Pei D, Kuo S-W, Wu D-A, Lin T-Y, Hseih M-C, Lee C-H, Hsu W-L, Chen S-P, Sheu W H-H, Li J-C
Department of Internal Medicine, Division of Endocrinology and Metabolism, Buddhist Tzu Chi General Hospital and College of Medicine, Tzu Chi University, Taiwan.
Int J Clin Pract. 2005 Dec;59(12):1408-16. doi: 10.1111/j.1368-5031.2005.00661.x.
Metabolic syndrome (MetS) is a complicated clinicopathological entity with clustering of cardiovascular and metabolic risk factors, which includes central obesity, hypertension, dyslipidemia and glucose intolerance. There were many studies investigating a wide variety of clinical and pathophysiological aspects of this syndrome. However, the cutoffs of the components of MetS are not yet being evaluated by measured the insulin resistance (IR) directly. In this study, we enrolled 564 (male/female: 250/314) middle-aged healthy subjects. Each of the male and the female group was further divided into four subgroups (group 1 to group 4). Group 4 had the top 25 percentile of most severe IR determined by insulin suppression test. We then obtain the mean values of each component of the MetS in group 4 and compared them with the definitions of World Health Organization, National Cholesterol Education Program Adult Treatment Panel III, European Study Group of Insulin Resistance and International Diabetes Federation. The means of the blood pressure (BP) (male, 125/81; female, 125/80 mmHg) and the triglyceride (TG) (male, 1.6; female, 1.4 mmol/l) in group 4 were lower, and the fasting plasma glucose (6.2 mmol/l) was higher than the cutoffs of the other four sets of the criteria. The means of the high-density lipoprotein cholesterol (male, 0.9; female, 1.03 mmol/l) and the body mass index (male, 26.9; female 26.1 kg/m(2)) in group 4 were consistent with the cutoffs of other four groups and also the Taiwan Health Department criteria. In conclusion, we suggest to lower the cutoffs of the BP from 140/90 to 125/80 mmHg, TG from 1.7 to 1.6 mmol/l for males and 1.4 mmol/l for females for MetS definition, at least in Taiwan. This may help to early detect subjects under high risk of future coronary heart disease and diabetes. Still, these newly proposed cutoffs need larger-scale epidemiological studies to confirm.
代谢综合征（MetS）是一种复杂的临床病理实体，伴有心血管和代谢危险因素的聚集，包括中心性肥胖、高血压、血脂异常和葡萄糖耐量异常。有许多研究调查了该综合征的各种临床和病理生理方面。然而，尚未通过直接测量胰岛素抵抗（IR）来评估代谢综合征各组成部分的临界值。在本研究中，我们纳入了564名（男/女：250/314）中年健康受试者。男性和女性组各自进一步分为四个亚组（1组至4组）。通过胰岛素抑制试验确定，第4组具有最严重胰岛素抵抗的前25%。然后，我们获取了第4组中代谢综合征各组成部分的平均值，并将其与世界卫生组织、美国国家胆固醇教育计划成人治疗小组第三次报告、欧洲胰岛素抵抗研究组和国际糖尿病联盟的定义进行比较。第4组的血压平均值（男性，125/81；女性，125/80 mmHg）和甘油三酯平均值（男性，1.6；女性，1.4 mmol/l）较低，而空腹血糖（6.2 mmol/l）高于其他四套标准的临界值。第4组的高密度脂蛋白胆固醇平均值（男性，0.9；女性，1.03 mmol/l）和体重指数平均值（男性，26.9；女性，26.1 kg/m²）与其他四组的临界值以及台湾卫生部门的标准一致。总之，我们建议至少在台湾地区，将代谢综合征定义中血压的临界值从140/90 mmHg降至125/80 mmHg，男性甘油三酯从1.7 mmol/l降至1.6 mmol/l，女性降至1.4 mmol/l。这可能有助于早期发现未来患冠心病和糖尿病高风险的受试者。尽管如此，这些新提出的临界值仍需要大规模的流行病学研究来证实。
