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目的比较儿童青少年腰围与体重指数(BMI)在代谢综合征(MS)诊断中的实用价值。方法采用随机抽样的方法于2009年6月至2010年10月从南宁市14所中小学中抽取6～18岁儿童青少年7893人,分析腰围、BMI与MS各检测指标的相关性。以中华医学会糖尿病学分会(CDS)及国际糖尿病联盟(IDF)(2007)建议的MS标准应用受试者工作特征曲线(ROC),比较腰围及BMI的ROC曲线下面积,反映腰围及BMI诊断MS的准确性大小。结果 (1)除高密度脂蛋白胆固醇(HDL-C)均值随肥胖增加而降低外,MS的各检测指标均值比较[除外空腹血糖(FBG)和天冬氨酸转移酶(AST)]均为肥胖组>超重组>正常组,3组间差异有统计学意义(P<0.05)。(2)腰围、BMI均与臀围、腰臀比、收缩压(SBP)、舒张压(DBP)、FBG、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)呈正相关,与HDL-C呈负相关,其中腰围与FBG、TG、HDL-C、FINS、HOMA-IR的相关程度较BMI密切。(3)腰围检出MS各组分异常的灵敏性明显高于BMI,阳性预测值(除外HDL-C异常)均相对好于BMI。(4)腰围及BMI的ROC曲线下面积在CDS标准下分别为0.949和0.951;在IDF标准下分别为0.941和0.921。结论儿童青少年MS的诊断中,腰围较BMI更具诊断价值,腰围测量有助于儿童青少年MS的筛查。
Objective To compare the practical value of waist circumference and body mass index (BMI) in the diagnosis of metabolic syndrome (MS) in children and adolescents. Methods A total of 7,893 adolescents aged 6-18 years were selected from 14 primary and secondary schools in Nanning from June 2009 to October 2010 by random sampling method to analyze the correlation between waist circumference, BMI and MS. The receiver operating characteristic curve (ROC) was applied to MS criteria recommended by CDS and IDF (2007) to compare the area under the ROC curve of waistline and BMI to reflect the diagnosis of waist circumference and BMI MS’s accuracy size. Results (1) Except for the mean of high-density lipoprotein cholesterol (HDL-C) decreased with the increase of obesity, the mean values of MS in every test [except fasting blood glucose (FBG) and aspartate aminotransferase (AST) Obesity group> overweight group> normal group, the difference between the three groups was statistically significant (P <0.05). (2) Waist circumference and BMI were significantly correlated with hip circumference, waist-to-hip ratio, SBP, DBP, FBG, TG, LDL-C and fasting insulin FINS, HOMA-IR and negatively correlated with HDL-C. The correlation between waist circumference and FBG, TG, HDL-C, FINS and HOMA-IR was closer than BMI. (3) The sensitivities of waist circumference to MS abnormalities were significantly higher than those of BMI. The positive predictive value (except for HDL-C abnormalities) was better than BMI. (4) The area under the ROC curve of waist circumference and BMI were 0.949 and 0.951 under the CDS standard, respectively, and 0.941 and 0.921 under the IDF standard. Conclusion The diagnostic accuracy of MS in children and adolescents is more diagnostic value than that of BMI. Waist measurement is helpful for the screening of MS in children and adolescents.