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目的比较4种代谢综合征(MS)诊断标准在云南省6县(区)城乡居民中对流行率诊断的差异及一致性。方法 2010年10—12月,采用多阶段分层随机抽样的方法对云南省6个疾病监测点≥18岁常住居民进行慢病危险因素调查,分别采用美国国家胆固醇教育计划成人组第3次报告[NCEP-ATPⅢ(2005年修订)]、国际糖尿病联盟(IDF,2005)、中华医学会糖尿病分会(CDS,2004)和《中国成人血脂异常防治指南》(GCADP,2007)4种不同MS诊断标准分析MS流行特征、结果一致性和危险因素聚集状况,用ROC曲线下面积(AUC)比较4个诊断标准的诊断效率。结果该次调查有效样本3 600例,其中男性1 726例,女性1 874例,平均年龄(41.98±15.34)岁;ATPⅢ、IDF、CDS和GCADP诊断标准下MS流行粗率(标化率)依次为17.2%(16.6%)、13.5%(13.1%)、10.4%(10.0%)和15.5%(15.0%),4种标准诊断的流行率经Cochran Q检验,P<0.01;4种标准下≥3个危险因素检出率ATPⅢ/IDF最高(均为22.8%),GCADP次之(15.5%),CDS最低(13.6%)(P<0.01);ATPⅢ与IDF一致性最高,Kappa值为0.857,GCADP与CDS和ATPⅢ的Kappa值分别为0.670、0.676,一致性好,其余两两一致性一般;男性腰围切点>90 cm,女性>85 cm时,ROC曲线下面积分别为0.698、0.668,灵敏度及特异度较好,预测MS危险因素聚集的能力相对较好。结论4种诊断标准MS流行率存在差异;ATPⅢ标准对MS及≥3个危险因素的检出率最高;ATPⅢ与IDF一致性最好;适宜的最佳腰围切点为男性>90 cm、女性>85 cm。
Objective To compare the diagnostic accuracy of four kinds of metabolic syndrome (MS) in the prevalence of urban and rural residents in 6 counties (districts) in Yunnan Province. Methods From October to December 2010, a multistage stratified random sampling method was used to investigate the risk factors of chronic diseases in ≥6-year-old residents at six disease surveillance sites in Yunnan Province. The third national report of adults in cholesterol education program Four different MS diagnostic criteria, including NCEP-ATPⅢ (revised in 2005), International Diabetes Federation (IDF), Diabetes Branch of Chinese Medical Association (CDS, 2004) and Guidelines for Prevention and Treatment of Dyslipidemia in Chinese Adults (GCADP, 2007) The prevalence of MS, the consistency of results, and the aggregation of risk factors were analyzed. The diagnostic efficiency of the four diagnostic criteria was compared using the area under the ROC curve (AUC). Results A total of 3 600 valid samples were obtained from this survey, including 1 726 males and 1874 females, with an average age of (41.98 ± 15.34) years. MS prevalence rates (standardized rates) of ATP Ⅲ, IDF, CDS and GCADP were The prevalences of the four standard diagnoses were 17.2% (16.6%), 13.5% (13.1%), 10.4% (10.0%) and 15.5% (15.0% The highest detection rate of ATP III / IDF was 22.8%, GCADP was the second (15.5%) and CDS was the lowest (13.6%) (P <0.01). ATPⅢ and IDF were the highest, Kappa was 0.857, GCADP And Kappa values of CDS and ATP Ⅲ were 0.670 and 0.676, respectively. The concordance was good, and the consistency of the other two was normal. The area under ROC curve of male waist circumference> 90 cm and female> 85 cm were 0.698,0.668, Specificity is better, the ability to predict the aggregation of MS risk factors is relatively good. Conclusions The prevalence of MS among the four diagnostic criteria is different. The ATP Ⅲ standard has the highest detection rate for MS and ≥3 risk factors. The ATPⅢ has the best consistency with IDF. The optimal waist circumference is 90 cm for male and> 85 cm.