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目的 探讨肥胖评价指标在2型糖尿病(T2DM)及高危人群筛查中的应用价值.方法 选择首钢4个社区无糖尿病病史的T2DM普查人群,根据口服葡萄糖耐量试验(OGTT)结果分层随机抽取7582人,其中糖耐量正常组3080人,T2DM高危组2992人(包括空腹血糖受损、糖耐量减低及二者均异常),T2DM组1510例.采用Logistic回归分析和受试者工作特征(ROC)曲线对比分析肥胖评价指标体质指数(BMI)、腰臀比和腰高比对T2DM及高危人群筛查的应用价值.结果 Logistic回归分析结果显示,腰臀比、腰高比、BMI及糖尿病家族史与T2DM及T2DM的高危人群呈显著正相关(P<0.05或0.01),均以腰高比最为显著,其OR值分别为90.409及69.285.ROC曲线分析,筛查T2DM时曲线下面积(AUC)男性为腰高比>BMI>腰臀比,女性为BMI>腰高比>腰臀比,提示男性以腰高比筛查T2DM效果最优,女性以BMI筛查T2DM效果最优.筛查T2DM的男、女最合适的切点分别为:腰臀比(0.91,0.86)、腰高比(0.51,0.52)、BMI(25.47 kg/m2,24.95 kg/m2).筛查T2DM高危人群时AUC男性及女性均腰高比>BMI>腰臀比,提示腰高比筛查T2DM高危人群效果优于BMI及腰臀比.筛查T2DM高危人群的男、女最合适的切点分别为:腰臀比(0.91,0.86)、腰高比(0.51,0.51)、BMI(25.30 kg/m2, 24.81 kg/m2).结论 腰高比是一个有效的筛查T2DM及高危人群的指标,其效果优于BMI和腰臀比.

Objective This study investigated the application value of waist-to-height ratio (WHtR), body mass index (BMI), and waist-to-hip ratio (WHR) in screening for type 2 diabetes mellitus (T2DM) and high risk of T2DM. Methods A total of 7 582 subjects aged 40-75 years were randomly selected and stratified based on the results of an oral glucose tolerance test (OGTT) administered during a standard screening for T2DM in the Shougang community.Three anthropometric indices(WHtR,BMI,and WHR) were compared, with the optimal cutoffs for WHtR, BMI, and WHR identified using receiver operating characteristic curve (ROC) analysis. Using multivariate logistic regression analysis and the area under the curve(AUC)of ROC,the associations between BMI,WHR,and WHtR and T2DM were analyzed by group: normal glucose tolerance group (n= 3 080), T2DM high-risk group (n= 2 992 cases), and T2DM group(n=1 510).Results Logistic regression analysis showed that BMI,WHR,WHtR,and family history of diabetes were positively correlated with T2DM and high risk of T2DM(P<0.05 and P<0.01,respectively);WHtR was most significant, with odds ratios of 90.409 and 69.285, respectively. WHtR had the greatest AUC under the ROC in men,whereas BMI had the greatest AUC in women.The optimal cutoffs values for the detection of T2DM were 0.51, 25.47 kg/m2, and 0.91 for WHtR, BMI, and WHR in men, respectively, and 0.52, 24.95 kg/m2, and 0.86 for WHtR, BMI, and WHR in women, respectively. WHtR was more efficient than WHR and BMI based on the AUC. The optimal cutoff values for detecting a high risk for T2DM were 0.51,25.30 kg/m2,and 0.91 for WHtR,BMI,and WHR in men and 0.51,24.81 kg/m2,and 0.86 for WHtR, BMI, and WHR in women, respectively. Conclusion Waist-to-height ratio may be a more effective index for diagnosing type 2 diabetes mellitus and identifying individuals at high risk for T2DM than BMI or WHR.