Recommendations for revision of Chinese diagnostic criteria for metabolic syndrome: A nationwide study
关于代谢综合征的中国诊断标准的修改建议:一项来自全国调查数据的分析
Abstract
enBackground
Diagnostic criteria for metabolic syndrome (MS) proposed by the Chinese Diabetes Society (CDS) may have limitations because an additional 2-h postprandial plasma glucose (2-h PPG) test is required to diagnose hyperglycemia. The aim of this study was to revise the CDS-MS criteria by removing the 2-h PPG test and determining the optimal fasting plasma glucose (FPG) cut-off for a diagnosis of hyperglycemia in the Chinese population.
Methods
The study population was from the 2007–08 China Diabetes and Metabolic Disorders Study. The optimal FPG diagnostic cut-off value was determined using receiver operating characteristic curves. Hyperglycemia defined using CDS-MS criteria was the end-point. Agreement between different diagnostic methods was assessed using κ values.
Results
The study enrolled 46 239 participants (mean age 44.95 years). The optimal diagnostic cut-off for FPG was found to be 5.62 mmol/L, which showed a sensitivity of 66.92%, a specificity of 89.09%, and an area under the curve of 0.848. Using this diagnostic criterion, the standardized prevalence of MS was similar to that using the CDS-MS criteria (18.26% vs 17.89%, respectively), with both values being lower than those obtained using conventional international criteria (20.64–26.67%). Compared with the CDS-MS criteria, the recommended FPG cut-off showed better agreement (κ) with international criteria: 0.695, 0.774, and 0.730 with the International Diabetes Federation (IDF), revised Adult Treatment Panel III, and Joint Interim Statement of the IDF criteria, respectively.
Conclusions
We recommend eliminating the 2-h PPG blood test and lowering the FPG diagnostic cut-off value to 5.6 mmol/L in the CDS-MS diagnostic criteria.
摘要
zh背景
中国糖尿病协会(Chinese Diabetes Society, CDS)对于代谢综合征(metabolic syndrome, MS)的诊断标准可能存在不足, 因为诊断高血糖必须参考餐后2小时血糖(2-h postprandial plasma glucose, 2-h PPG)。本研究旨在对CDS诊断MS的标准进行修改, 取消2-h PPG测定, 寻找中国人群利用空腹血糖(fasting plasma glucose, FPG)诊断高血糖的最佳诊切点。
方法
本研究人群来自2007年-2008年中国糖尿病和代谢紊乱研究。以CDS-MS的诊断标准定义的高血糖为终点事件, 使用受试者工作特征曲线(ROC曲线)确定FPG最佳诊断切点。用Kappa值判断不同诊断方法的一致性。
结果
本研究共纳入46239人, 平均年龄44.95岁。应用ROC曲线确定空腹血糖最佳诊断切点为5.62 mmol/L, 敏感性为66.92%, 特异性为89.09%, 曲线下面积为0.848。根据我们的诊断标准与CDS诊断标准, 标准化后的代谢综合征患病率相似(分别是18.26%和17.89%), 都低于传统的国际标准(20.64%-26.67%)。与CDS标准相比, 我们的空腹血糖切点诊断标准与国际糖尿病联盟(International Diabetes Federation, IDF)、修订后成人治疗工作组III(Adult Treatment Panel III, ATP III)以及IDF联合临时声明的诊断标准的一致性(Kappa值)均有所提高(分别为0.695、0.774、0.730)。
结论
我们推荐取消糖餐后2小时血糖检测, 并且将CDS代谢综合征诊断标准中空腹血糖的诊断切点下调到5.6 mmol/L。
