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高血压患者不同代谢综合征诊断标准比较

Comparison on metabolic syndrome diagnosis with different criteria among hypertension patients

  • 摘要: 目的比较美国国家胆固醇教育计划成人组第三次报告(NECP/ATPⅢ)、国际糖尿病联盟(IDF)以及中华医学会糖尿病学分会(CDS)代谢综合征(MS)诊断标准在高血压患者中应用的异同。方法采用整群随机抽样方法对在宁夏回族自治区银川市24家社区卫生服务站抽取的2 994例高血压患者分别应用NECP/ATPⅢ、IDF和CDS标准进行MS的诊断,比较MS的检出率及诊断的一致性,并分析不同性别、年龄及代谢异常构成的分布特点。结果高血压患者采用NECP/ATPⅢ、IDF和CDS诊断标准MS的检出率分别为37.4%、47.0%、38.6%,3种诊断标准MS检出率两两比较差异均有统计学意义(P<0.001);CDS诊断标准男性MS的检出率(42.1%)高于女性(36.4%),NECP/ATPⅢ和IDF诊断标准男性MS的检出率(25.8%和39.9%)均低于女性(44.6%和51.5%),差异均有统计学意义(P<0.001);高血压患者3种诊断标准MS的检出率均随着年龄增长而呈增高趋势(P<0.05);NECP/ATPⅢ和CDS诊断标准一致性最高(Kappa=0.514,P<0.001);NECP/ATPⅢ、IDF和CDS诊断标准在高血压伴1种代谢异常中高血压伴血脂异常检出率均最高,分别为46.5%、23.9%、22.2%,在高血压伴2种代谢异常中高血压伴肥胖和血脂异常检出率最高,分别为11.2%、34.3%、25.3%,在高血压伴肥胖、血脂异常和糖尿病3种代谢异常中检出率分别为2.5%、11.1%、5.4%。结论高血压患者中MS普遍存在;IDF诊断标准在高血压患者中MS的检出率相对较高。

     

    Abstract: Objective To compare different criteria established by National Cholesterol Education Program’s Adult Treatment Panel Ⅲ( NCEP / ATP Ⅲ),International Diabetes Federation( IDF),and Chinese Diabetes Society( CDS) for diagnosis of metabolic syndrome( MS) among hypertension patients. Methods Totally 2 994 hypertention patients were recruited from 24 communities in Yinchuan city,Ningxia Hui Autonomous Region with cluster random sampling. The prevalences of MS diagnosed with the 3 crieria were analyzed. Results The overall prevalence of MS was 37. 4%,47. 0%,and 38. 6% according to NCEP / ATP Ⅲ,IDF,and CDS criteria,respectively( ATP vs CDS: = 454. 19,ATP vs IDF: = 457. 99,IDF vs CDS: = 793. 07,P < 0. 001 for all) among the patients. In contrast to CDS definition,the prevalence of MS in males diagnosed with NCEP / ATP Ⅲ and IDF was significantly lower than those in females( P <0. 001). The prevalence of the MS was higher in men( 42. 1%) than in women( 36. 4%) using CDS definition but this gender difference was reversed when using the NCEP / ATP Ⅲ( 25. 8% for males vs 44. 6% for females) and the IDF( 39. 9% for males vs 51. 5% for females) criteria. Different criteria resulted in the same increased prevalence of MS with age( P < 0. 05). Consistency in MS diagnosis with NCEP / ATP Ⅲ and CDS was higher in the patients of different gender and age( Kappa = 0. 514,P < 0. 001). In the hypertension patients with one metabolic disorder,the comorbidity rate of hypertension with dyslipidemia was the highest based on the criteria of NECP / ATP Ⅲ( 46. 5%),IDF( 23. 9%),and CDS( 22. 2%). In the hypertension patients with two metabolic disorders,the comorbidity rate of hypertension with obesity and dyslipidemia was the highest based on the 3 different criteria( 11. 2% for NECP / ATP Ⅲ,34. 3% for IDF,and 25. 3% for CDS). The comorbidity rates of hypertension with obesity,dyslipidemia and diabetes mellitus based on NCEP / ATP Ⅲ,IDF and CDS criteria were 2. 5%,11. 1% and 5. 4%,respectively. Conclusion The MS is highly prevalent among hypertension patients. Compared with NCEP / ATP Ⅲ and CDS criteria,the diagnostic rate of MS by IDF criteria is higher.

     

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