성인 남성에서 대사증후군 진단도구별 유병률과 관상동맥질환 발생위험도
The Diagnostic Criteria of Metabolic Syndrome and the Risk of Coronary Heart Disease according to Definitions in Men
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초록
연구배경: 대사증후군 합병증을 예방하기 위해 대사증후군의 조기 진단이 중요하지만, 국제적인 진단기준의 일치가 없는 상황이다. 이 연구는 대사증후군의 진단도구별 유병률과각각의 일치도를 비교하고 관상동맥질환 고위험군 선별에 어느 진단도구가 더 유용한지 알아보기 위해 실시되었다. 방법: 2007년 3월부터 12월까지 대구광역시 소재 일개 대학병원종합검진센터에서 종합검진을 받은 40세 이상의 남성 426명을 대상으로 하였다. 5가지 진단도구; 수정된 World Health Organization (WHO), National Cholesterol Education Program Third Adult Treatment Panel (NCEP-ATP III), International diabetes Federation (IDF), American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI), 그리고 세계보건기구 아시아-태평양기준에 따라 허리둘레가 수정된 NCEPATP III (modied NCEP-ATP III)에 따른 유병률과 일치율을 살펴보았다. 또한 Framingham risk score (FRS)를 이용하여 구해진 고위험군과 각 진단도구별 민감도 및 특이도를 구하였다. 결과: 대사증후군의 유병률은 WHO에서 7.7%, NCEP-ATP III 에서 10.6%, IDF에서 17.8%, 수정된 NECP-ATPIII에서 18.1%,AHA/NHLBI에서 27.2%였다. 진단도구 간의 일치율은 0.30에서 0.88까지 나타났다. FRS에 대한 진단도구별 민감도는WHO에서 13.4%, NCEP-ATP III에서 15.3%, IDF에서 24.8%, 수정된 NCEP-ATP III에서 27.4%, AHA/NHLBI에서 32.5%였다. 결론: 진단도구별 대사증후군 유병률 차이는 컸다. 관상동맥질환 고위험군 선별 측면에서 AHA/NHLBI 및 수정된 NCEPATP III, IDF가 다른 진단도구보다 좋았다.
Abstract
Background: Early detection of metabolic syndrome (MS) is important to prevent complications. Yet, there is no internationally agreed definition for MS. This study was performed to compare the diagnostic criteria of MS using various definitions and agreements, and to find better definition for screening high risk group of coronary heart disease. Methods: The participants were 426 men above forty years old who had visited to have health screening in a general hospital in Daegu from March to December in 2007. The diagnostic criteria of MS and Kappa statistic were calculated according to the following five diagnostic definitions; modified World Health Organization (WHO), National Cholesterol Education Program Third Adult Treatment Panel (NCEP-ATP III), International Diabetes Federation (IDF), American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI) and NCEP-ATP III modified waist circumference ≥ 90 cm (modified NCEP-ATP III). The sensitivity and specificity of each definition of MS were calculated with respect to high risk group by Framingham risk score (FRS). Results: The diagnostic criteria of MS were 6.6% by IDF, 7.7% by WHO, 10.6% by NCEP-ATP III, 18.1% by modified NCEPATP III and 22.3% by AHA/NHLBI. The kappa satistic ranged from 0.30 to 0.87. The sensitivity of each definition with respect to FRS was 8.3% in IDF, 13.4% in WHO, 15.3% in NCEP-ATP III, 27.4% in modified NCEP-ATP III and 32.5% in AHA/NHLBI. Conclusion: There was great difference in the diagnostic criteria of MS according to diagnostic definitions. The author suggests that AHA/NHLBI or modified NCEP-ATP III definition may be better for screening high risk group of coronary heart disease than others.
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