Appel Susan J, Jones Ellen D, Kennedy-Malone Laurie
Acute Care Nurse Practitioner Program, University of Alabama at Birmingham, USA.
J Am Acad Nurse Pract. 2004 Aug;16(8):335-42. doi: 10.1111/j.1745-7599.2004.tb00456.x.
To describe screening measures that will determine which clients are at risk for the metabolic syndrome, common manifestations of the syndrome, preventive diagnostic considerations, and management and treatment options that primary care providers can implement.
Review of the clinical and research literature, supplemented with specific diagnostic criteria.
Central obesity is the cornerstone of the metabolic syndrome, which may lead to type 2 diabetes and cardiovascular disease. Generalized obesity is defined as body weight that is considerably greater than the ideal weight and that is distributed on all parts of the body. Generalized obesity has long been considered a significant risk factor for developing type 2 diabetes and cardiovascular disease. Those clients of ideal body weight have been considered at less risk for developing these conditions. However, this perception may not always be accurate. Weight distribution plays a major role in acquiring the metabolic syndrome. Because waist circumference is as important as overall body weight, central obesity is key to determining the risk.
The metabolic syndrome has now been given a CPT code (277.7). It is more likely that clients at risk for or with the metabolic syndrome may first be seen by a primary care provider. Primary care providers need to be able to diagnose, treat, and provide preventive interventions for the metabolic syndrome. Clients at risk will likely be identified during routine health screening. Early detection of and interventions focused on the metabolic syndrome may reduce the occurrence of type 2 diabetes and cardiovascular disease. Use of a tape measure to determine waist circumference may help the provider to identify at-risk clients who are of normal weight, and thus not previously believed to be at risk, as well as those more obviously at risk. It is necessary to determine not only patients' overall body weight but also their waist circumference. A measuring tape may be the key tool for establishing a patient's early risk for the metabolic syndrome and, ultimately, for prevention of type 2 diabetes and cardiovascular disease.
描述筛查措施，这些措施将确定哪些患者有代谢综合征风险、该综合征的常见表现、预防性诊断注意事项以及初级保健提供者可以实施的管理和治疗方案。
对临床和研究文献进行综述，并辅以特定诊断标准。
中心性肥胖是代谢综合征的基石，代谢综合征可能导致2型糖尿病和心血管疾病。全身性肥胖定义为体重明显高于理想体重且分布于身体各个部位。长期以来，全身性肥胖一直被认为是发生2型糖尿病和心血管疾病的重要危险因素。那些体重理想的患者被认为发生这些疾病的风险较低。然而，这种观念可能并不总是准确的。体重分布在获得代谢综合征中起主要作用。由于腰围与总体重同样重要，中心性肥胖是确定风险的关键。
代谢综合征现在已有一个现行程序编码（277.7）。有代谢综合征风险或患有代谢综合征的患者更有可能首先由初级保健提供者诊治。初级保健提供者需要能够诊断、治疗代谢综合征并提供预防性干预措施。有风险的患者可能会在常规健康筛查期间被识别出来。早期发现并针对代谢综合征进行干预可能会减少2型糖尿病和心血管疾病的发生。使用卷尺测量腰围可能有助于提供者识别体重正常但此前未被认为有风险的高危患者，以及那些更明显有风险的患者。不仅要确定患者的总体重，还必须确定其腰围。卷尺可能是确定患者早期代谢综合征风险并最终预防2型糖尿病和心血管疾病的关键工具。
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