CAJ | 학술논문

目的比较国际糖尿病联盟(IDF)、美国胆固醇教育计划成人治疗专家组(NCEP-ATPⅢ)和中华医学会糖尿病学分会(CDS)3个既便于操作又有中国人肥胖指标的代谢综合征(MS)诊断标准在江苏人群中的适用性.方法采用"江苏省多代谢异常和MS综合防治研究"队列资料(1971例),用IDF、ATP Ⅲ和CDS标准诊断MS,通过计算敏感度、特异度和ROC曲线距离,比较检出心血管疾病(CVD)和2型糖尿病(T2DM)假阳性和假阴性率均较低的MS诊断标准;并通过Cox回归分析,比较发生CVD和T2DM的相对危险度(95%可信区间)[RR(95% CI)].结果三标准中,虽然CDS标准检出CVD、T2DM的特异度最高[IDF、ATP Ⅲ、CDS检出CVD、T2DM的特异度分别为83.52%、76.36%、89.57%和85.02%、78.67%、92.28%];但是其检出CVD、T2DM的敏感度太低(40.82%,29.47%),此标准将会漏诊大于50%的患者;无论是对于检出CVD或T2DM,ROC曲线最短距离相应的诊断标准均为ATP Ⅲ(0.4369;0.5777),表明ATP Ⅲ诊断标准检出CVD或T2DM的假阳性率和假阴性率相对较低.进一步分析发现,与ATP Ⅲ-/IDF-组相对照,ATP Ⅲ+/IDF-组比ATP Ⅲ+/IDF+组MS的CVD[RR(95% CI):5.59(2.62～11.92) vs 2.90(1.41～5.93)]、1r2DM[3.36(1.92～5.79)vs 1.97(1.16～3.34)]发生风险高,证明ATP Ⅲ+/IDF-组这部分人群应纳入MS中.结论对于这3个MS标准,本研究认为ATP Ⅲ标准在江苏人群中适用性最好.
목적 비교국제당뇨병련맹(IDF)、미국담고순교육계화성인치료전가조(NCEP-ATPⅢ)화중화의학회당뇨병학분회(CDS)3개기편우조작우유중국인비반지표적대사종합정(MS)진단표준재강소인군중적괄용성.방법 채용"강소성다대사이상화MS종합방치연구"대렬자료(1971례),용IDF、ATP Ⅲ화CDS표준진단MS,통과계산민감도、특이도화ROC곡선거리,비교검출심혈관질병(CVD)화2형당뇨병(T2DM)가양성화가음성솔균교저적MS진단표준;병통과Cox회귀분석,비교발생CVD화T2DM적상대위험도(95%가신구간)[RR(95% CI)].결과삼표준중,수연CDS표준검출CVD、T2DM적특이도최고[IDF、ATP Ⅲ、CDS검출CVD、T2DM적특이도분별위83.52%、76.36%、89.57%화85.02%、78.67%、92.28%];단시기검출CVD、T2DM적민감도태저(40.82%,29.47%),차표준장회루진대우50%적환자;무론시대우검출CVD혹T2DM,ROC곡선최단거리상응적진단표준균위ATP Ⅲ(0.4369;0.5777),표명ATP Ⅲ진단표준검출CVD혹T2DM적가양성솔화가음성솔상대교저.진일보분석발현,여ATP Ⅲ-/IDF-조상대조,ATP Ⅲ+/IDF-조비ATP Ⅲ+/IDF+조MS적CVD[RR(95% CI):5.59(2.62～11.92) vs 2.90(1.41～5.93)]、1r2DM[3.36(1.92～5.79)vs 1.97(1.16～3.34)]발생풍험고,증명ATP Ⅲ+/IDF-조저부분인군응납입MS중.결론 대우저3개MS표준,본연구인위ATP Ⅲ표준재강소인군중괄용성최호.
Objective To compare the applicability of the three diagnostic criteria for metabolic syndrome (MS) proposed by the International Diabetes Federation(IDF) in 2005 ,Adult Treatment Panel Ⅲ of National Cholesterol Education Program(NCEP-ATP Ⅲ) in 2005 and Chinese Diabetes Socie(CDS) in 2004. Methods Based on the findings of cohort study of multiple metabolic disorders and metabolic syndrome (1971 cases) in Jiangsu province, MS was diagnosed according to these three definitions respectively,and by calculating the sensitivity, specificity, and ROC curve distance, those with lower false positive and false negative rates were identified as to detecting cardio vascular diseases(CVD) and type 2 diabetes mellitus(T2DM). While, through Cox regression analysis, to compare their relative risk (RR) and 95% confidential interval (CI)was wade. Results Among three diagnostic criteria,the specificity by CDS of MS was higher than the other criteria (83.52%, 76. 36%, 89. 57% ; 85.02%, 78. 67%, 92. 28%), however the sensitivity of CDS of MS was low (40. 82% , 29.47%). When using CDS, over 50 percent of diagnosis might be missed. ATP Ⅲ definition corresponded to the shortest distance in ROC curve,namely,at the diagnostic criteria, the rates of false positive and false negative for identifying clustering of CVD and T2DM were minimum(0. 4369; 0. 5777). The incidence of CVD [5.59 (2. 62 - 11.92) vs 2.90 (1.41 -5.93)],T2DM [3.36(1.92 -5.79) vs 1.97 (1.16 -3.34)] was significantly higher in cases of ATPⅢ +/IDF- than ATP Ⅲ +/IDF +, as compared with ATP Ⅲ -/IDF -. Conclusion Among three diagnostic criteria,the ATP Ⅲ definition of the MS should be the most applicable diagnostic criteria for MS in Jiangsu population.