and international association f or the study of obesity[J]. Circulation, 2009, 120(16): 1640-1645. DOI: 10.1161/CIRCULATIONAHA.109.192644.
[8]	Alberti KGMM, Zimmet P, Shaw J. The metabolic syndrome-a new worldwide definit ion[J]. Lancet, 2005, 366(9491): 1059-1062. DOI: 10.1016/S0140-6736(05)67402-8.
[9]	Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabol ic syndrome: an American heart association/national heart, lung, and blood institute sci entific statement[J]. Circulation, 2005, 112(17): 2735-2752. DOI: 10.1161/CIRCULATIONAHA.105.169404.
[10]	张云红, 沙敏, 赵义娟, 等. 三种诊断标准下大理白族自治州老年人代谢综合征临床特点分析[J]. 中国基层医药, 2017, 24(23): 3557-3562. DOI: 10.3760/cma.j.issn.1008.6706.2017.23.010. Zhang YH, Sha M, Zhao YJ, et al. Analysis of clinical charecteristics of metabolic syndrome under three diagnostic criteria in eldly people of Dali Bai Autonomous Prefecture[J]. Chin J Prim Med Pharm, 2017, 24(23): 3557-3562. DOI: 10.3760/cma.j.issn.1008.6706.2017.23.010.
[11]	朱徐慧, 章荣华, 周标, 等. 浙江省老年人膳食结构与代谢综合征的关系[J]. 中华老年医学杂志, 2015, 34(10): 1131-1136. DOI: 10.3760/cma.j.issn.0254-9026.2015.10.023. Zhu XH, Zhang RH, Zhou B, et al. Association between dietary patterns and metabolic syndrome among elderly people in Zhejiang province[J]. Chin J Geriatr, 2015, 34(10): 1131-1136. DOI: 10.3760/cma.j.issn.0254-9026.2015.10.023.
[12]	Paola F, Gian LP, Benedetta M, et al. Metabolic syndrome and all-cause mortality in old er men and women[J]. Eur J Clin Invest, 2012, 42(9): 1000-1009. DOI: 10.1111/j.1365-2362.2012.02688.x.
[13]	高素颖, 于凯, 王拥军, 等. 4种代谢综合征诊断标准在河北任丘老年居民中应用的比较[J]. 临床荟萃, 2015, 30(9): 992-996. DOI: 10.3969/j.issn.1004-583X.2015.09.009. Gao SY, Yu K, Wang YJ, et al. Comparison of four diagnostic criteria of metabolic syndrome in elderly residents in Hebei Renqiu[J]. Clinical Focus, 2015, 30(9): 992-996. DOI: 10.3969/j.issn.1004-583X.2015.09.009.
[14]	高欣, 吴晓光, 汤哲, 等. 代谢综合征3种诊断标准在北京城区社区老年人中的应用[J]. 中华老年医学杂志, 2012, 31(3): 248-250. DOI: 10.3760/cma.j.issn.0254-9026.2012.03.020. Gao X, Wu XG, Tang Z, et al. Application of three diagnostic criteria for metabolic syndrome among the elderly in urban community of Beijing[J]. Chin J Geriatr, 2012, 31(3): 248-250. DOI: 10.3760/cma.j.issn.0254-9026.2012.03.020.
[15]	Araceli ORM, Yanez VL, Carnevale A, et al. Prevalence of metabolic syndrome amo ng elderly Mexicans[J]. Archives of Gerontology and Geriatrics, 2017, 73: 288-293. DOI: 10.1016/j.archger.2017.09.001.
[16]	Lu J, Wang L, Li M, et al. Metabolic syndrome among adults in China: the 2010 China noncommunicable disease surveillance[J]. J Clin Endocrinol Metab, 2017, 102(2): 507-515. DOI: 10.1210/jc.2016-2477.
[17]	何宇纳, 赵文华, 赵丽云, 等. 中国2010-2012年成年人代谢综合征流行特征[J]. 中华流行病学杂志, 2017, 38(2): 212-215. DOI: 10.3760/cma.j.issn.0254-6450.2017.02.015. He NY, Zhao WH, Zhao LY, et al. Prevalence of metabolic syndrome in Chinese adults in 2010-2012[J]. Chin J Epidemiol, 2017, 38(2): 212-215. DOI: 10.3760/cma.j.issn.0254-6450.2017.02.015.
[18]	胡召, 徐慧兰. 湖南益阳农村老年人糖尿病前期人群代谢综合征及其影响因素分析[J]. 中华疾病控制杂志, 2017, 21(8): 762-766. DOI: 10.16462/j.cnki.zhjbkz.2017.08.003. Hu Z, Xu HL. Analysis on the metabolic syndrome and the influencing factors in the elderly with prediabetes in rural areas in Yiyang of Hunan[J]. Chin J Dis Control Prev, 2017, 21(8): 762-766. DOI: 10.16462/j.cnki.zhjbkz.2017.08.003.
[19]	王睿, 彭年春, 时立新, 等. 四种代谢综合征诊断标准在贵阳市成人流行病学调查中的应用比较[J]. 中华糖尿病杂志, 2014, 6(8): 606-610. DOI: 10.3760/cma.j.issn.1674-5809.2014.08.011. Wang R, Peng NC, Shi LX, et al. Comparison of four different diagnostic criteriaon metabolic syndrome in all epidemiological study in Guiyang city[J]. Chin J Diabetes Mellitus, 2014, 6(8): 606-610. DOI: 10.3760/cma.j.issn.1674-5809.2014.08.011.