Strazzullo Pasquale, Barbato Antonio, Siani Alfonso, Cappuccio Francesco P, Versiero Marco, Schiattarella Pierluigi, Russo Ornella, Avallone Sonia, della Valle Elisabetta, Farinaro Eduardo
Department of Clinical and Experimental Medicine, "Federico II" University of Naples, 80131 Naples, Italy.
Metabolism. 2008 Mar;57(3):355-61. doi: 10.1016/j.metabol.2007.10.010.
This analysis compares the performance of 7 different diagnostic criteria of metabolic syndrome (MS) with regard to the prevalence of the syndrome, the characteristics of subjects with a positive diagnosis, and the ability to correctly identify individuals at high calculated cardiovascular (CV) risk or with signs of systemic inflammation or early organ damage. The diagnostic criteria proposed by the World Health Organization (1998); European Group for the Study of Insulin Resistance (EGIR) (1999); Adult Treatment Panel III (ATP III) (2001); American Association of Clinical Endocrinologists (AACE) (2003); ATP III (2004); International Diabetes Federation (IDF) (2005); and American Heart Association/National Heart, Lung, and Blood Institute (2005) were applied to the population of 933 men aged 59.5 years (range, 33-81 years) attending the 2002-2004 examination of the Olivetti Heart Study. Standardized measurements were available for body mass index, waist circumference, blood pressure, fasting serum total and high-density lipoprotein cholesterol, triglyceride, glucose, insulin, high-sensitivity C-reactive protein, and microalbuminuria. Insulin resistance was estimated by the homeostasis model assessment index; and CV risk, by the Prospective Cardiovascular Munster algorithm. The MS prevalence ranged from 8.6% (AACE) to 44.5% (IDF). Among MS-positive subjects, insulin resistance ranged from 94.8% (EGIR) to 49.2% (IDF), whereas type 2 diabetes mellitus (excluded by EGIR and AACE criteria) rated 59.9% by World Health Organization and 22% to 24% by ATP III, IDF, or American Heart Association/National Heart, Lung, and Blood Institute. By most criteria, MS-positive subjects had greater calculated CV risk than MS-negative subjects; but in general, the ability to correctly identify individuals at high CV risk was dampened by limited sensitivity (maximum 60%). Lowering the cutoff for abdominal adiposity (waist circumference <94 cm by IDF) did not improve the performance in this regard but identified a larger number of individuals with microalbuminuria (56%) and elevated C-reactive protein (53%).
本分析比较了代谢综合征（MS）的7种不同诊断标准在该综合征患病率、诊断阳性的受试者特征以及正确识别心血管（CV）风险高、有全身炎症迹象或早期器官损伤个体的能力方面的表现。应用了世界卫生组织（1998年）、欧洲胰岛素抵抗研究组（EGIR）（1999年）、成人治疗小组第三次报告（ATP III）（2001年）、美国临床内分泌医师协会（AACE）（2003年）、ATP III（2004年）、国际糖尿病联盟（IDF）（2005年）以及美国心脏协会/美国国立心肺血液研究所（2005年）提出的诊断标准，对参加2002 - 2004年奥利维蒂心脏研究检查的933名59.5岁（范围33 - 81岁）男性人群进行分析。可获得体重指数、腰围、血压、空腹血清总胆固醇和高密度脂蛋白胆固醇、甘油三酯、血糖、胰岛素、高敏C反应蛋白和微量白蛋白尿的标准化测量值。胰岛素抵抗通过稳态模型评估指数估算；CV风险通过前瞻性心血管明斯特算法估算。MS患病率从8.6%（AACE）到44.5%（IDF）不等。在MS阳性受试者中，胰岛素抵抗从94.8%（EGIR）到49.2%（IDF）不等，而2型糖尿病（EGIR和AACE标准排除在外）在世界卫生组织标准下为59.9%，在ATP III、IDF或美国心脏协会/美国国立心肺血液研究所标准下为22%至24%。根据大多数标准，MS阳性受试者的计算CV风险高于MS阴性受试者；但总体而言，正确识别高CV风险个体的能力因敏感性有限（最高60%）而受到影响。降低腹部肥胖的临界值（IDF标准下腰围<94 cm）在这方面并未改善表现，但识别出更多微量白蛋白尿（56%）和C反应蛋白升高（53%）的个体。
