CAJ | 학술논문

目的：分析代谢综合征（MS）患者的危险因素，研究γ-谷氨酰转移酶（GGT）对 MS 的预测价值。方法选择2007年11月在首都医科大学附属北京世纪坛医院体检中心参加全面体检的铁道部机关在职人员471例，2008—2010年连续观察，每年11月于本院随访一次，随访3年。观察患者一般资料（包括性别、年龄、饮酒史、吸烟史、既往疾病史及家族史等）及随访时检测丙氨酸氨基转移酶（ ALT）、天冬氨酸氨基转移酶（ AST）、碱性磷酸酶（ALP）、GGT、尿素氮（ BUN）、肌酐（ Cr）、尿酸（ UA）、总胆固醇（ TC）、三酰甘油（ TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、空腹血糖（FPG）水平，计算稳态模型胰岛素抵抗指数（HOMA - IR）。结果入组时 MS 患病率为25.1％（118/471）。男性患病率为27.5％（104/378），高于女性的15.1％（14/93）（χ2＝6.171，P＝0.013）。新发 MS 组 BMI、WC、SBP、DBP、TC、TG、LDL、UA、HOMA - IR、ALT、ALP、GGT 较无 MS 组高， HDL 水平较无 MS 组低（P ﹤0.05）；但两组年龄、FPG、AST 比较，差异无统计学意义（P ﹥0.05）。多因素 Logistic 回归分析显示，腰围增大、GGT 升高、TC 升高、HDL 升高是 MS 发生的影响因素（P ﹤0.05）。GGT 的曲线下面积大于ALT、AST、SBP、DBP、TG、HDL、FPG 的曲线下面积，而 WC 的曲线下面积大于 GGT 的曲线下面积（P ﹤0.05）。随着 GGT 水平升高灵敏度降低，特异度升高；当灵敏度为0.803，特异度为0.599时，约登（ Youden）指数最大为0.402，GGT 预测 MS 的最佳临界值为20.5 U/ L。结论 GGT 对 MS 的预测具有较高的灵敏度和特异度，为临床诊断提供了参考依据。
목적：분석대사종합정（MS）환자적위험인소，연구γ-곡안선전이매（GGT）대 MS 적예측개치。방법선택2007년11월재수도의과대학부속북경세기단의원체검중심삼가전면체검적철도부궤관재직인원471례，2008—2010년련속관찰，매년11월우본원수방일차，수방3년。관찰환자일반자료（포괄성별、년령、음주사、흡연사、기왕질병사급가족사등）급수방시검측병안산안기전이매（ ALT）、천동안산안기전이매（ AST）、감성린산매（ALP）、GGT、뇨소담（ BUN）、기항（ Cr）、뇨산（ UA）、총담고순（ TC）、삼선감유（ TG）、고밀도지단백（HDL）、저밀도지단백（LDL）、공복혈당（FPG）수평，계산은태모형이도소저항지수（HOMA - IR）。결과입조시 MS 환병솔위25.1％（118/471）。남성환병솔위27.5％（104/378），고우녀성적15.1％（14/93）（χ2＝6.171，P＝0.013）。신발 MS 조 BMI、WC、SBP、DBP、TC、TG、LDL、UA、HOMA - IR、ALT、ALP、GGT 교무 MS 조고， HDL 수평교무 MS 조저（P ﹤0.05）；단량조년령、FPG、AST 비교，차이무통계학의의（P ﹥0.05）。다인소 Logistic 회귀분석현시，요위증대、GGT 승고、TC 승고、HDL 승고시 MS 발생적영향인소（P ﹤0.05）。GGT 적곡선하면적대우ALT、AST、SBP、DBP、TG、HDL、FPG 적곡선하면적，이 WC 적곡선하면적대우 GGT 적곡선하면적（P ﹤0.05）。수착 GGT 수평승고령민도강저，특이도승고；당령민도위0.803，특이도위0.599시，약등（ Youden）지수최대위0.402，GGT 예측 MS 적최가림계치위20.5 U/ L。결론 GGT 대 MS 적예측구유교고적령민도화특이도，위림상진단제공료삼고의거。
Objective To analyze the risk factors for patients with metabolic syndrome,and to explore the predictive value of γ - glutamyl transpeptidase(GGT)for metabolic syndrome(MS). Methods 471 serving officers of railway ministry departments who received physical examination in Department of Endocrinology,Beijing Shijitan Hospital Affiliated to Capital Medical University in November 2007,were selected as study subjects,and they were followed up from 2008 to 2010,that is, they received reexamination in the same hospital per year for 3 years. During follow - up,general informations( gender,age, history of drinking,history of cigarette smoking,history of diseases and family medical history)of cases,and their alanine aminotransferase( ALT ), aspartate aminotransferase ( AST ), alkaline phosphatase ( ALP ), GGT, blood urea nitrogen (BUN),creatinine ( Cr ), uric acid ( UA ), total cholesterol ( TC ), triacylglycerol ( TG ), high density lipoprotein (HDL),low density lipoprotein(LDL),fasting blood - glucose(FPG)were recorded. The homeostasis model assessment of insulin resistance(HOMA - IR)was calculated. Results Prevalence of MS in baseline was 25. 1% (118 / 471). Prevalence of MS among male cases〔27. 5% (104 / 378)〕was significantly higher than that among female cases〔15. 1% (14 / 93)〕(χ2 =6. 171,P = 0. 013). BMI,WC,SBP,DBP,TC,TG,LDL,UA,HOMA - IR,ALT,ALP and GGT level of cases in MS group was significantly higher than that in non - MS group,respectively,while HDL level of cases in MS group was significantly lower than that in non - MS group(P ﹤ 0. 05). There was no significant difference in age,FPG and AST between two groups(P for occurrence of MS( P ﹤ 0. 05). Area under the curve( AUC)for GGT was significantly bigger than that for ALT,AST, SBP,DBP,TG,HDL and FPG,AUC for WC was significantly bigger than that for GGT(P ﹤ 0. 05). As GGT level rised, sensitivity decreased,specificity increased. When sensitivity reached 0. 803,and specificity reached 0. 599,Youden index reached the biggest value 0. 402,the optimal critical value of GGT was 20. 5 U/ L when it was used to diagnose MS. Conclusion GGT has relatively higher sensitivity and specificity in the diagnosis of metabolic syndrome.