摘要
目的分析体质量指数(BMI)、腰围、臀围、腰臀比(WHR)、脐旁皮褶厚度、颈部黑棘皮程度6项体格测量指标对胰岛素抵抗(IR)的预测意义,并计算出可用于临床检测的各个指标的切点。方法测量162例肥胖儿童身高、体质量、腰围、臀围,计算BMI(BMI=体质量/身高2)、WHR(WHR=腰围/臀围),并评价其颈部黑棘皮程度;测量其空腹血糖(FBG)及空腹胰岛素(FIN),通过稳态模型法(HOMA)计算IR指数(HOMA-IR)(HOMA-IR=FBG×FIN/22.5),评价胰岛素敏感性;通过ROC曲线下面积评价各项指标对IR的预测能力,并计算出相应指标的特异度及灵敏度,两者同时最大的点作为各项指标的切点。结果ROC曲线下面积(95%可信区间)、切点分别为:BMI0.778(0.684～0.872)、27.45,腰围0.800(0.718～0.883)、87.25cm,臀围0.72(0.612～0.828)、99.75cm,WHR0.698(0.601～0.796)、0.895,脐旁皮褶厚度0.781(0.684～0.878)、4.05cm,颈部黑棘皮程度0.752(0.646～0.858)、3度。结论BMI、腰围、臀围、WHR、脐旁皮褶厚度、颈部黑棘皮程度均可作为独立预测IR的指标。其中腰围、脐旁皮褶厚度和BMI的预测意义最大。BMI可作为初步筛查IR的首要指标,而脐旁皮褶厚度在排除IR时有一定的参考意义,BMI及脐旁皮褶厚度联合参考、综合分析,可同时减小漏诊率及误诊率。若各指标测量值在相应切点以上时应当予以重视,以提高早期诊断率。
Objective To analyze the prediction significance of anthropometric parameters including body mass index（BMI）,waist cir-cumference,hip circumference,waist hip ratio （WHR）,skinfold thickness of the abdomen,and the degree of acanthosis nigricans on insulin resistance（IR） in obese children,then get the cut off points of each indicators for clinical assessment.Methods The weight,height,waist circumference,hip circumference of each participants were measured,the BMI,WHR were calculated,finally the skinfold thickness of the abdomen and the degree of the acanthosis nigricans of neck of the 162 obese children from the Tianjin Medical University General Hospital were evaluated;Fasting blood samples were taken to measure fasting blood glucose （FBG） and fasting insulin（FIN）,then the IR was evaluated by homeostasis model assessment IR（HOMA-IR）=FBG×FIN/22.5.The receiver operating characteristic curves （ROC curve） was used to estimate the ability of predicting IR and the cut off points which make the sensitivity and the specificity maximum simultaneous was got.Results After analysis of the area under ROC curve （95% confidence interval）,and the cut off points were follows：BMI 0.778（0.684-0.872）,27.45,waist circumference 0.800 （0.718-0.883）,87.25 cm,hip circumference 0.72（0.612-0.828）,99.75 cm,WHR 0.698 （0.601-0.796）,0.895,skinfold thickness of the abdomen 0.781（0.684-0.878）,4.05 cm,the degree of the neck acanthosis nigricans 0.752 （0.646-0.858）,degree 3.Conclusions The above indicators appear to offer good predictive power for IR,and the waist circumference,skinfold thickness of the abdomen,BMI has better ability to predict IR,BMI can be used as the most important indicator for screening,and the skinfold thickness of the abdomen can be used to exclude the IR patients to some extent,and the 2 indicators should be considered together to improve the misdiagnosis rate,indicators above the cut off points should be paid more attention to improve the rate of early diagnosis.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2010年第7期484-485,521,共3页
Journal of Applied Clinical Pediatrics
关键词
体格测量
胰岛素抵抗
肥胖
儿童
anthropometric parameters
insulin resistance
obesity
child
