建立代谢综合征的尸检标准：一项基于尸检的横断面研究。
Establishing post mortem criteria for the metabolic syndrome: an autopsy based cross-sectional study.
作者信息
Christensen Martin Roest, Bugge Anne, Malik Mariam Elmegaard, Thomsen Jørgen Lange, Lynnerup Niels, Rungby Jørgen, Banner Jytte
机构信息
1Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark.
2Department of Forensic Medicine, University of Southern Denmark, Odense, Denmark.
出版信息
Diabetol Metab Syndr. 2018 Apr 25;10:36. doi: 10.1186/s13098-018-0339-0. eCollection 2018.
BACKGROUND
Individuals who suffer from mental illness are more prone to obesity and related co-morbidities, including the metabolic syndrome. Autopsies provide an outstanding platform for the macroscopic, microscopic and molecular-biological investigation of diseases. Autopsy-based findings may assist in the investigation of the metabolic syndrome. To utilise the vast information that an autopsy encompasses to elucidate the pathophysiology behind the syndrome further, we aimed to both develop and evaluate a method for the post mortem definition of the metabolic syndrome.
METHODS
Based on the nationwide Danish SURVIVE study of deceased mentally ill, we established a set of post mortem criteria for each of the harmonized criteria of the metabolic syndrome. We based the post mortem (PM) evaluation on information from the police reports and the data collected at autopsy, such as anthropometric measurements and biochemical and toxicological analyses (PM information). We compared our PM evaluation with the data from the Danish health registries [ante mortem (AM) information, considered the gold standard] from each individual.
RESULTS
The study included 443 deceased individuals (272 male and 171 female) with a mean age of 50.4 (± 15.5) years and a median (interquartile range) post mortem interval of 114 (84-156) hours. We found no significant difference when defining the metabolic syndrome from the PM information in comparison to the AM information (= 0.175). The PM evaluation yielded a high specificity (0.93) and a moderate sensitivity (0.63) with a moderate level of agreement compared to the AM evaluation (Cohen's κ = 0.51). Neither age nor post mortem interval affected the final results.
CONCLUSIONS
Our model of a PM definition of the metabolic syndrome proved reliable when compared to the AM information. We believe that an appropriate estimate of the prevalence of the metabolic syndrome can be established post mortem. However, while neither the PM nor the AM information is exhaustive in terms of defining an individual's health status, a superlative estimate may be obtained by combining the PM and the AM information. With this model, we open up the possibility of utilising autopsy data for future studies of the metabolic syndrome.
背景
患有精神疾病的个体更容易肥胖及出现包括代谢综合征在内的相关合并症。尸检为疾病的宏观、微观及分子生物学研究提供了一个出色的平台。基于尸检的发现可能有助于代谢综合征的研究。为了利用尸检所包含的大量信息进一步阐明该综合征背后的病理生理学机制，我们旨在开发并评估一种用于死后定义代谢综合征的方法。
方法
基于丹麦全国范围内针对已故精神病患者的SURVIVE研究，我们为代谢综合征的各项统一标准制定了一套死后标准。我们的死后（PM）评估基于警方报告中的信息以及尸检时收集的数据，如人体测量数据、生化和毒理学分析（PM信息）。我们将PM评估结果与来自丹麦健康登记处的每位个体的数据[生前（AM）信息，视为金标准]进行了比较。
结果
该研究纳入了443名已故个体（272名男性和171名女性），平均年龄为50.4（±15.5）岁，死后间隔时间中位数（四分位间距）为114（84 - 156）小时。与AM信息相比，根据PM信息定义代谢综合征时我们未发现显著差异（= 0.175）。与AM评估相比，PM评估具有较高的特异性（0.93）和中等灵敏度（0.63），一致性水平中等（Cohen's κ = 0.51）。年龄和死后间隔时间均未影响最终结果。
结论
与AM信息相比，我们的代谢综合征PM定义模型被证明是可靠的。我们认为可以在死后对代谢综合征的患病率进行合理估计。然而，虽然PM信息和AM信息在定义个体健康状况方面都不详尽，但通过结合PM信息和AM信息可能会获得更好的估计。借助这个模型，我们开启了利用尸检数据进行未来代谢综合征研究的可能性。
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