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目的评价人体测量指标筛检糖尿病(DM)的价值及各测量指标最佳切点,为山东省DM疾病筛查和健康教育宣传提供科学依据。方法采用多阶段分层整群随机抽样,对15 350名18～69岁山东省常住居民进行DM筛查,其诊断采用WHO标准。同时测量身高、体质量、腰围、臀围及空腹血糖,并利用受试者工作特征曲线(ROC)计算曲线下面积(AUC)和不同切点下筛检DM的灵敏度、特异度及约登指数,以约登指数最大的点为最佳切点值,并对最佳切割点及其邻近点值进行筛检的一致性分析。结果本次共筛查出DM病例794例,患病率为4.59%。山东省居民人体测量指标和糖尿病患病率均有随年龄增加而增大的趋势,此趋势在女性中尤为明显。男、女性各人体测量指标AUC差异均有统计学意义(P均<0.001)。腰臀比(WHR)筛检DM的AUC最大,与体质量指数(BMI)比较有统计学意义(P<0.05)。男女之间AUC大小差异无统计学意义(P均>0.05)。男性BMI、腰围和WHR筛检DM的最佳切割点分别为25 kg/m2、91 cm和0.92,女性分别为25 kg/m2、83 cm和0.87,其筛检DM的约登指数最大,且筛检的一致性最好。结论 BMI、腰围和WHR对DM均具有较好的筛检价值,且一致性好,上述切割点可作为山东省居民筛检DM和确定DM高危人群的重要参数。
Objective To evaluate the value of anthropometric index screening diabetes mellitus (DM) and the best cut point of each measuring index to provide a scientific basis for screening of DM disease and health education in Shandong Province. Methods The stratified randomized stratified multistage stratified sampling was used to screen DM for 15 350 permanent residents aged 18-69 in Shandong Province. The diagnostic criteria were WHO standard. Body height, body mass, waist circumference, hip circumference and fasting blood glucose were measured at the same time. The area under the curve (AUC) and sensitivity, specificity and Youden index of screening DM under different cutoff points were calculated by receiver operating characteristic curve (ROC) , The point with the largest Youden index is the best cut-point value, and the best cutting point and its neighbor point value screening consistency analysis. Results A total of 794 cases of DM were screened, the prevalence was 4.59%. The anthropometric indexes and the prevalence of diabetes in Shandong Province all tend to increase with age, especially in women. There were significant differences in AUC between male and female body measurements (all P <0.001). The AUC of waist-to-hip ratio (WHR) screening was the highest, which was statistically significant compared with body mass index (BMI) (P <0.05). There was no significant difference in AUC between men and women (P> 0.05). The best cutting points for male BMI, waist circumference and WHR screening DM were 25 kg / m2, 91 cm and 0.92, respectively, and women were 25 kg / m2, 83 cm and 0.87, respectively. The best consistency of screening. Conclusion BMI, waist circumference and WHR have a good screening value for DM, and the consistency is good. The above cutting point can be used as an important parameter for screening residents in Shandong Province and identifying DM at high risk.