WHO and ATPIII proposals for the definition of the metabolic syndrome in patients with Type 2 diabetes
WHO and ATPIII proposals for the definition of the metabolic syndrome in patients with Type 2 diabetes
复制标题
DOI：
10.1111/j.1464-5491.2004.01115.x
复制
发表时间：
2004-04-01
影响因子：
3.5
通讯作者：
Melchionda, N
中科院分区：
文献类型：
--
作者：
Marchesini, G;Forlani, G;Melchionda, N
目的世界卫生组织(WHO)和全国成人高胆固醇血胆固醇检测、评估和治疗专家小组(ATPIII)第三次报告提出了不同的代谢综合征诊断标准。方法在1569例2型糖尿病患者中，根据两种不同的诊断标准确定代谢综合征的患病率。结果81%的患者(95%可信区间，79~83)为代谢综合征。微量白蛋白尿的特异性最高(99%)，内脏肥胖症的敏感性最高(93%)。78%的患者(95%可信区间，76-80)符合ATPIII代谢综合征标准，低高密度脂蛋白-胆固醇具有最高的特异性(95%)，高血压具有最高的敏感性。根据这两项建议，1113名患者为阳性；183名患者一致为阴性，表明有相当好的一致性(k统计，0.464)。仅对世卫组织建议呈阳性的受试者更多地是男性，他们的BMI较低，动脉压较高。只有ATPIII建议确定的受试者以前发现的冠心病患病率显著高于其他受试者。正确识别综合征对于采取综合方法减少高昂的费用和相关的残疾非常重要。ATPIII提案更清楚地确定了与代谢综合征相关的冠心病负担。
Aims Different criteria have been proposed by the World Health Organization (WHO) and by the Third Report of the National Cholesterol Education Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATPIII) for the diagnosis of the metabolic syndrome. Its identification is of particular importance for coronary risk assessment.Methods The prevalence of the metabolic syndrome was determined according to the two different proposals in 1569 consecutive subjects with Type 2 diabetes.Results By the WHO proposal, 81% of cases (95% confidence interval, 79-83) were labelled as metabolic syndrome. Microalbuminuria had the highest specificity (99%) and visceral obesity the highest sensitivity (93%). Seventy-eight per cent of patients (95% CI, 76-80) fulfilled the ATPIII criteria for metabolic syndrome, low HDL-cholesterol having the highest specificity (95%), elevated blood pressure having the highest sensitivity. According to both proposals, 1113 patients were positive; 183 were concordantly negative, indicative of a fairly good agreement (k statistics, 0.464). Subjects only positive for the WHO proposal were more frequently males, had a lower BMI and a higher arterial pressure. Only subjects identified by the ATPIII proposal had a significantly higher prevalence of previously detected coronary heart disease.Conclusions Minimum criteria for the metabolic syndrome are met in most patients with Type 2 diabetes. Correct identification of the syndrome is important for an integrated approach to reduce the high costs and the associated disabilities. The ATPIII proposal more clearly identifies the burden of coronary heart disease associated with the metabolic syndrome.