肥胖测量指标结合糖尿病家族史识别血糖异常的效能评价

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摘要目的：比较肥胖测量指标在糖尿病家族史（FHD+）和无糖尿病家族史（FHD-）人群中识别血糖异常的效能。方法：对温州市4个社区进行横断面调查，入选40岁及以上人群4 867人，其中FHD+组979人，FHD-组3 878人，利用Pearson相关分析对体质量指数（BMI）、腰围（WC）、腰臀比（WHR）、腰围身高比（WHtR）与血糖指标，包括空腹血糖（FPG）、餐后2 h血糖（2hPG）、糖化血红蛋白（HbA1c）进行分析，比较4项指标在识别血糖异常的ROC曲线下面积，确定最佳切点值。结果：BMI、WC、WHR、WHtR均与4项血糖指标相关（r=0.114～0.253，P＜0.05）。对FHD进行分层，FHD+组血糖异常的发生率明显高于FHD-组，差异有统计学意义（P＜0.05）。WHtR在FHD+组和FHD-组筛检血糖异常的最佳切点分别为0.54和0.56，BMI分别为23.5 kg/m2和24.8 kg/m2，WC分别为86.1 cm和88.2 cm，WHR均为0.89，ROC曲线分析显示WHtR的曲线下面积为最大（均为0.65）。结论：肥胖测量指标在FHD+组识别血糖异常的切点值低于FHD-组，建议对于FHD+人群，应制定更加严格的筛查切点。2组人群中，WHtR均是识别血糖异常的最佳指标。

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关键词 ：血糖异常, 糖尿病家族史, 体质量指数, 腰围, 腰围身高比, 腰臀比

Abstract：Objective: To compare the effectiveness of obesity measurement index in identifying abnormal blood glucose (prediabetes and diabetes) in populations with family history of diabetes (FHD+) and those with non-diabetic family history (FHD-). Methods: A cross-sectional study was carried out in four communities of Wenzhou city. A total of 4 867 people aged above 40 years old were included in the study, among whom, 979 people were FHD+ group and 3 878 people in FHD- group. A correlation analysis was made of body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), waist-to-height ratio (WHtR) and blood glucose level (fasting plasma glucose, 2-hour postprandial blood glucose and hemoglobin A1c) using Pearson correlation. Areas under the working characteristic curve of four indexes in identifying subjects with abnormal blood glucose were compared and the optimal cut-off value was determined. Results: BMI, WC, WHR, WHtR were all related to blood glucose indexes (r=0.114~0.253, P<0.05). FHD was layered, and the incidence of abnormal blood glucose in FHD+ group was significantly higher than that in FHD- group (P<0.05). The optimal cut-off value of WHtR in screening glucose abnormality in FHD+ group and FHD- group was 0.54 and 0.56 respectively; that of BMI was 23.5 kg/m2 and 24.8 kg/m2 respectively; that of WC was 86.1 cm and 88.2 cm respectively; that of WHR was both 0.89; ROC curve analysis showed that the area under curve of waist-to-height ratio was the largest (both 0.65). Conclusion: The cut-off value of obesity measurement indexes in identifying glucose abnormality in FHD+ group is lower than that in FHD- group. It is suggested that stricter cut-off value should be given for FHD+ population. Of the two groups, WHtR is the best index to identify glucose abnormality.

Key words： abnormal blood glucose family history of diabetes body mass index waist circumference waist-height ratio waist-hip ratio

收稿日期: 2017-09-19

基金资助:国家自然科学基金青年基金资助项目（81200576）；温州市科技局科研基金资助项目（Y20170047）。

通讯作者: 顾雪疆，副主任医师，硕士生导师，Email：guxuejiang@wmu.edu.cn。

作者简介: 徐静（1992-），男，浙江温州人，硕士生

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I4/245

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