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Agreement Level of Definitions of the Metabolic Syndrome by by set6tyhsd

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									                                                                ‫ﻣﺠﻠﻪﻱ ﻏﺪﺩ ﺩﺭﻭﻥﺭﻳﺰ ﻭ ﻣﺘﺎﺑﻮﻟﻴﺴﻢ ﺍﻳﺮﺍﻥ‬
                                           ‫ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻲ ﻭ ﺧﺪﻣﺎﺕ ﺑﻬﺪﺍﺷﺘﻲ ـ ﺩﺭﻣﺎﻧﻲ ﺷﻬﻴﺪ ﺑﻬﺸﺘﻲ‬
                                             ‫ﺩﻭﺭﻩﻱ ﺩﻫﻢ، ﺷﻤﺎﺭﻩﻱ ۵، ﺻﻔﺤﻪﻫﺎﻱ ۳۴۴ ـ ۵۳۴ )ﺩﻱ ۷۸۳۱(‬




                               ‫ﻣﻴﺰﺍﻥ ﺗﻮﺍﻓﻖ ﺗﻌﺮﻳﻒﻫﺎﻱ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺍﺭﺍﻳﻪ ﺷﺪﻩ ﺗﻮﺳﻂ ‪ATP‬‬
‫ﻣﻘﺎﻟﻪﻱ ﭘﮋﻭﻫﺸﻲ‬




                               ‫‪ Modified III‬ﻭ ‪ IDF‬ﺑﺎ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺩﺭ ﻣﻄﺎﻟﻌﻪﻱ ﻗﻨﺪ ﻭ‬
                                                                            ‫ﻟﻴﭙﻴﺪ ﺗﻬﺮﺍﻥ‬
                                                  ‫۲‬
                                                      ‫ﺩﻛﺘﺮ ﺷﻴﻮﺍ ﺑﺮﺯﻭﺋﻲ۱، ﺩﻛﺘﺮ ﻓﺮﻫﺎﺩ ﺣﺴﻴﻦﭘﻨﺎﻩ۱، ﺩﻛﺘﺮ ﻓﺮﻳﺪﻭﻥ ﻋﺰﻳﺰﻱ‬




                                                                                                    ‫‪D‬‬
                              ‫۱( ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎﺕ ﭘﻴﺸﮕﻴﺮﻱ ﻭ ﺩﺭﻣﺎﻥ ﭼﺎﻗﻲ ﻭ ۲( ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎﺕ ﻏﺪﺩ، ﭘﮋﻭﻫﺸﻜﺪﻩﻱ ﻋﻠﻮﻡ ﻏﺪﺩ ﺩﺭﻭﻥﺭﻳﺰ ﻭ ﻣﺘﺎﺑﻮﻟﻴﺴﻢ، ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ‬
                             ‫ﭘﺰﺷﮑﻲ ﻭ ﺧﺪﻣﺎﺕ ﺑﻬﺪﺍﺷﺘﻲ ـ ﺩﺭﻣﺎﻧﻲ ﺷﻬﻴﺪ ﺑﻬﺸﺘﻲ ؛ ﻧﺸﺎﻧﻲ ﻣﮑﺎﺗﺒﻪﻱ ﻧﻮﻳﺴﻨﺪﻩﻱ ﻣﺴﺌﻮﻝ: ﺗﻬﺮﺍﻥ، ﺻﻨﺪﻭﻕ ﭘﺴﺘﻲ ۳۶۷۴-۵۹۳۹۱،‬




                       ‫‪Modified ATP III‬‬
                                                                                       ‫‪SI‬‬
                                                          ‫ﺩﻛﺘﺮ ﻓﺮﻫﺎﺩ ﺣﺴﻴﻦﭘﻨﺎﻩ؛ ‪e-mail: fhospanah@endocrine.ac.ir‬‬




                                          ‫ﻣﻘﺪﻣﻪ: ﻫﺪﻑ ﺍﺯ ﻣﻄﺎﻟﻌﻪﻱ ﺣﺎﺿﺮ ﺑﺮﺭﺳﻲ ﺩﻗﺖ ﺗﺸﺨﻴﺼﻲ ﺗﻌﺮﻳﻒﻫﺎﻱ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﻃﺒﻖ ﻣﻌﻴﺎﺭﻫﺎﻱ‬
                                                                                                                                         ‫ﭼﻜﻴﺪﻩ‬
                                                                         ‫‪of‬‬
                       ‫ﻭ ‪ IDF‬ﺩﺭ ﺷﻨﺎﺳﺎﻳﻲ ﺍﻓﺮﺍﺩ ﻣﺒﺘﻼ ﺑﻪ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﻭ ﺍﺭﺯﻳﺎﺑﻲ ﻣﻴﺰﺍﻥ ﺗﻮﺍﻓﻖ ﺑﻴﻦ ﺍﻳﻦ ﺗﻌﺮﻳﻒﻫﺎ ﻭ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ‬
                       ‫ﺍﺳﺖ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵﻫﺎ: ﻧﻤﻮﻧﻪﻫﺎ ﺷﺎﻣﻞ ۷۴۳ ﻓﺮﺩ ﻏﻴﺮﺩﻳﺎﺑﺘﻲ ﺍﺯ ﻣﻄﺎﻟﻌﻪﻱ ﻗﻨﺪ ﻭ ﻟﻴﭙﻴﺪ ﺗﻬﺮﺍﻥ )۰۴۱ ﻣﺮﺩ ﻭ ۷۰۲ ﺯﻥ( ﺑﺎ ﺳﻦ ۴۸-‬
                       ‫۱۲ ﺳﺎﻝ ﺑﻮﺩﻧﺪ. ﻣﺮﺟﻊ ﺍﺳﺘﺎﻧﺪﺍﺭﺩ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ، ‪ HOMA-IR‬ﺑﻮﺩ ﻭ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺑﻪ ﺻﻮﺭﺕ ۵/۲ ≥ ‪HOMA-IR‬‬
                       ‫ﺩﺭ ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ. ﻳﺎﻓﺘﻪﻫﺎ: ﺑﺮﺍﺳﺎﺱ ﻣﻌﻴﺎﺭﻫﺎﻱ ‪ ATP III‬ﻭ ‪ IDF‬ﺑﻪ ﺗﺮﺗﻴﺐ ۹/۸۳% ﻭ ۵۴% ﻣﺒﺘﻼ ﺑﻪ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺑﻮﺩﻧﺪ.‬
                                           ‫‪ive‬‬

                       ‫ﺣﺴﺎﺳﻴﺖ ﻭ ﻭﻳﮋﮔﻲ ‪ ATP III‬ﺑﻪ ﺗﺮﺗﻴﺐ ۳/۲۵% ﻭ ۵۶% ﻭ ﺑﺮﺍﺳﺎﺱ ‪ IDF‬ﺑﻪ ﺗﺮﺗﻴﺐ ۰۶% ﻭ ۹۵% ﺑﻮﺩ. ﺿﺮﻳﺐ ﺗﻮﺍﻓﻖ ﻛﺎﭘﺎ ﺑﻴﻦ‬
                       ‫‪ ATP III‬ﻭ ‪ IDF‬ﺑﺎ ‪ HOMA-IR‬ﺑﻪ ﺗﺮﺗﻴﺐ ۴۱/۰ ﻭ ۵۱/۰ ﺑﻮﺩ. ﺩﻗﺖ ﺗﺸﺨﻴﺼﻲ ﺳﻄﺢ ﺯﻳﺮ ﻣﻨﺤﻨﻲ ﺭﺍﻙ ﻛﻪ ﺍﺯ ﻃﺮﻳﻖ ﺷﻤﺎﺭﺵ‬
                       ‫ﺗﻌﺪﺍﺩ ﺍﺟﺰﺍﻱ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺭﺳﻢ ﺷﺪ، ﺑﻪ ﻧﺴﺒﺖ ﭘﺎﻳﻴﻦ ﺑﻮﺩ. ﻭﻗﺘﻲ ﻛﻪ ﻫﺮ ﻳﻚ ﺍﺯ ﺍﺟﺰﺍﻱ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺑﻪ ﻋﻨﻮﺍﻥ ﻣﻘﺎﺩﻳﺮ‬
                       ‫ﻛﻤﻲ ﺩﺭ ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪﻧﺪ، ﺩﻭﺭ ﻛﻤﺮ ﻭ ﻗﻨﺪ ﺧﻮﻥ ﻧﺎﺷﺘﺎ ﺑﻪ ﺗﻨﻬﺎﻳﻲ ﺩﻗﺘﻲ ﻣﻌﺎﺩﻝ ﻳﺎ ﺣﺘﻲ ﺑﻴﺸﺘﺮ ﺍﺯ ﺷﻤﺎﺭﺵ ﺍﺟﺰﺍﻱ ﺳﻨﺪﺭﻡ‬     ‫‪‬‬
                                         ‫‪ch‬‬



                       ‫ﻣﺘﺎﺑﻮﻟﻴﻚ ﺩﺍﺷﺘﻨﺪ. ﻧﺘﻴﺠﻪﮔﻴﺮﻱ: ﺗﻌﺮﻳﻒﻫﺎﻱ ‪ Modified ATP III‬ﻭ ‪ IDF‬ﺑﺮﺍﻱ ﺗﺸﺨﻴﺺ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺍﺯ ﺣﺴﺎﺳﻴﺖ‬
                       ‫ﻛﻤﻲ ﺑﺮﺧﻮﺭﺩﺍﺭ ﺑﻮﺩﻩ، ﺗﻮﺍﻓﻖ ﻧﺎﭼﻴﺰﻱ ﺑﻴﻦ ﺍﻳﻦ ﻣﻌﻴﺎﺭﻫﺎ ﻭ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﻭﺟﻮﺩ ﺩﺍﺭﺩ. ﺍﻧﺪﺍﺯﻩﮔﻴﺮﻱ ﺩﻭﺭ ﻛﻤﺮ ﻳﺎ ﻗﻨﺪ ﺧﻮﻥ‬
                                                                 ‫ﻧﺎﺷﺘﺎ ﺳﺎﺩﻩﺗﺮ ﺍﺳﺖ ﻭ ﺑﺮﺍﻱ ﺗﺸﺨﻴﺺ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺩﻗﺖ ﺑﻴﺸﺘﺮﻱ ﺩﺍﺭﺩ.‬
                           ‫‪Ar‬‬




                              ‫ﻭﺍﮊﮔﺎﻥ ﻛﻠﻴﺪﻱ: ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ، ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ، ﺗﻮﺍﻓﻖ، ‪TLGS ،IDF ،Modified ATP III ،HOMA-IR‬‬
                                                   ‫ﺩﺭﻳﺎﻓﺖ ﻣﻘﺎﻟﻪ: ۷/۵/۷۸ ـ ﺩﺭﻳﺎﻓﺖ ﺍﺻﻼﺣﻴﻪ: ۰۱/۶/۷۸ـ ﭘﺬﻳﺮﺵ ﻣﻘﺎﻟﻪ: ۶۱/۶/۷۸‬




                ‫ﻫﻤﻮﺍﺭﻩ ﺍﻣﻜﺎﻥﭘﺬﻳﺮ ﻧﻴﺴﺖ ﻭ ﻫﺰﻳﻨﻪﻫﺎﻱ ﺗﺤﻤﻴﻠﻲ ﺁﻥ ﻗﺎﺑﻞ ﺗﻮﺟﻪ‬                                                     ‫ﻣﻘﺪﻣﻪ‬
                ‫ﺍﺳﺖ، ﻣﻌﻴﺎﺭﻫﺎﻳﻲ ﻛﻪ ﻣﺒﺘﻨﻲ ﺑﺮ ﻣﻌﺎﻳﻨﻪﻫﺎﻱ ﺑﺎﻟﻴﻨﻲ ﻭ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ‬
                ‫ﺭﻭﺵﻫﺎﻱ ﺁﺯﻣﺎﻳﺸﮕﺎﻫﻲ ﺳﺎﺩﻩﺗﺮ ﻫﺴﺘﻨﺪ ﺑﺎ ﻋﻨﻮﺍﻥ »ﺳﻨﺪﺭﻡ‬                           ‫ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﻛﻪ ﺑﺎ ﻛﺎﻫﺶ ﭘﺎﺳﺦ ﻃﺒﻴﻌﻲ ﺑﺎﻓﺖﻫﺎﻱ‬
                ‫ﻣﺘﺎﺑﻮﻟﻴﻚ« ﻣﻄﺮﺡ ﺷﺪﻧﺪ ﺗﺎ ﺗﺸﺨﻴﺺ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺑﺎ‬                        ‫ﻣﺤﻴﻄﻲ ﻧﺴﺒﺖ ﺑﻪ ﻋﻤﻠﻜﺮﺩ ﺍﻧﺴﻮﻟﻴﻦ ﻣﺸﺨﺺ ﻣﻲﺷﻮﺩ، ﺑﻪ ﻋﻨﻮﺍﻥ‬
                ‫ﺳﺎﺩﮔﻲ ﺑﻴﺸﺘﺮﻱ ﻫﻤﺮﺍﻩ ﺷﻮﺩ.۴ ﺍﺯ ﺟﻤﻠﻪﻱ ﺍﻳﻦ ﻣﻌﻴﺎﺭﻫﺎ،‬                           ‫ﻳﻚ ﻋﺎﻣﻞ ﺧﻄﺮﺳﺎﺯ ﻣﻬﻢ ﺑﺮﺍﻱ ﺑﻴﻤﺎﺭﻱﻫﺎﻱ ﻗﻠﺒﻲ ـ ﻋﺮﻭﻗﻲ ﺷﻨﺎﺧﺘﻪ‬
                ‫ﺗﻌﺮﻳﻒﻫﺎﻱ ﺍﺭﺍﻳﻪ ﺷﺪﻩﻱ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺗﻮﺳﻂ ‪Modified‬‬                         ‫ﺷﺪﻩ ﺍﺳﺖ.۳-۱ ﺍﺯ ﺁﻥﺟﺎ ﻛﻪ ﺍﻧﺪﺍﺯﻩﮔﻴﺮﻱ ﺍﻧﺴﻮﻟﻴﻦ ﺧﻮﻥ ﻭ ﺗﺸﺨﻴﺺ‬
                                                                                         ‫ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺑﻪ ﻋﻨﻮﺍﻥ ﻳﻚ ﺍﻗﺪﺍﻡ ﻣﻌﻤﻮﻝ ﻳﺎ ﺑﺮﺍﻱ ﻏﺮﺑﺎﻟﮕﺮﻱ‬
                                                                                         ‫ﺍﻓﺮﺍﺩ ﺟﺎﻣﻌﻪ ﺑﻪ ﻣﻨﻈﻮﺭ ﭘﻴﺸﮕﻴﺮﻱ ﺍﺯ ﺑﺮﻭﺯ ﻋﻮﺍﺭﺽ ﻗﻠﺒﻲ ـ ﻋﺮﻭﻗﻲ‬


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                                          ‫ﺩﻭﺭﻩﻱ ﺩﻫﻢ, ﺷﻤﺎﺭﻩﻱ ۵، ﺩﻱ ۷۸۳۱‬         ‫ﻣﺠﻠﻪﻱ ﻏﺪﺩ ﺩﺭﻭﻥﺭﻳﺰ ﻭ ﻣﺘﺎﺑﻮﻟﻴﺴﻢ ﺍﻳﺮﺍﻥ‬         ‫۶۳۴‬

‫ﺑﺮﺍﺳﺎﺱ ﺣﺪﺍﻗﻞ ﻣﻮﺭﺩ ﺍﻧﺘﻈﺎﺭ ﺣﺴﺎﺳﻴﺖ ۲۴% ﻭ ﻭﻳﮋﮔﻲ ۰۹%‬                ‫‪ iATP III‬ﻭ ‪ iiIDF‬ﺍﺳﺖ ﻛﻪ ﺩﺭ ﺁﻥﻫﺎ ﺍﺯ ﺷﺎﺧﺺﻫﺎﻱ ﺩﻭﺭ ﻛﻤﺮ،‬
‫ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺑﻪ ﻣﻨﻈﻮﺭ ﺗﺸﺨﻴﺺ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﻭ‬              ‫ﻓﺸﺎﺭ ﺧﻮﻥ، ﺗﺮﻱﮔﻠﻴﺴﺮﻳﺪ، ﻛﻠﺴﺘﺮﻭﻝ ‪ HDL‬ﻭ ﻗﻨﺪﺧﻮﻥ ﻧﺎﺷﺘﺎ‬
‫ﺑﺎ ﺩﺭ ﻧﻈﺮ ﺩﺍﺷﺘﻦ ﺿﺮﻳﺐ ﺍﻃﻤﻴﻨﺎﻥ ۵۹% ﻭ ﺣﺪﺍﻛﺜﺮ ﺧﻄﺎﻱ ۵۰/۰،‬           ‫ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪﻩ ﺍﺳﺖ.۶،۵ ﺗﺸﺨﻴﺺ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺑﺮﺍﺳﺎﺱ ﭼﺎﻗﻲ‬
‫۷۴۳ ﻧﻔﺮ ﺗﻌﻴﻴﻦ ﺷﺪ ﻛﻪ ﺑﺮﺍﺳﺎﺱ ﻣﻌﻴﺎﺭﻫﺎﻱ ﻭﺭﻭﺩ ﻭ ﺧﺮﻭﺝ ﺑﻪ‬             ‫ﺷﻜﻤﻲ، ﺍﻓﺰﺍﻳﺶ ﻓﺸﺎﺭ ﺧﻮﻥ، ﺍﻓﺰﺍﻳﺶ ﺳﻄﺢ ﺗﺮﻱﮔﻠﻴﺴﺮﻳﺪ، ﭘﺎﻳﻴﻦ‬
‫ﺻﻮﺭﺕ ﻧﻤﻮﻧﻪﺑﺮﺩﺍﺭﻱ ﺗﺼﺎﺩﻓﻲ ﺳﺎﺩﻩ ﻭ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﻟﻴﺴﺖ‬              ‫ﺑﻮﺩﻥ ﻛﻠﺴﺘﺮﻭﻝ ‪ HDL‬ﻭ ﺍﻓﺰﺍﻳﺶ ﻗﻨﺪﺧﻮﻥ ﻧﺎﺷﺘﺎ ﺍﻧﺠﺎﻡ ﻣﻲﺷﻮﺩ.‬
‫ﺍﻋﺪﺍﺩ ﺗﺼﺎﺩﻓﻲ ﻛﺎﻣﭙﻴﻮﺗﺮﻱ ﺍﺯ ﻧﻤﻮﻧﻪﻫﺎﻱ ﻣﻮﺟﻮﺩ ﺩﺭ ﻣﻄﺎﻟﻌﻪﻱ‬            ‫ﺩﺭ ﺗﻌﺮﻳﻒ ‪ ،۵Modified ATP III‬ﻭﺟﻮﺩ ﺳﻪ ﻣﻌﻴﺎﺭ ﺍﺯ ﭘﻨﺞ ﻣﻌﻴﺎﺭ‬
           ‫ﺑﺰﺭﮒ ﻗﻨﺪ ﻭ ﻟﻴﭙﻴﺪ ﺗﻬﺮﺍﻥ )‪ iv(TLGS‬ﺍﻧﺘﺨﺎﺏ ﺷﺪﻧﺪ.‬        ‫ﻓﻮﻕ ﺍﻟﺰﺍﻣﻲ ﺍﺳﺖ ﻭ ﺩﺭ ﺗﻌﺮﻳﻒ ‪ ،۶IDF‬ﭼﺎﻗﻲ ﺷﻜﻤﻲ ﺑﻪ ﻋﻨﻮﺍﻥ‬
‫ﻣﻌﻴﺎﺭﻫﺎﻱ ﻭﺭﻭﺩ ﺷﺎﻣﻞ ﺳﻦ ۰۲ ﺳﺎﻝ ﻭ ﺑﺎﻻﺗﺮ، ﻋﺪﻡ ﺍﺑﺘﻼ ﺑﻪ‬              ‫ﻣﻌﻴﺎﺭ ﺍﺻﻠﻲ ﻭ ﺿﺮﻭﺭﻱ ﺩﺭ ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪﻩ ﺍﺳﺖ ﻛﻪ ﻫﻤﺮﺍﻩ ﺑﺎ ﺩﻭ‬
‫ﺩﻳﺎﺑﺖ، ﻋﺪﻡ ﻣﺼﺮﻑ ﺩﺍﺭﻭﻫﺎﻱ ﻛﺎﻫﻨﺪﻩﻱ ﻗﻨﺪ ﺧﻮﻥ ﻳﺎ ﺍﻧﺴﻮﻟﻴﻦ‬             ‫ﻣﻌﻴﺎﺭ ﺩﻳﮕﺮ ﺗﺸﺨﻴﺺ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺭﺍ ﻣﻄﺮﺡ ﻣﻲﻛﻨﺪ. ﻫﻢﭼﻨﻴﻦ،‬
‫ﻭ ﻋﺪﻡ ﻣﺼﺮﻑ ﺩﺍﺭﻭﻫﺎﻱ ﻣﺆﺛﺮ ﺑﺮ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ‬                   ‫ﺣﺪ ﻣﻤﻴﺰ ﭼﺎﻗﻲ ﺷﻜﻤﻲ ﺩﺭ ‪ ،Modified ATP III‬ﺩﻭﺭ ﻛﻤﺮ ﺣﺪﺍﻗﻞ‬
‫)ﺍﺳﺘﺮﻭﺋﻴﺪ ﻭ ﻣﺘﻔﻮﺭﻣﻴﻦ( ﺑﻮﺩ. ﺍﻓﺮﺍﺩ ﺣﺎﻣﻠﻪ، ﺷﻴﺮﺩﻩ ﻭ ﺍﻓﺮﺍﺩ ﻣﺒﺘﻼ‬     ‫۲۰۱ ﺳﺎﻧﺘﻲﻣﺘﺮ ﺩﺭ ﻣﺮﺩﺍﻥ ﻭ ۸۸ ﺳﺎﻧﺘﻲﻣﺘﺮ ﺩﺭ ﺯﻧﺎﻥ ﺍﺳﺖ. ﺩﺭ‬




                                                                          ‫‪D‬‬
‫ﺑﻪ ﺑﻴﻤﺎﺭﻱﻫﺎﻱ ﻗﻠﺒﻲ ـ ﻋﺮﻭﻗﻲ، ﻛﻠﻴﻮﻱ، ﻛﺒﺪﻱ ﻭ ﺗﻴﺮﻭﺋﻴﺪﻱ ﺍﺯ‬           ‫ﺣﺎﻟﻲﻛﻪ ﺩﺭ ﺗﻌﺮﻳﻒ ‪ ،IDF‬ﺣﺪ ﻣﻤﻴﺰ ﭼﺎﻗﻲ ﺷﻜﻤﻲ ﺩﻭﺭ ﻛﻤﺮ ﺣﺪﺍﻗﻞ‬
                                       ‫ﻣﻄﺎﻟﻌﻪ ﺧﺎﺭﺝ ﺷﺪﻧﺪ.‬       ‫۴۹ ﺳﺎﻧﺘﻲﻣﺘﺮ ﺩﺭ ﻣﺮﺩﺍﻥ ﻭ ۰۸ ﺳﺎﻧﺘﻲﻣﺘﺮ ﺩﺭ ﺯﻧﺎﻥ ﺍﺳﺖ.‬



                                                             ‫‪SI‬‬
‫ﺍﻃﻼﻋﺎﺕ ﺑﺎﻟﻴﻨﻲ ﻭ ﺁﺯﻣﺎﻳﺶﻫﺎﻱ ﻣﻌﻤﻮﻝ ﺑﻪ ﻃﻮﺭ ﺩﻗﻴﻖ ﺍﺯ‬                 ‫ﻣﻌﻴﺎﺭﻫﺎﻱ ﺩﻳﮕﺮ ﺩﺭ ﻫﺮ ﺩﻭ ﺗﻌﺮﻳﻒ ﻣﺸﺘﺮﻙ ﻫﺴﺘﻨﺪ. ﻣﻄﺎﻟﻌﻪﻫﺎﻱ‬
‫ﺍﻃﻼﻋﺎﺕ ﻣﻮﺟﻮﺩ ﺩﺭ ﺑﺎﻧﻚ ﺍﻃﻼﻋﺎﺗﻲ ﻣﻄﺎﻟﻌﻪﻱ ﻗﻨﺪ ﻭ ﻟﻴﭙﻴﺪ‬               ‫ﺍﺧﻴﺮ ﻳﺎﻓﺘﻪﻫﺎﻱ ﻣﺘﻔﺎﻭﺗﻲ ﺩﺭ ﺧﺼﻮﺹ ﺍﺭﺗﺒﺎﻁ ﺍﻳﻦ ﻣﻌﻴﺎﺭﻫﺎ ﺑﺎ‬
                                       ‫ﺗﻬﺮﺍﻥ ﺍﺳﺘﺨﺮﺍﺝ ﺷﺪ.‬       ‫ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﻣﻨﺘﺸﺮ ﻛﺮﺩﻩﺍﻧﺪ ﺑﻪ ﮔﻮﻧﻪﺍﻱ ﻛﻪ ﺑﺮﺧﻲ‬
‫ﻣﻄﺎﻟﻌﻪﻱ ﻗﻨﺪ ﻭ ﻟﻴﭙﻴﺪ ﺗﻬﺮﺍﻥ ﭘﮋﻭﻫﺸﻲ ﺍﺳﺖ ﻛﻪ ﺩﺭ ۵۰۰۵۱‬               ‫ﻣﻄﺎﻟﻌﻪﻫﺎ ﻧﺸﺎﻥ ﺩﺍﺩﻩﺍﻧﺪ ﻛﻪ ﺍﺭﺗﺒﺎﻁ ﺿﻌﻴﻔﻲ ﺑﻴﻦ ﺗﻌﺮﻳﻒﻫﺎﻱ‬
                                                    ‫‪of‬‬
                                                                         ‫۹-۷‬
‫ﺷﻬﺮﻭﻧﺪ ﺑﺎﻻﻱ ۳ ﺳﺎﻝ ﺑﻪ ﻣﻨﻈﻮﺭ ﺗﻌﻴﻴﻦ ﻋﻮﺍﻣﻞ ﺧﻄﺮﺳﺎﺯ‬                  ‫ﺑﺎ ﺗﻮﺟﻪ‬     ‫ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﻭ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﻭﺟﻮﺩ ﺩﺍﺭﺩ‬
‫ﺁﺗﺮﻭﺍﺳﻜﻠﺮﻭﺯ ﺩﺭ ﻣﻴﺎﻥ ﺟﻤﻌﻴﺖ ﺷﻬﺮﻱ ﺗﻬﺮﺍﻥ، ﺍﺭﺗﻘﺎﻱ‬                   ‫ﺑﻪ ﺍﻳﻦ ﻛﻪ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﻧﻪ ﺗﻨﻬﺎ ﺑﺎ ﻋﻮﺍﺭﺽ ﻗﻠﺒﻲ ـ ﻋﺮﻭﻗﻲ‬
‫ﻣﻴﺰﺍﻥﻫﺎﻱ ﻣﺒﺘﻨﻲ ﺑﺮ ﺟﻤﻌﻴﺖ ﺑﺎ ﻫﺪﻑ ﺍﻳﺠﺎﺩ ﺗﻐﻴﻴﺮ ﺩﺭ ﺷﻴﻮﻩﻱ‬            ‫ﻫﻤﺮﺍﻫﻲ ﺩﺍﺭﺩ ﺑﻠﻜﻪ ﻧﻘﺶ ﺁﻥ ﺩﺭ ﺩﻳﺎﺑﺖ ﻗﻨﺪﻱ،۰۱ ﺳﻨﺪﺭﻡ ﺗﺨﻤﺪﺍﻥ‬
                          ‫‪ive‬‬

                                                                   ‫۳۱‬                     ‫۲۱‬                         ‫۱۱‬
‫ﺯﻧﺪﮔﻲ ﻣﺮﺩﻡ ﻭ ﭘﻴﺸﮕﻴﺮﻱ ﺭﻭﻧﺪ ﺭﻭ ﺑﻪ ﺭﺷﺪ ﺩﻳﺎﺑﺖ ﻭ ﺩﻳﺲ‬                ‫ﻭ‬    ‫ﺁﭘﻨﻪﻫﺎﻱ ﺧﻮﺍﺏ‬            ‫ﻛﺒﺪ ﭼﺮﺏ ﻏﻴﺮﺍﻟﻜﻠﻲ،‬         ‫ﭘﻠﻲﻛﻴﺴﺘﻴﻚ،‬
                                                                                                            ‫۴۱‬
‫ﻟﻴﭙﻴﺪﻣﻲ، ﺍﻧﺠﺎﻡ ﺷﺪ.۶۱ ﺍﻃﻼﻋﺎﺕ ﻣﺮﺑﻮﻁ ﺑﻪ ﺍﻓﺮﺍﺩ ﻣﻮﺭﺩ ﺑﺮﺭﺳﻲ‬          ‫ﺑﺪﺧﻴﻤﻲﻫﺎﻱ ﻣﺨﺘﻠﻒ ﺷﻨﺎﺧﺘﻪ ﺷﺪﻩ ﺍﺳﺖ ﻭ ﺍﺯ ﻃﺮﻓﻲ ﻫﻤﺮﺍﻫﻲ‬
‫ﭘﺲ ﺍﺯ ﮔﺮﻓﺘﻦ ﺭﺿﺎﻳﺖ ﻛﺘﺒﻲ ﺩﺭ ﺩﻭ ﺑﺨﺶ ﺩﺍﺩﻩﻫﺎﻱ ﺑﺎﻟﻴﻨﻲ ﻭ‬              ‫ﻣﻌﻴﺎﺭﻫﺎﻱ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺑﺎ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﻣﻲﺗﻮﺍﻧﺪ ﺗﺤﺖ‬
                               ‫ﺁﺯﻣﺎﻳﺸﮕﺎﻫﻲ ﺟﻤﻊﺁﻭﺭﻱ ﺷﺪ.‬          ‫ﺗﺄﺛﻴﺮ ﻋﻮﺍﻣﻞ ﻧﮋﺍﺩﻱ ﻭ ﻣﻨﻄﻘﻪ ﺟﻐﺮﺍﻓﻴﺎﻳﻲ ﻗﺮﺍﺭ ﮔﻴﺮﺩ،۵۱ ﻟﺬﺍ ﻻﺯﻡ‬
                        ‫‪ch‬‬



‫ﺳﻨﺠﺶﻫﺎﻱ ﺁﻧﺘﺮﻭﭘﻮﻣﺘﺮﻱ ﺷﺎﻣﻞ ﻗﺪ ﻭ ﻭﺯﻥ ﺑﺮﺍﺳﺎﺱ‬                       ‫ﺍﺳﺖ ﺩﺭ ﻫﺮ ﻣﻨﻄﻘﻪ ﻣﻴﺰﺍﻥ ﺍﻳﻦ ﻫﻤﺮﺍﻫﻲ ﺑﺮﺭﺳﻲ ﺷﻮﺩ ﺗﺎ ﺑﺘﻮﺍﻥ‬
‫ﺑﺮﻧﺎﻣﻪﻱ ﺍﺳﺘﺎﻧﺪﺍﺭﺩ ﺍﻧﺠﺎﻡ ﺷﺪ. ﻭﺯﻥ ﺍﻓﺮﺍﺩ ﺑﺎ ﺣﺪﺍﻗﻞ ﭘﻮﺷﺶ ﻭ‬          ‫ﻣﻌﻴﺎﺭﻫﺎﻱ ﻣﻨﺎﺳﺐ ﺟﻬﺖ ﺷﻨﺎﺳﺎﻳﻲ ﺍﻓﺮﺍﺩ ﺩﭼﺎﺭ ﻣﻘﺎﻭﻣﺖ ﺑﻪ‬
‫ﺑﺪﻭﻥ ﻛﻔﺶ ﺑﺎ ﺗﺮﺍﺯﻭﻱ ﺩﻳﺠﻴﺘﺎﻝ ﺑﺎ ﺩﻗﺖ ۰۰۱ ﮔﺮﻡ ﺍﻧﺪﺍﺯﻩﮔﻴﺮﻱ‬           ‫ﺍﻧﺴﻮﻟﻴﻦ ﺩﺭ ﺁﻥ ﺟﺎﻣﻌﻪ ﺭﺍ ﻳﺎﻓﺖ. ﺑﻨﺎ ﺑﺮ ﺍﻳﻦ ﻫﺪﻑ ﺍﺯ ﺍﻧﺠﺎﻡ ﺍﻳﻦ‬
            ‫‪Ar‬‬




‫ﻭ ﺛﺒﺖ ﺷﺪ. ﻫﻢﭼﻨﻴﻦ ﻗﺪ ﺁﻥﻫﺎ ﺑﺎ ﻣﺘﺮ ﻧﻮﺍﺭﻱ ﺩﺭ ﻭﺿﻌﻴﺖ‬                 ‫ﻣﻄﺎﻟﻌﻪ ﺗﻌﻴﻴﻦ ﺩﻗﺖ ﺗﻌﺮﻳﻒﻫﺎﻱ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﻃﺒﻖ ﻣﻌﻴﺎﺭﻫﺎﻱ‬
‫ﺍﻳﺴﺘﺎﺩﻩ ﻛﻨﺎﺭ ﺩﻳﻮﺍﺭ ﻭ ﺑﺪﻭﻥ ﻛﻔﺶ ﺩﺭ ﺣﺎﻟﻲ ﻛﻪ ﻛﺘﻒﻫﺎﻱ ﺁﻥﻫﺎ‬           ‫‪ Modified ATP III‬ﻭ ‪ IDF‬ﺩﺭ ﺗﺸﺨﻴﺺ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ‬
‫ﺩﺭ ﺷﺮﺍﻳﻂ ﻋﺎﺩﻱ ﻗﺮﺍﺭ ﺩﺍﺷﺖ ﻭ ﺑﺎ ﺩﻗﺖ ۱ ﺳﺎﻧﺘﻲﻣﺘﺮ‬                    ‫ﺗﻮﺳﻂ ﺭﻭﺵ ‪ iiiHOMA-IR‬ﻭ ﺑﺮﺭﺳﻲ ﺗﻮﺍﻓﻖ ﺑﻴﻦ ﺍﻳﻦ ﺗﻌﺮﻳﻒﻫﺎ‬

‫ﺍﻧﺪﺍﺯﻩﮔﻴﺮﻱ ﺷﺪ. ﺩﻭﺭ ﻛﻤﺮ ﺩﺭ ﺑﺎﺭﻳﻚﺗﺮﻳﻦ ﻧﺎﺣﻴﻪﻱ ﺁﻥ ﺩﺭ‬                                                        ‫ﻭ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺑﻮﺩ.‬

‫ﺣﺎﻟﺘﻲ ﻛﻪ ﻓﺮﺩ ﺩﺭ ﺍﻧﺖﻫﺎﻱ ﺑﺎﺯﺩﻡ ﻃﺒﻴﻌﻲ ﺧﻮﺩ ﻗﺮﺍﺭ ﺩﺍﺷﺖ،‬
‫ﺍﻧﺪﺍﺯﻩ ﮔﺮﻓﺘﻪ ﺷﺪ. ﺑﺮﺍﻱ ﺍﻧﺪﺍﺯﻩﮔﻴﺮﻱ ﺩﻭﺭ ﺑﺎﺳﻦ، ﺑﺮﺟﺴﺘﻪﺗﺮﻳﻦ‬                                  ‫ﻣﻮﺍﺩ ﻭ ﺭﻭﺵﻫﺎ‬
‫ﻗﺴﻤﺖ ﺁﻥ ﺩﺭ ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﻭ ﺍﻧﺪﺍﺯﻩﮔﻴﺮﻱ ﺷﺪ. ﺍﻧﺪﺍﺯﻩﮔﻴﺮﻱ ﺩﻭﺭ‬
                                                               ‫ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺍﺯ ﺍﻧﻮﺍﻉ ﻣﻄﺎﻟﻌﻪﻫﺎﻱ ﺗﻮﺻﻴﻔﻲ ـ ﺗﺤﻠﻴﻠﻲ ﺍﺳﺖ‬
‫ﻛﻤﺮ ﻭ ﺩﻭﺭ ﺑﺎﺳﻦ ﺑﺎ ﻳﻚ ﻣﺘﺮ ﻧﻮﺍﺭﻱ ﻏﻴﺮﻗﺎﺑﻞ ﺍﺭﺗﺠﺎﻉ ﺑﺪﻭﻥ‬
                                                               ‫ﻛﻪ ﺑﻪ ﺭﻭﺵ ﻣﻘﻄﻌﻲ ﺍﻧﺠﺎﻡ ﺷﺪ. ﺗﻌﺪﺍﺩ ﻧﻤﻮﻧﻪﻱ ﻣﻮﺭﺩ ﻧﻴﺎﺯ‬
‫ﺗﺤﻤﻴﻞ ﻫﻴﭻ ﻓﺸﺎﺭﻱ ﺑﻪ ﺑﺪﻥ ﻓﺮﺩ ﺑﺎ ﺩﻗﺖ ۱/۰ ﺳﺎﻧﺘﻲﻣﺘﺮ ﺍﻧﺠﺎﻡ‬
‫ﺷﺪ. ﺑﻪ ﻣﻨﻈﻮﺭ ﺣﺬﻑ ﺧﻄﺎﻱ ﻓﺮﺩﻱ، ﻫﻤﻪﻱ ﺍﻧﺪﺍﺯﻩﮔﻴﺮﻱﻫﺎ‬
                                                               ‫‪i- Adult Treatment Panel III‬‬
                                                               ‫‪ii- International Diabetes Federation‬‬
‫‪iv - Tehran Lipid and Glucose Study‬‬                            ‫‪iii- Homeostatic Model Assessment-Insulin Resistance‬‬

                                                                                                                     ‫‪www.SID.ir‬‬
‫۷۳۴‬      ‫ﺗﻮﺍﻓﻖ ﺗﻌﺮﻳﻒﻫﺎﻱ ﻣﺨﺘﻠﻒ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ‬     ‫ﺩﻛﺘﺮ ﺷﻴﻮﺍ ﺑﺮﺯﻭﺋﻲ ﻭ ﻫﻤﻜﺎﺭﺍﻥ‬

‫ﺑﺮﺍﺳﺎﺱ ﺍﻃﻼﻕ ﺣﺪ ﻣﻤﻴﺰ ‪ ،HOMA‬ﻣﻴﺰﺍﻥ ﻣﻘﺎﻭﻣﺖ ﺑﻪ‬                         ‫ﺗﻮﺳﻂ ﻳﻚ ﻧﻔﺮ ﺍﻧﺠﺎﻡ ﺷﺪ. ﺑﺮﺍﻱ ﺍﻧﺪﺍﺯﻩﮔﻴﺮﻱ ﻓﺸﺎﺭ ﺧﻮﻥ، ﻓﺮﺩ‬
‫ﺍﻧﺴﻮﻟﻴﻦ ﻭ ﻧﻴﺰ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺷﺎﺧﺺﻫﺎﻱ ‪ ATP III‬ﻭ ‪،IDF‬‬                ‫ﻣﻮﺭﺩ ﻣﻄﺎﻟﻌﻪ ﺑﻪ ﻣﺪﺕ ۵۱ ﺩﻗﻴﻘﻪ ﻣﻲﻧﺸﺴﺖ ﻭ ﺳﭙﺲ ﭘﺰﺷﻚ‬
‫ﺍﺑﺘﻼ ﻳﺎ ﻋﺪﻡ ﺍﺑﺘﻼ ﻫﺮ ﻓﺮﺩ ﺑﻪ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﻣﺸﺨﺺ ﻭ‬                  ‫ﻭﺍﺟﺪ ﺷﺮﺍﻳﻂ ﻓﺸﺎﺭ ﺧﻮﻥ ﺍﻭ ﺭﺍ ﺩﻭﺑﺎﺭ ﺍﻧﺪﺍﺯﻩﮔﻴﺮﻱ ﻣﻲﻛﺮﺩ.‬
                               ‫ﺁﻧﺎﻟﻴﺰﻫﺎﻱ ﺁﻣﺎﺭﻱ ﺍﻧﺠﺎﻡ ﺷﺪ.‬          ‫ﺑﺮﺍﻱ ﺍﻳﻦ ﻛﺎﺭ ﺍﺯ ﺩﺳﺘﮕﺎﻩ ﻓﺸﺎﺭﺳﻨﺞ ﺟﻴﻮﻫﺎﻱ ﺍﺳﺘﺎﻧﺪﺍﺭﺩ ﻛﻪ‬
‫ﺑﺮﺍﻱ ﻳﺎﻓﺘﻦ ﺣﺪ ﻣﻤﻴﺰ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺍﺯ ﻳﻚ ﮔﺮﻭﻩ‬                   ‫ﺗﻮﺳﻂ ﺍﻧﺴﺘﻴﺘﻮ ﺍﺳﺘﺎﻧﺪﺍﺭﺩ ﻭ ﺗﺤﻘﻴﻘﺎﺕ ﺻﻨﻌﺘﻲ ﻣﻨﺪﺭﺝ ﺷﺪﻩ ﺑﻮﺩ،‬
‫ﻫﺸﺘﺎﺩ ﻧﻔﺮ ﻛﻪ ﺩﺍﺭﺍﻱ ﺷﺮﺍﻳﻂ ﺯﻳﺮ ﺑﻮﺩﻧﺪ، ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪ: ﺍﻳﻦ ﺍﻓﺮﺍﺩ‬         ‫ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪ. ﺩﺭ ﻫﺮ ﺑﺎﺭ ﺍﻧﺪﺍﺯﻩﮔﻴﺮﻱ، ﻛﺎﻑ ﻓﺸﺎﺭ ﺳﻨﺞ ﺑﺮ‬
                                                 ‫2‬
‫ﺩﺍﺭﺍﻱ ‪ ،BMI<۲۵Kg/m‬ﻗﻨﺪ ﺧﻮﻥ ﻧﺎﺷﺘﺎﻱ ﻛﻤﺘﺮ ﺍﺯ ۰۰۱‬                      ‫ﺑﺎﺯﻭﻱ ﺭﺍﺳﺖ ﻭ ﺩﺭ ﺭﺍﺳﺘﺎﻱ ﻗﻠﺐ ﻗﺮﺍﺭ ﮔﺮﻓﺖ ﻭ ﻓﺸﺎﺭ ﺁﻥ ﺍﺯ‬
‫ﻣﻴﻠﻲﮔﺮﻡ ﺩﺭ ﺩﺳﻲﻟﻴﺘﺮ ﻭ ﻗﻨﺪﺧﻮﻥ ﺩﻭ ﺳﺎﻋﺘﻪﻱ ﻛﻤﺘﺮ ﺍﺯ ۰۴۱‬                 ‫ﺯﻣﺎﻥ ﻗﻄﻊ ﺻﺪﺍﻱ ﻧﺒﺾ ﺭﺍﺩﻳﺎﻝ ۰۳ ﻣﻴﻠﻲﻣﺘﺮ ﺟﻴﻮﻩ ﺑﺎﻻﺗﺮ ﺑﺮﺩﻩ‬
‫ﻣﻴﻠﻲﮔﺮﻡ ﺩﺭ ﺩﺳﻲﻟﻴﺘﺮ ﺑﻮﺩﻧﺪ. ﻣﺤﺪﻭﺩﻩﻱ ﺳﻦ ﺍﻳﻦ ﮔﺮﻭﻩ ۴۸-۵۲‬               ‫ﺷﺪ. ﺣﺪﺍﻗﻞ ﺯﻣﺎﻥ ﺑﻴﻦ ﺍﻳﻦ ﺩﻭ ﺍﻧﺪﺍﺯﻩﮔﻴﺮﻱ ۰۳ ﺛﺎﻧﻴﻪ ﺑﻮﺩ ﻭ‬
‫ﺳﺎﻝ ﻭ ﻣﻴﺎﻧﮕﻴﻦ ﺳﻦ ﺁﻥﻫﺎ ۵/۵۱±۳/۵۴ ﺳﺎﻝ ﺑﻮﺩ. ۵/۲۵% ﻣﺮﺩ‬                ‫ﻣﻴﺎﻧﮕﻴﻦ ﺍﻳﻦ ﺩﻭ ﻓﺸﺎﺭ ﺧﻮﻥ ﺑﻪ ﻋﻨﻮﺍﻥ ﻓﺸﺎﺭ ﺧﻮﻥ ﻣﻮﺭﺩﻧﻈﺮ‬
‫ﻭ ۵/۷۴% ﺯﻥ ﺑﻮﺩﻧﺪ. ﺗﻮﺯﻳﻊ ﻣﻘﺎﺩﻳﺮ ‪ HOMA-IR‬ﺩﺭ ﺍﻳﻦ‬                     ‫ﺛﺒﺖ ﺷﺪ. ﻓﺸﺎﺭﺧﻮﻥ ﺳﻴﺴﺘﻮﻟﻲ ﺑﺎ ﺷﻨﻴﺪﻥ ﺍﻭﻟﻴﻦ ﺻﺪﺍ )ﻓﺎﺯ ﺍﻭﻝ‬




                                                                              ‫‪D‬‬
‫ﺟﻤﻌﻴﺖ ﻏﻴﺮ ﻧﺮﻣﺎﻝ ﺑﻮﺩ ﻭ ﺻﺪﻙﻫﺎﻱ ۵۷ ﻭ ۰۸ ﻭ ۵۸ ﻭ ۰۹ ﻭ‬                  ‫ﻛﺮﺗﻜﻮﻑ( ﺗﻌﻴﻴﻦ ﻭ ﻓﺸﺎﺭﺧﻮﻥ ﺩﻳﺎﺳﺘﻮﻟﻲ ﺑﺎ ﻧﺎﭘﺪﻳﺪ ﺷﺪﻥ ﺍﻳﻦ‬
‫۵۹ ﺗﻮﺯﻳﻊ ‪ HOMA-IR‬ﺩﺭ ﺍﻳﻦ ﮔﺮﻭﻩ ﺑﻪ ﺗﺮﺗﻴﺐ ۹۴/۱، ۴۶/۱،‬                 ‫ﺻﺪﺍ )ﻓﺎﺯ ﭘﻨﺠﻢ ﻛﺮﺗﻜﻮﻑ( ﻣﺸﺨﺺ ﺷﺪ. ﺳﺮﻋﺖ ﺧﺎﻟﻲ ﺷﺪﻥ‬



                                                                ‫‪SI‬‬
‫۲۸/۱، ۳۲/۲ ﻭ ۵/۲ ﺑﻮﺩ. ﺻﺪﻙ ۵۹ ﺗﻮﺯﻳﻊ ‪ HOMA‬ﺑﻪ ﻋﻨﻮﺍﻥ‬                  ‫ﻫﻮﺍﻱ ﻛﺎﻑ ﺣﻴﻦ ﺍﻧﺪﺍﺯﻩﮔﻴﺮﻱ ﻓﺸﺎﺭﺧﻮﻥ ﺳﻴﺴﺘﻮﻟﻲ، ﺩﻳﺎﺳﺘﻮﻟﻲ‬
‫ﺣﺪ ﻣﻤﻴﺰ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺩﺭ ﺟﻤﻌﻴﺖ ﻣﻮﺭﺩ ﻣﻄﺎﻟﻌﻪ ﺩﺭ ﻧﻈﺮ‬             ‫۳-۲ ﻣﻴﻠﻲﻣﺘﺮ ﺩﺭ ﺛﺎﻧﻴﻪ ﺑﻮﺩ. ﺍﺯ ﻫﻤﻪﻱ ﺷﺮﻛﺖﻛﻨﻨﺪﮔﺎﻥ ﭘﺲ ﺍﺯ‬
                                             ‫2‬
                          ‫ﮔﺮﻓﺘﻪ ﺷﺪ ) ‪.(۲/۵ Mu.mmol/L‬‬              ‫۴۱-۲۱ ﺳﺎﻋﺖ ﻧﺎﺷﺘﺎﻳﻲ، ۵ ﺳﻲﺳﻲ ﺧﻮﻥ ﺑﻴﻦ ﺳﺎﻋﺖﻫﺎﻱ ۹-۷‬
                                  ‫‪‬‬
‫ﺩﺍﺩﻩﻫﺎﻱ ﻛﻤﻲ ﺑﻪ ﺻﻮﺭﺕ ﻣﻴﺎﻧﮕﻴﻦ ± ﺍﻧﺤﺮﺍﻑ ﻣﻌﻴﺎﺭ ﻭ‬                                                                    ‫ﺻﺒﺢ ﮔﺮﻓﺘﻪ ﺷﺪ.‬
                                                     ‫‪of‬‬
‫ﺩﺍﺩﻩﻫﺎﻱ ﻛﻴﻔﻲ ﺑﻪ ﺻﻮﺭﺕ ﻧﺴﺒﺖ ﻭ ﺩﺭﺻﺪ ﮔﺰﺍﺭﺵ ﺷﺪﻧﺪ.‬                      ‫ﺳﻄﺢ ﻗﻨﺪ ﺧﻮﻥ ﻧﺎﺷﺘﺎ ﺩﺭ ﻫﻤﺎﻥ ﺭﻭﺯ ﻧﻤﻮﻧﻪﮔﻴﺮﻱ، ﺑﺎ ﺭﻭﺵ‬
‫ﺑﺮﺍﻱ ﺗﻌﻴﻴﻦ ﻧﺮﻣﺎﻝ ﺑﻮﺩﻥ ﺗﻮﺯﻳﻊ ﻣﺘﻐﻴﺮﻫﺎ ﺁﺯﻣﻮﻥ ﻛﻮﻟﻤﻮﮔﺮﺍﻑ‬               ‫ﺭﻧﮓﺳﻨﺠﻲ ﻭ ﺑﺎ ﺭﻭﺵ ﮔﻠﻮﻛﺰ ﺍﻛﺴﻴﺪﺍﺯ ﻭ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﻛﻴﺖ‬
‫ﺍﺳﻤﻴﺮﻧﻮﻑ ﺑﻪ ﻛﺎﺭ ﮔﺮﻓﺘﻪ ﺷﺪ. ﺑﺮﺍﻱ ﺑﺮﺭﺳﻲ ﺗﻮﺍﻧﺎﻳﻲ‬                      ‫ﭘﺎﺭﺱ ﺁﺯﻣﻮﻥ ﺍﻧﺪﺍﺯﻩﮔﻴﺮﻱ ﺷﺪ. ﻏﻠﻈﺖ ﺗﺮﻱﮔﻠﻴﺴﺮﻳﺪ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ‬
                          ‫‪ive‬‬

‫ﺗﻌﺮﻳﻒﻫﺎﻱ ﻣﺨﺘﻠﻒ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺩﺭ ﺗﺸﺨﻴﺺ ﻣﻘﺎﻭﻣﺖ ﺑﻪ‬                  ‫ﺍﺯ ﻛﻴﺖﻫﺎﻱ ﺗﺠﺎﺭﻱ ﺷﺮﻛﺖ ﭘﺎﺭﺱﺁﺯﻣﻮﻥ ﻭ ﺑﺎ ﺩﺳﺘﮕﺎﻩ‬
‫ﺍﻧﺴﻮﻟﻴﻦ ﺍﺯ ﻣﺤﺎﺳﺒﻪﻱ ﺣﺴﺎﺳﻴﺖ، ﻭﻳﮋﮔﻲ، ﺍﺭﺯﺵ ﺍﺧﺒﺎﺭﻱ‬                     ‫ﺍﺗﻮﺁﻧﺎﻟﻴﺰﺭ ﺳﻠﻜﺘﺮﺍ ۲، ﻭ ﻏﻠﻈﺖ ‪ HDL-C‬ﺳﺮﻡ ﭘﺲ ﺍﺯ ﺭﺳﻮﺏ‬
‫ﻣﺜﺒﺖ ﻭ ﻣﻨﻔﻲ ﻭ ﻧﻴﺰ ﺑﻪ ﻣﻨﻈﻮﺭ ﺗﻌﻴﻴﻦ ﻣﻴﺰﺍﻥ ﺗﻮﺍﻓﻖ ﺳﻨﺪﺭﻡ ﺑﺎ‬             ‫ﺩﺍﺩﻥ ﻟﻴﭙﻮﭘﺮﻭﺗﺌﻴﻦﻫﺎﻱ ﺣﺎﻭﻱ ﺁﭘﻮ-‪ β‬ﺑﺎ ﻣﺤﻠﻮﻝ ﻓﺴﻔﺮ ﺗﻨﮕﺴﺘﺎﺕ‬
‫ﻣﻴﺰﺍﻥ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺍﺯ ﺿﺮﻳﺐ ﺗﻮﺍﻓﻖ ﻛﺎﭘﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪ.‬            ‫ﺍﺳﻴﺪ ﺍﻧﺪﺍﺯﻩﮔﻴﺮﻱ ﺷﺪ. ﻫﻤﻪﻱ ﻧﻤﻮﻧﻪﻫﺎ ﺩﺭ ﺷﺮﺍﻳﻄﻲ ﺁﻧﺎﻟﻴﺰ ﺷﺪﻧﺪ‬
                        ‫‪ch‬‬



                ‫۲‬
‫ﺩﺭ ﻣﻨﺤﻨﻲ ﺭﻭﻙ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺟﺬﺭ ﻓﺮﻣﻮﻝ )ﺍﺧﺘﺼﺎﺻﻴﺖ -۱(‬                ‫ﻛﻪ ﻛﻨﺘﺮﻝ ﻛﻴﻔﻴﺖ ﺩﺭﻭﻧﻲ ﻣﻌﻴﺎﺭﻫﺎﻱ ﻗﺎﺑﻞ ﺑﻮﺩﻥ ﺭﺍ ﺍﺧﺬ ﻛﺮﺩﻩ‬
                                                     ‫۲‬
‫+ )ﺣﺴﺎﺳﻴﺖ -۱( ﺣﺪ ﻣﻤﻴﺰ ﻣﻨﺎﺳﺐ ﺑﺮﺍﻱ ﻣﺆﻟﻔﻪﻫﺎﻱ ﺳﻨﺪﺭﻡ‬                   ‫ﺑﻮﺩﻧﺪ. ‪ CV‬ﺩﺭﻭﻥ ﻭ ﺑﺮﻭﻥ ﺁﺯﻣﻮﻥ ﻛﻤﺘﺮ ﺍﺯ ۵ ﺩﺭﺻﺪ )ﺑﻪ ﺗﺮﺗﻴﺐ‬
‫ﻣﺘﺎﺑﻮﻟﻴﻚ ﺩﺭ ﺗﺸﺨﻴﺺ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺑﻪ ﺩﺳﺖ ﺁﻣﺪ.‬                   ‫۵/۲، ۱/۴ ﻭ ۵/۴ ﺩﺭﺻﺪ( ﺑﻮﺩ. ﺍﻧﺴﻮﻟﻴﻦ ﺑﺎ ﺭﻭﺵ‬
            ‫‪Ar‬‬




‫ﻣﻘﺪﺍﺭ ۵۰/۰<‪ P‬ﺑﻪ ﻋﻨﻮﺍﻥ ﺳﻄﺢ ﻣﻌﻨﻲﺩﺍﺭﻱ ﺩﺭ ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﻭ‬                 ‫ﺭﺍﺩﻳﻮﺍﻳﻤﻮﻧﻮﺍﺳﻲ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﻛﻴﺖ ﻣﺮﻛﻮﺩﻳﺎ‪ i‬ﺳﺎﺧﺖ ﻛﺸﻮﺭ‬
‫ﺑﺮﺍﻱ ﺗﺤﻠﻴﻞ ﺁﻣﺎﺭﻱ ﺍﺯ ﻧﺮﻡﺍﻓﺰﺍﺭ ‪ SPSS‬ﻧﺴﺨﻪﻱ ۵۱ ﺍﺳﺘﻔﺎﺩﻩ‬                ‫ﺳﻮﺋﺪ ﺍﻧﺪﺍﺯﻩﮔﻴﺮﻱ ﺷﺪ ﻛﻪ ‪ CV‬ﺩﺭﻭﻥ ﻭ ﺑﺮﻭﻥ ﺁﺯﻣﻮﻥ ﻛﻤﺘﺮ ﺍﺯ‬
                                                     ‫ﺷﺪ.‬                                                           ‫۴ ﺩﺭﺻﺪ ﺑﻮﺩ.‬
                                                                  ‫ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺭﺍﺑﻄﻪﻱ ﺯﻳﺮ ﻣﻘﺪﺍﺭ ﺷﺎﺧﺺ ﻣﻘﺎﻭﻣﺖ ﺑﻪ‬

                       ‫ﻳﺎﻓﺘﻪﻫﺎ‬                                    ‫ﺍﻧﺴﻮﻟﻴﻦ )‪ (HOMA-IR‬ﺑﻪ ﻋﻨﻮﺍﻥ ﻣﺮﺟﻊ ﺍﺳﺘﺎﻧﺪﺍﺭﺩ، ﺑﺮﺍﻱ ﻫﺮ‬
                                                                                                           ‫ﻓﺮﺩ ﺍﻧﺪﺍﺯﻩﮔﻴﺮﻱ ﺷﺪ.‬
‫ﺩﺭ ۷۴۳ ﺑﻴﻤﺎﺭ ﻣﻮﺭﺩ ﺑﺮﺭﺳﻲ، ﻣﺤﺪﻭﺩﻩﻱ ﺳﻦ ﺍﻓﺮﺍﺩ ۴۸-۱۲‬
‫ﺳﺎﻝ ﻭ ﻣﻴﺎﻧﮕﻴﻦ ﺳﻦ ﻭ ﺍﻧﺤﺮﺍﻑ ﻣﻌﻴﺎﺭ ۲/۳۱±۸/۷۴ ﺳﺎﻝ ﺑﻮﺩ. ﺍﺯ‬                              ‫)‪ (mmol/L‬ﻗﻨﺪﺧﻮﻥ ﻧﺎﺷﺘﺎ× )‪ (mIU/L‬ﺍﻧﺴﻮﻟﻴﻦ ﺧﻮﻥ ﻧﺎﺷﺘﺎ‬
                                                                   ‫=‪HOMA-IR‬‬
                                                                                                    ‫۵/۲۲‬
‫ﺍﻳﻦ ﺗﻌﺪﺍﺩ، ۰۴۱ ﻧﻔﺮ )۳/۰۴%( ﻣﺮﺩ ﻭ ۷۰۲ ﻧﻔﺮ )۷/۹۵%( ﺯﻥ‬
‫ﺑﻮﺩﻧﺪ. ﻭﻳﮋﮔﻲﻫﺎﻱ ﭘﺎﻳﻪﻱ ۷۴۳ ﺩﺍﻭﻃﻠﺐ ﻣﺬﻛﻮﺭ ﺩﺭ ﺟﺪﻭﻝ ۱‬
‫ﺁﻭﺭﺩﻩ ﺷﺪﻩ ﺍﺳﺖ. ﺑﺮﺍﺳﺎﺱ ﺍﻳﻦ ﺟﺪﻭﻝ، ﺩﺭ ﮔﺮﻭﻩ ﻣﻮﺭﺩ ﻣﻄﺎﻟﻌﻪ‬
‫ﻣﺮﺩﺍﻥ ﺩﺍﺭﺍﻱ ﻭﺯﻥ ﺑﻴﺸﺘﺮﻱ ﺑﻮﺩﻧﺪ ﻭ ﻧﻴﺰ ﺳﻄﺢ ﺑﺎﻻﺗﺮ‬
                                                                  ‫‪i- Mercodia‬‬

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                                           ‫ﺩﻭﺭﻩﻱ ﺩﻫﻢ, ﺷﻤﺎﺭﻩﻱ ۵، ﺩﻱ ۷۸۳۱‬          ‫ﻣﺠﻠﻪﻱ ﻏﺪﺩ ﺩﺭﻭﻥﺭﻳﺰ ﻭ ﻣﺘﺎﺑﻮﻟﻴﺴﻢ ﺍﻳﺮﺍﻥ‬           ‫۸۳۴‬

‫ﺩﺭ ﺯﻧﺎﻥ ﻧﺴﺒﺖ ﺑﻪ ﻣﺮﺩﺍﻥ ﺑﺎﻻﺗﺮ ﺑﻮﺩ ﻭ ﺗﻔﺎﻭﺕ ﻣﻌﻨﻲﺩﺍﺭﻱ‬                   ‫ﺗﺮﻱﮔﻠﻴﺴﺮﻳﺪ ﻭ ﺳﻄﺢ ﭘﺎﻳﻴﻦﺗﺮ ﻛﻠﺴﺘﺮﻭﻝ ‪ HDL‬ﻧﺴﺒﺖ ﺑﻪ ﺯﻧﺎﻥ‬
                                         ‫ﺩﺍﺷﺖ )۵۰/۰<‪.(P‬‬            ‫ﺩﺍﺷﺘﻨﺪ. ﻗﻨﺪﺧﻮﻥ ﺩﻭ ﺳﺎﻋﺘﻪ، ﻣﻴﺰﺍﻥ ﺍﻧﺴﻮﻟﻴﻦ ﺳﺮﻡ ﻭ ‪HOMA‬‬



                                                                                  ‫ﺟﺪﻭﻝ ۱- ﻭﻳﮋﮔﻲﻫﺎﻱ ﭘﺎﻳﻪﻱ ﺍﻓﺮﺍﺩ ﻣﻮﺭﺩ ﻣﻄﺎﻟﻌﻪ‬

             ‫ﺯﻥ‬                              ‫ﻣﺮﺩ‬                      ‫ﻛﻞ ﺍﻓﺮﺍﺩ‬
            ‫۷۰۲‬                              ‫۰۴۱‬                       ‫۷۴۳‬                                                      ‫ﺗﻌﺪﺍﺩ‬
         ‫۳/۲۱±۴/۶۴‬                        ‫۲/۴۱±۷/۹۴‬                 ‫۲/۳۱±۸/۷۴*‬                                             ‫ﺳﻦ )ﺳﺎﻝ(‬
          ‫۶/۵±۶۵۱†‬                         ‫۵/۶±۸۶۱‬                  ‫۶/۸±۲/۱۶۱‬                                           ‫ﻗﺪ )ﺳﺎﻧﺘﻲﻣﺘﺮ(‬
         ‫۵/۲۱±۵/۹۶†‬                       ‫۳۱±۸/۵۷‬                   ‫۱/۳۱±۸/۲۷‬                                           ‫ﻭﺯﻥ )ﻛﻴﻠﻮﮔﺮﻡ(‬
           ‫۵±۶/۸۲‬                          ‫۴±۶/۶۲‬                    ‫۷/۴±۸/۷۲‬                ‫ﻧﻤﺎﻳﻪﻱ ﺗﻮﺩﻩﻱ ﺑﺪﻥ )ﻛﻴﻠﻮﮔﺮﻡ ﺑﺮ ﻣﺘﺮﻣﺮﺑﻊ(‬
         ‫۸/۱۱±۵/۰۹‬                        ‫۹/۰۱±۴/۱۹‬                 ‫۶/۰۱±۹/۰۹‬                                   ‫ﺩﻭﺭ ﻛﻤﺮ )ﺳﺎﻧﺘﻲﻣﺘﺮ(‬




                                                                              ‫‪D‬‬
           ‫۶/۹±۰۹‬                         ‫۶/۹±۶/۳۹‬                   ‫۸/۹±۴/۱۹‬                   ‫ﻗﻨﺪ ﺧﻮﻥ ﻧﺎﺷﺘﺎ )ﻣﻴﻠﻲﮔﺮﻡ ﺩﺭ ﺩﺳﻲﻟﻴﺘﺮ(‬
        ‫۲/۵۲±۹/۳۱۱†‬                      ‫۳/۸۲±۴/۵۰۱‬                 ‫۸/۶۲±۴/۰۱۱‬               ‫ﻗﻨﺪ ﺧﻮﻥ ۲ ﺳﺎﻋﺘﻪ )ﻣﻴﻠﻲﮔﺮﻡ ﺩﺭ ﺩﺳﻲﻟﻴﺘﺮ(‬
         ‫۹/۰۹±۴۶۱†‬
         ‫۳/۱۱±۵/۴۴†‬
         ‫۶/۰۲±۸/۱۲۱‬
         ‫۵/۱۱±۸/۹۷‬
                                         ‫۳۵۱±۳/۴۹۱‬
                                          ‫۳/۹±۶/۷۳‬
                                         ‫۹/۷۱±۸/۲۲۱‬
                                          ‫۳/۰۱±۴/۹۷‬
                                                                 ‫‪SI‬‬‫۶/۰۲۱±۳/۶۷۱‬
                                                                     ‫۱۱±۷/۱۴‬
                                                                    ‫۶/۹۱±۲/۲۲۱‬
                                                                     ‫۱۱±۶/۹۷‬
                                                                                                  ‫ﺗﺮﻱﮔﻠﻴﺴﺮﻳﺪ )ﻣﻴﻠﻲﮔﺮﻡ ﺩﺭ ﺩﺳﻲﻟﻴﺘﺮ(‬
                                                                                               ‫‪ HDL‬ﻛﻠﺴﺘﺮﻭﻝ )ﻣﻴﻠﻲﮔﺮﻡ ﺩﺭ ﺩﺳﻲﻟﻴﺘﺮ(‬
                                                                                                ‫ﻓﺸﺎﺭ ﺧﻮﻥ ﺳﻴﺴﺘﻮﻟﻲ )ﻣﻴﻠﻲﻣﺘﺮ ﺟﻴﻮﻩ(‬
                                                                                                ‫ﻓﺸﺎﺭ ﺧﻮﻥ ﺩﻳﺎﺳﺘﻮﻟﻲ )ﻣﻴﻠﻲﻣﺘﺮ ﺟﻴﻮﻩ(‬
                                                      ‫‪of‬‬
            ‫۵/۲۴‬                             ‫۰۴‬                        ‫۵/۱۴‬                                  ‫ﭘﺮﻓﺸﺎﺭﻱ ﺧﻮﻥ )ﺩﺭﺻﺪ(‬
            ‫۶/۰۱‬                            ‫۴/۱۲‬                        ‫۵۱‬                                             ‫‪) ‡ IFG‬ﺩﺭﺻﺪ(‬
             ‫۲/۸‬                             ‫۹/۷‬                        ‫۱/۸‬                                            ‫‪) § IGT‬ﺩﺭﺻﺪ(‬
                           ‫‪ive‬‬

             ‫۳/۴‬                             ‫۱/۲‬                        ‫۵/۳‬                                       ‫‪) IFG+IGT‬ﺩﺭﺻﺪ(‬
          ‫۲/۷±۹/۸†‬                         ‫۲/۷±۲/۷‬                   ‫۳/۷±۲/۸‬                  ‫ﺍﻧﺴﻮﻟﻴﻦ ﺳﺮﻡ )ﻣﻴﻜﺮﻭﻳﻮﻧﻴﺖ ﺩﺭ ﻣﻴﻠﻲﻟﻴﺘﺮ(‬
         ‫۳۷/۱±۱۰/۲†‬                       ‫۱۶/۱±۸۶/۱‬                 ‫۹۶/۱±۸۸/۱‬                                             ‫‪HOMA-IR‬‬

            ‫۵/۷۲‬                            ‫۷/۰۲‬                       ‫۸/۴۲‬                              ‫ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ )ﺩﺭﺻﺪ(‬
                         ‫‪ch‬‬



                                                                                                                       ‫ﭼﺎﻗﻲ ﻣﺮﻛﺰﻱ)%(‬
           ‫۵/۶۵†‬                            ‫۶/۸۱‬                       ‫۲/۱۴‬                                        ‫‪ATP III‬‬

           ‫۷/۰۸†‬                             ‫۳۴‬                        ‫۴/۵۶‬                                             ‫‪IDF‬‬

                                                                                                                 ‫ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ )%(‬
            ‫‪Ar‬‬




            ‫۳۴†‬                             ‫۹/۲۳‬                       ‫۹/۸۳‬                                        ‫‪ATP III‬‬

           ‫۲/۲۵†‬                            ‫۳/۴۳‬                        ‫۵۴‬                                              ‫‪IDF‬‬

         ‫* ﺍﻋﺪﺍﺩ ﺑﻴﺎﻧﮕﺮ ﻣﻴﺎﻧﮕﻴﻦ±ﺍﻧﺤﺮﺍﻑ ﻣﻌﻴﺎﺭ ﻣﻲﺑﺎﺷﻨﺪ، ﺑﻪ ﺟﺰ ﻣﻮﺍﺭﺩ ﻣﺮﺑﻮﻁ ﺑﻪ ﺩﺭﺻﺪﻫﺎ؛ † ۵۰/۰<‪ P‬ﺑﺮﺍﻱ ﺍﺧﺘﻼﻑ ﺑﻴﻦ ﺩﻭ ﺟﻨﺲ ﻣﻌﻨﻲﺩﺍﺭ ﺍﺳﺖ.‬
‫‪‡ Impaired Fasting Glucose; § Impaired Glucose Tolerance‬‬




‫ﺑﺮﺍﺳﺎﺱ ﺷﺎﺧﺺ ‪ ۱۳۵ ،Modified ATP III‬ﻧﻔﺮ‬                              ‫ﺑﺮﺍﺳﺎﺱ ﺍﻃﻼﻕ ﺣﺪ ﻣﻤﻴﺰ ۵/۲=‪ ۸۶ ،HOMA-IR‬ﻧﻔﺮ ﻳﻌﻨﻲ‬
‫)۹/۸۳%( ﻭ ﺑﺮﺍﺳﺎﺱ ﺷﺎﺧﺺ ‪ ۱۵۶ ،IDF‬ﻧﻔﺮ )۵۴%( ﺩﺍﺭﺍﻱ‬                     ‫۸/۴۲% ﺩﺍﺭﺍﻱ ۵/۲≥‪ HOMA‬ﻭ ﺩﺭ ﻧﺘﻴﺠﻪ ﺩﺍﺭﺍﻱ ﻣﻘﺎﻭﻣﺖ ﺑﻪ‬
‫ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺑﻮﺩﻧﺪ. ﻃﺒﻖ ﻫﺮ ﺩﻭ ﺗﻌﺮﻳﻒ، ﻓﺮﺍﻭﺍﻧﻲ ﺳﻨﺪﺭﻡ‬               ‫ﺍﻧﺴﻮﻟﻴﻦ ﺑﻮﺩﻧﺪ ﺑﻪ ﻟﺤﺎﻅ ﺗﻔﻜﻴﻚ ﺟﻨﺴﻲ ﺍﺯ ﻣﺠﻤﻮﻉ ۰۴۱ ﻣﺮﺩ،‬
                     ‫ﻣﺘﺎﺑﻮﻟﻴﻚ ﺩﺭ ﺯﻧﺎﻥ ﺑﻴﺸﺘﺮ ﺑﻮﺩ )۱۰/۰=‪.(P‬‬          ‫۹۲ ﻧﻔﺮ )۷/۰۲%( ﻭ ﺍﺯ ﻣﺠﻤﻮﻉ ۷۰۲ ﺯﻥ، ۷۵ ﻧﻔﺮ )۵/۷۲%( ﺩﺍﺭﺍﻱ‬
                                                                   ‫ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺑﻮﺩﻧﺪ. ﻣﻘﺎﻳﺴﻪﻱ ﺍﻳﻦ ﻧﺴﺒﺖﻫﺎ ﺗﻔﺎﻭﺕ‬
                                                                                   ‫ﺁﻣﺎﺭﻱ ﻣﻌﻨﻲﺩﺍﺭﻱ ﺭﺍ ﻧﺸﺎﻥ ﻧﺪﺍﺩ ﺍﺳﺖ )۵۰/۰>‪.(P‬‬


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‫۹۳۴‬           ‫ﺗﻮﺍﻓﻖ ﺗﻌﺮﻳﻒﻫﺎﻱ ﻣﺨﺘﻠﻒ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ‬                   ‫ﺩﻛﺘﺮ ﺷﻴﻮﺍ ﺑﺮﺯﻭﺋﻲ ﻭ ﻫﻤﻜﺎﺭﺍﻥ‬

‫ﺗﻔﻜﻴﻚ ﺟﻨﺴﻲ، ﺍﻳﻦ ﻧﺴﺒﺖ ﺩﺭ ﺯﻥﻫﺎ ﺍﺯ ﻣﺮﺩﻫﺎ ﻛﻤﺘﺮ ﺑﻮﺩ. ﺿﺮﻳﺐ‬                                     ‫ﻓﺮﺍﻭﺍﻧﻲ ﭼﺎﻗﻲ ﻣﺮﻛﺰﻱ ﻃﺒﻖ ﻣﻌﻴﺎﺭﻫﺎﻱ ‪ %۴۱/۲ ATP III‬ﻭ‬
‫ﺗﻮﺍﻓﻖ ﻛﺎﭘﺎ ﻛﻪ ﺑﻴﺎﻥﮔﺮ ﻣﻴﺰﺍﻥ ﺗﻮﺍﻓﻖ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﻭ‬                                        ‫ﻃﺒﻖ ﻣﻌﻴﺎﺭﻫﺎﻱ ‪ %۶۵/۴ IDF‬ﺑﻮﺩ ﻛﻪ ﺩﺭ ﺯﻧﺎﻥ ﻧﺴﺒﺖ ﺑﻪ ﻣﺮﺩﺍﻥ‬
‫ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺍﺳﺖ، ﺩﺭ ﻛﻞ ﺟﻤﻌﻴﺖ ﻭ ﺑﻪ ﺗﻔﻜﻴﻚ ﺟﻨﺲ ﺑﻪ‬                                                                             ‫ﺑﺎﻻﺗﺮ ﺑﻮﺩ )۲۰/۰=‪.(P‬‬
                       ‫ﺧﺼﻮﺹ ﺩﺭ ﺯﻧﺎﻥ ﺿﻌﻴﻒ ﺑﻮﺩ )ﺟﺪﻭﻝ ۲(.‬                                   ‫ﺣﺴﺎﺳﻴﺖ ﻭ ﻭﻳﮋﮔﻲ ‪ Modified ATP III‬ﻭ ‪ IDF‬ﺑﺮﺍﻱ‬
                                                                                         ‫ﺗﺸﺨﻴﺺ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺑﻪ ﻧﺴﺒﺖ ﭘﺎﻳﻴﻦ ﺑﻮﺩ ﻛﻪ ﺩﺭ‬



                 ‫ﺟﺪﻭﻝ ۲- ﺧﺼﻮﺻﻴﺎﺕ ﺗﺸﺨﻴﺺ ﺗﻌﺮﻳﻒﻫﺎﻱ ‪ ATP III‬ﻭ ‪ IDF‬ﺑﺮﺍﻱ ﺗﺸﺨﻴﺺ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺑﻪ ﺗﻔﻜﻴﻚ ﺟﻨﺲ‬

                             ‫‪IDF‬‬                                                                     ‫‪ATP III‬‬
         ‫ﺯﻥ‬                  ‫ﻣﺮﺩ‬                   ‫ﻛﻞ ﺍﻓﺮﺍﺩ‬                     ‫ﺯﻥ‬                    ‫ﻣﺮﺩ‬             ‫ﻛﻞ ﺍﻓﺮﺍﺩ‬
‫)۳/۲۷-۹/۲۴( ۶/۹۵‬       ‫)۸/۹۷-۴/۴۴( ۵/۲۶‬    ‫)۸/۰۷-۲/۰۵( ۱/۰۶‬               ‫)۱/۲۶-۱/۶۳( ۰/۹۴‬     ‫)۵/۶۷-۷/۰۴( ۶/۸۵‬   ‫)۹/۲۶-۷/۱۴(۳/۲۵*‬            ‫ﺣﺴﺎﺳﻴﺖ‬
‫)۸/۶۵-۴/۰۴(۶/۸۴‬        ‫)۲/۱۸-۴/۴۶( ۸/۲۷‬        ‫)۱/۵۶-۱/۳۵(۴/۹۵‬            ‫)۷/۶۶-۹/۱۵(۸/۸۵‬      ‫)۸/۱۸-۴/۵۶(۶/۳۷‬    ‫)۹/۰۷-۳/۹۵( ۵/۵۶‬               ‫ﻭﻳﮋﮔﻲ‬




                                                                                                  ‫‪D‬‬
‫)۳/۰۴-۷/۲۲(۵/۱۳‬        ‫)۲/۱۵-۸/۳۲(۵/۷۳‬         ‫)۰/۷۴-۹/۵۲(۳/۳۳‬            ‫)۲/۱۴-۸/۱۲(۵/۱۳‬      ‫)۴/۱۵-۱/۳۲(۲/۷۳‬    ‫)۲/۱۴-۳/۵۲(۳/۳۳‬     ‫ﺍﺭﺯﺵ ﺍﺧﺒﺎﺭﻱ ﻣﺜﺒﺖ‬
‫)۱/۴۸-۵/۶۶(۳/۵۷‬        ‫)۶/۴۹-۲/۱۸(۰/۸۸‬         ‫)۱/۷۸-۹/۵۷(۱/۱۸‬            ‫)۹/۲۸-۱/۷۶(۵/۵۷‬      ‫)۹/۳۹-۳/۰۸(۴/۷۸‬    ‫)۸/۵۸-۲/۵۷(۴/۰۸‬     ‫ﺍﺭﺯﺵ ﺍﺧﺒﺎﺭﻱ ﻣﻨﻔﻲ‬




                                                                                     ‫‪SI‬‬
        ‫۲۱/۰‬                ‫۸۲/۰‬                    ‫۵۱/۰‬                       ‫۱۱/۰‬                   ‫۶۲/۰‬             ‫۴۱/۰‬             ‫ﺿﺮﻳﺐ ﺗﻮﺍﻓﻖ ﻛﺎﭘﺎ‬
                                                                                                ‫* ﺍﻋﺪﺍﺩ ﺩﺍﺧﻞ ﭘﺮﺍﻧﺘﺰ ﻣﺮﺑﻮﻁ ﺑﻪ ﻓﺎﺻﻠﻪﻱ ﺍﻃﻤﻴﻨﺎﻥ ۵۹% ﺍﺳﺖ.‬
                                                                      ‫‪of‬‬
        ‫ﺟﺪﻭﻝ ۳- ﺳﻄﺢ ﺯﻳﺮﻣﻨﺤﻨﻲ، ﻓﺎﺻﻠﻪﻱ ﺍﻃﻤﻴﻨﺎﻥ ۵۹% ﻭ ﺣﺪ ﻣﻤﻴﺰ ﻫﺮ ﻳﻚ ﺍﺯ ﺍﺟﺰﺍﻱ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﻣﻨﺤﻨﻲ ﺭﻭﻙ‬

                ‫ﺯﻥ‬                                    ‫ﻣﺮﺩ‬                                       ‫ﻛﻞ‬
                                ‫‪ive‬‬

 ‫ﺣﺪ‬                                       ‫ﺣﺪ‬                                      ‫ﺣﺪ‬
                     ‫‪*AUC‬‬                                  ‫‪AUC‬‬                                       ‫‪AUC‬‬
 ‫ﻣﻤﻴﺰ‬                                 ‫ﻣﻤﻴﺰ‬                                       ‫ﻣﻤﻴﺰ‬
                     ‫۷۰۲‬                                      ‫۰۴۱‬                                    ‫۷۴۳‬                                     ‫ﺗﻌﺪﺍﺩ ﺍﻓﺮﺍﺩ‬
 ‫۵/۲۹‬         ‫)۰۶۶/۰-۸۴/۰(۷۵/۰‬        ‫۵/۳۹‬         ‫)۱۸/۰-۰۶/۰(۳۷/۰‬                   ‫-‬       ‫)۸۶/۰-۴۵/۰(۲۶/۰†‬                        ‫ﺩﻭﺭ ﻛﻤﺮ )ﺳﺎﻧﺘﻲﻣﺘﺮ(‬
                              ‫‪ch‬‬



 ‫۲۹‬           ‫)۴۷/۰-۷۵/۰(۸۶/۰‬             ‫۶۹‬       ‫)۱۸/۰-۹۵/۰(۰۷/۰‬                ‫۲۹‬         ‫)۲۷/۰-۹۵/۰(۵۶/۰‬       ‫ﻗﻨﺪ ﺧﻮﻥ ﻧﺎﺷﺘﺎ )ﻣﻴﻠﻲﮔﺮﻡ ﺩﺭ ﺩﺳﻲﻟﻴﺘﺮ(‬
 ‫۲۴‬           ‫)۵۴/۰-۹۲/۰(۷۳/۰‬             ‫۴۳‬       ‫)۰۶/۰-۷۳/۰(۸۴/۰‬                   ‫-‬       ‫)۰۵/۰-۶۳/۰(۳۴/۰‬       ‫‪ HDL‬ﻛﻠﺴﺘﺮﻭﻝ )ﻣﻴﻠﻲﮔﺮﻡﺩﺭﺩﺳﻲﻟﻴﺘﺮ(‬
 ‫۱۶۱‬          ‫)۷۶/۰-۰۵/۰(۸۵/۰‬            ‫۳۷۱‬       ‫)۶۷/۰-۳۵/۰(۴۶/۰‬                ‫۲۷۱‬        ‫)۶۶/۰-۳۵/۰(۰۶/۰‬        ‫ﺗﺮﻱ ﮔﻠﻴﺴﺮﻳﺪ )ﻣﻴﻠﻲﮔﺮﻡ ﺩﺭ ﺩﺳﻲﻟﻴﺘﺮ(‬
                 ‫‪Ar‬‬




 ‫۵۱۱‬           ‫)۳۶/۰-۶۴/۰(۵۵/۰‬           ‫۰۲۱‬       ‫)۸۷/۰-۹۵/۰(۸۶/۰‬                ‫۲۲۱‬        ‫)۶۶/۰-۲۵/۰(۰۶/۰‬       ‫ﻓﺸﺎﺭ ﺧﻮﻥ ﺳﻴﺴﺘﻮﻟﻲ )ﻣﻴﻠﻲﻣﺘﺮ ﺟﻴﻮﻩ(‬
 ‫۹۷‬           ‫)۱۶/۰-۴۴/۰(۲۵/۰‬             ‫۰۸‬       ‫)۲۷/۰-۰۵/۰(۱۶/۰‬                ‫۰۸‬         ‫)۲۶/۰-۹۴/۰(۵۵/۰‬       ‫ﻓﺸﺎﺭ ﺧﻮﻥ ﺩﻳﺎﺳﺘﻮﻟﻲ )ﻣﻴﻠﻲﻣﺘﺮ ﺟﻴﻮﻩ(‬
                                                                ‫* ‪Area Under the Curve‬؛ † ﺍﻋﺪﺍﺩ ﺩﺍﺧﻞ ﭘﺮﺍﻧﺘﺰ ﻣﺮﺑﻮﻁ ﺑﻪ ﻓﺎﺻﻠﻪﻱ ﺍﻃﻤﻴﻨﺎﻥ ۵۹% ﻫﺴﺘﻨﺪ.‬



‫ﻫﺮ ﻳﻚ ﺍﺯ ﺍﺟﺰﺍﻱ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺑﻪ ﻋﻨﻮﺍﻥ ﺷﺎﺧﺺ‬                                              ‫ﺳﻄﺢ ﺯﻳﺮ ﻣﻨﺤﻨﻲ ﺭﻭﻙ ﺑﺮﺍﺳﺎﺱ ﺗﻌﺪﺍﺩ ﺍﺟﺰﺍﻱ ﺳﻨﺪﺭﻡ‬
‫ﭘﻴﺶﺑﻴﻨﻲﻛﻨﻨﺪﻩﻱ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺩﺭ ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ ﻭ‬                                        ‫ﻣﺘﺎﺑﻮﻟﻴﻚ ﻃﺒﻖ ﺗﻌﺮﻳﻒﻫﺎﻱ ‪ ATP III‬ﻭ ‪ IDF‬ﺑﺮﺍﻱ ﺗﺸﺨﻴﺺ‬
‫ﻣﻨﺤﻨﻲ ﻫﺮ ﻳﻚ ﺟﺪﺍﮔﺎﻧﻪ ﺭﺳﻢ ﻭ ﻧﻴﺰ ﺑﻬﺘﺮﻳﻦ ﺣﺪ ﻣﻤﻴﺰ ﻫﺮ ﻳﻚ ﺍﺯ‬                                    ‫ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺑﻪ ﺗﺮﺗﻴﺐ ۲۶/۰ ﻭ ۴۶/۰ ﺑﻮﺩ. ﺩﺭ ﺗﻔﻜﻴﻚ‬
‫ﺍﺟﺰﺍ ﺗﻌﻴﻴﻦ ﺷﺪ. ﻳﺎﻓﺘﻪﻫﺎﻱ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﻣﻨﺤﻨﻲ ﺭﻭﻙ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ‬                                  ‫ﺟﻨﺴﻲ، ﺩﺭ ﻣﺮﺩﺍﻥ ﺳﻄﺢ ﺯﻳﺮ ﻣﻨﺤﻨﻲ ﺭﻭﻙ ﺍﺯ ﺯﻧﺎﻥ ﺑﻴﺸﺘﺮ ﺑﻮﺩ.‬
‫ﺍﺯ ﺍﺟﺰﺍﻱ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﻭ ﻧﻴﺰ ﺣﺪ ﻣﻤﻴﺰﻫﺎ ﺩﺭ ﺟﺪﻭﻝ ۳‬                                        ‫ﺍﻳﻦ ﻣﻮﺭﺩ ﺩﺭ ﺗﻌﺮﻳﻒ ‪ IDF‬ﺑﻴﺸﺘﺮ ﻣﺸﻬﻮﺩ ﺑﻮﺩ ﻛﻪ ﺩﺭ ﻣﺮﺩﺍﻥ‬
                                                   ‫ﺧﻼﺻﻪ ﺷﺪﻩ ﺍﺳﺖ.‬                         ‫۲۷% ﻭ ﺩﺭ ﺯﻧﺎﻥ ۲۵% ﻣﻮﺍﺭﺩ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺑﻪ ﺩﺭﺳﺘﻲ‬
‫ﺳﻄﺢ ﺯﻳﺮ ﻣﻨﺤﻨﻲ ﻗﻨﺪ ﺧﻮﻥ ﻧﺎﺷﺘﺎ ﺩﺭ ﻣﻨﺤﻨﻲ ﺭﻭﻙ، ۵۶/۰ ﻭ‬                                                                                    ‫ﺗﺸﺨﻴﺺ ﺩﺍﺩﻩ ﺷﺪﻧﺪ.‬
‫ﺩﻭﺭ ﻛﻤﺮ ۲۶/۰ ﺑﻮﺩﻩ ﺍﺳﺖ ﻛﻪ ﻣﻌﺎﺩﻝ ﺑﺎ ﺳﻄﺢ ﺯﻳﺮﻣﻨﺤﻨﻲ ﺗﻌﺪﺍﺩ‬


                                                                                                                                         ‫‪www.SID.ir‬‬
                                          ‫ﺩﻭﺭﻩﻱ ﺩﻫﻢ, ﺷﻤﺎﺭﻩﻱ ۵، ﺩﻱ ۷۸۳۱‬     ‫ﻣﺠﻠﻪﻱ ﻏﺪﺩ ﺩﺭﻭﻥﺭﻳﺰ ﻭ ﻣﺘﺎﺑﻮﻟﻴﺴﻢ ﺍﻳﺮﺍﻥ‬          ‫۰۴۴‬

‫ﻭﻗﺘﻲ ﺑﺮﺍﺳﺎﺱ ﺣﺪ ﻣﻤﻴﺰﻫﺎﻱ ﺟﺪﻳﺪ، ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ‬                      ‫ﻣﺆﻟﻔﻪﻫﺎﻱ ‪ ATP III‬ﻭ ‪ IDF‬ﺑﻮﺩ. ﺩﺭ ﻭﺍﻗﻊ ﺩﻗﺖ ﺗﺸﺨﻴﺼﻲ ﻗﻨﺪ‬
‫ﺩﻭﺑﺎﺭﻩ ﺗﻌﺮﻳﻒ ﻭ ﻣﻨﺤﻨﻲ ﺭﻭﻙ ﺑﺮﺍﺳﺎﺱ ﺗﻌﺪﺍﺩ ﺍﺟﺰﺍﻱ ﺳﻨﺪﺭﻡ‬                ‫ﺧﻮﻥ ﻧﺎﺷﺘﺎ ﻭ ﻳﺎ ﺩﻭﺭ ﻛﻤﺮ ﺑﻪ ﺗﻨﻬﺎﻳﻲ ﻣﻌﺎﺩﻝ ﺑﺎ ﺷﻤﺎﺭﺵ ﺗﻌﺪﺍﺩ‬
‫ﺭﺳﻢ ﺷﺪ، ﺩﻗﺖ ﺗﺸﺨﻴﺺ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﻧﻴﺰ ﺗﻐﻴﻴﺮ ﻛﺮﺩ.‬                  ‫ﺍﺟﺰﺍﻱ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺑﻮﺩ. ﺩﺭ ﻣﺮﺩﺍﻥ ﺳﻄﺢ ﺯﻳﺮ ﻣﻨﺤﻨﻲ‬
‫ﻫﻤﺎﻥﻃﻮﺭ ﻛﻪ ﺩﺭ ﺟﺪﻭﻝ ۴ ﺩﻳﺪﻩ ﻣﻲﺷﻮﺩ، ﺑﺮﺍﺳﺎﺱ ﺗﻌﺮﻳﻒ‬                    ‫ﻣﺘﻐﻴﺮﻫﺎﻱ ﺩﻭﺭ ﻛﻤﺮ ﻭ ﻗﻨﺪ ﺧﻮﻥ ﻧﺎﺷﺘﺎ ﺑﻪ ﺗﺮﺗﻴﺐ ۳۷/۰ ﻭ ۰۷/۰‬
‫‪ ATP III‬ﺳﻄﺢ ﺯﻳﺮ ﻣﻨﺤﻨﻲ ﺭﻭﻙ ﺩﺭ ﻣﺮﺩﺍﻥ ﻭ ﺯﻧﺎﻥ ﭘﺲ ﺍﺯ‬                  ‫ﺑﻮﺩ ﻳﻌﻨﻲ ﻫﺮ ﻳﻚ ﺍﺯ ﺍﻳﻦ ﻣﺘﻐﻴﺮﻫﺎ ﺑﻪ ﺗﻨﻬﺎﻳﻲ ﺣﺪﻭﺩ ۰۷% ﻣﻮﺍﺭﺩ‬
‫ﺗﻄﺒﻴﻖ ﺣﺪ ﻣﻤﻴﺰﻫﺎﻱ ﺟﺪﻳﺪ ﺍﻓﺰﺍﻳﺶ ﻳﺎﻓﺖ. ﺩﺭ ﻣﻮﺭﺩ ‪ IDF‬ﺳﻄﺢ‬               ‫ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺭﺍ ﺑﻪ ﺩﺭﺳﺘﻲ ﺗﺸﺨﻴﺺ ﺩﺍﺩﻧﺪ. ﺩﺭ ﺯﻧﺎﻥ‬
‫ﺯﻳﺮ ﻣﻨﺤﻨﻲ ﺭﻭﻙ ﺩﺭ ﻣﺮﺩﺍﻥ ﻧﺴﺒﺖ ﺑﻪ ﺗﻌﺮﻳﻒ ﻗﺒﻞ ﺗﻔﺎﻭﺗﻲ‬                  ‫ﻧﻴﺰ ﺑﻴﺸﺘﺮﻳﻦ ﺳﻄﺢ ﺯﻳﺮ ﻣﻨﺤﻨﻲ ﺭﻭﻙ ﻣﺮﺑﻮﻁ ﺑﻪ ﻗﻨﺪ ﺧﻮﻥ‬
‫ﻧﺪﺍﺷﺖ ﻭﻟﻲ ﺩﺭ ﺯﻧﺎﻥ ﻧﻴﺰ ﺳﻄﺢ ﺯﻳﺮ ﻣﻨﺤﻨﻲ ﺭﻭﻙ ﭘﺲ ﺍﺯ ﺗﻄﺒﻴﻖ‬              ‫ﻧﺎﺷﺘﺎ ﺑﻮﺩ ﻛﻪ ۸۶/۰ ﺑﻪ ﺩﺳﺖ ﺁﻣﺪ ﺩﺭ ﻭﺍﻗﻊ ۸۶% ﻣﻮﺍﺭﺩ ﻣﻘﺎﻭﻣﺖ‬
                            ‫ﺣﺪ ﻣﻤﻴﺰﻫﺎﻱ ﺟﺪﻳﺪ ﺍﻓﺰﺍﻳﺶ ﻳﺎﻓﺖ.‬                               ‫ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺑﻪ ﺩﺭﺳﺘﻲ ﺗﺸﺨﻴﺺ ﺩﺍﺩﻧﺪ.‬



               ‫ﺟﺪﻭﻝ ۴- ﺳﻄﺢ ﺯﻳﺮ ﻣﻨﺤﻨﻲ ﺭﻭﻙ ﺗﻌﺪﺍﺩ ﻣﺆﻟﻔﻪﻫﺎﻱ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ، ﺩﻭﺭ ﻛﻤﺮ ﻭ ﻗﻨﺪ ﺧﻮﻥ ﻧﺎﺷﺘﺎ ﺑﻪ ﺗﻔﻜﻴﻚ ﺟﻨﺲ‬




                                                                          ‫‪D‬‬
                                  ‫‪AUC‬‬                                                                                   ‫ﻣﺘﻐﻴﺮ‬
             ‫‪IDF‬‬                                       ‫‪ATP III‬‬
    ‫ﺯﻥ‬
   ‫۲۵/۰‬
   ‫۳۶/۰‬
   ‫۷۵/۰‬
                      ‫ﻣﺮﺩ‬
                      ‫۲۷/۰‬
                      ‫۳۷/۰‬
                      ‫۳۷/۰‬
                                               ‫ﺯﻥ‬
                                              ‫۹۵/۰‬
                                               ‫۵۶/۰‬
                                              ‫۷۵/۰‬
                                                                 ‫‪SI‬‬‫ﻣﺮﺩ‬
                                                                  ‫۷۶/۰‬
                                                                  ‫۴۷/۰‬
                                                                  ‫۳۷/۰‬
                                                                                                                 ‫ﺗﻌﺪﺍﺩ ﻣﺆﻟﻔﻪﻫﺎ‬
                                                                                                 ‫ﺗﻌﺪﺍﺩ ﻣﺆﻟﻔﻪﻫﺎ ﺑﺎ ﺣﺪ ﻣﻤﻴﺰ ﺟﺪﻳﺪ‬
                                                                                                          ‫ﺩﻭﺭ ﻛﻤﺮ )ﺳﺎﻧﺘﻲﻣﺘﺮ(‬
                                                      ‫‪of‬‬
   ‫۸۶/۰‬               ‫۰۷/۰‬                    ‫۸۶/۰‬                ‫۰۷/۰‬                    ‫ﻗﻨﺪ ﺧﻮﻥ ﻧﺎﺷﺘﺎ )ﻣﻴﻠﻲﮔﺮﻡ ﺩﺭ ﺩﺳﻲﻟﻴﺘﺮ(‬
                         ‫‪ive‬‬

‫ﺍﺭﺯﺵ ﺗﺸﺨﻴﺼﻲ ﻣﺸﺎﺑﻪ ﻭ ﺣﺘﻲ ﺑﻴﺸﺘﺮ ﺍﺯ ﻣﻌﻴﺎﺭﻫﺎﻱ ﻳﺎﺩ ﺷﺪﻩ‬                ‫ﺩﺭ ﻣﺮﺩﺍﻥ ﺩﻗﺖ ﺩﻭﺭ ﻛﻤﺮ ﻳﺎ ﻗﻨﺪ ﺧﻮﻥ ﻧﺎﺷﺘﺎ ﺑﻪ ﺗﻨﻬﺎﻳﻲ‬
                                            ‫ﺩﺍﺷﺘﻪ ﺑﺎﺷﻨﺪ.‬         ‫ﺑﻴﺸﺘﺮ ﺍﺯ ﺷﻤﺎﺭﺵ ﺗﻌﺪﺍﺩ ﺍﺟﺰﺍﻱ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﻃﺒﻖ ﺗﻌﺮﻳﻒ‬
‫ﻣﻄﺎﻟﻌﻪﻫﺎ ﻧﺸﺎﻥ ﺩﺍﺩﻩﺍﻧﺪ ﻛﻪ ﺧﻮﺩ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺑﻪ‬                ‫‪ ATP III‬ﻭﻟﻲ ﻣﻌﺎﺩﻝ ﺑﺎ ﺗﻌﺪﺍﺩ ﺍﺟﺰﺍﻱ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﻃﺒﻖ‬
‫ﺗﻨﻬﺎﻳﻲ ﺑﻌﺪ ﺍﺯ ﺗﻌﺪﻳﻞ ﻫﻤﻪﻱ ﻋﻮﺍﻣﻞ ﻣﺘﺎﺑﻮﻟﻴﻚ ﻣﻨﺠﺮ ﺑﻪ ﺍﻓﺰﺍﻳﺶ‬           ‫ﺗﻌﺮﻳﻒ ‪ IDF‬ﺑﻮﺩ. ﺑﺮﺍﺳﺎﺱ ﻫﺮ ﺩﻭ ﺗﻌﺮﻳﻒ ﺩﺭ ﺯﻧﺎﻥ، ﻗﻨﺪ ﺧﻮﻥ‬
                       ‫‪ch‬‬



‫ﻋﻮﺍﺭﺽ ﻗﻠﺒﻲ ـ ﻋﺮﻭﻗﻲ ﻣﻲﺷﻮﺩ ﻭ ﺍﻳﻦ ﻣﺮﺑﻮﻁ ﻣﻲﺷﻮﺩ ﺑﻪ‬                    ‫ﻧﺎﺷﺘﺎ ﺑﻪ ﺗﻨﻬﺎﻳﻲ ﺩﻗﺖ ﺗﺸﺨﻴﺼﻲ ﺑﻴﺸﺘﺮﻱ ﺍﺯ ﺷﻤﺎﺭﺵ ﺗﻌﺪﺍﺩ‬
‫ﺳﺎﻳﺮ ﺍﺟﺰﺍﻱ ﺷﻨﺎﺧﺘﻪ ﺷﺪﻩ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﻛﻪ ﺍﺯ ﺁﻥ ﺟﻤﻠﻪ‬                                            ‫ﺍﺟﺰﺍﻱ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺩﺍﺷﺖ.‬
‫ﻣﻲﺗﻮﺍﻥ ﺑﻪ ﺍﺧﺘﻼﻝ ﻋﻤﻠﻜﺮﺩ ﺍﻧﺪﻭﺗﻠﻴﻮﻡ ﻋﺮﻭﻕ، ﺍﻓﺰﺍﻳﺶ‬
           ‫‪Ar‬‬




‫ﺍﻧﻌﻘﺎﺩﭘﺬﻳﺮﻱ ﻭ ﻭﺟﻮﺩ ﻋﻮﺍﻣﻞ ﺍﻟﺘﻬﺎﺑﻲ ﺍﺷﺎﺭﻩ ﻛﺮﺩ ﻛﻪ ﺩﺭ‬                                           ‫ﺑﺤﺚ‬
‫ﺗﻌﺮﻳﻒﻫﺎﻱ ﺑﺎﻟﻴﻨﻲ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺟﺎﻳﮕﺎﻫﻲ ﻧﺪﺍﺭﻧﺪ. ﺑﻪ ﻫﺮ‬
‫ﺻﻮﺭﺕ، ﺑﺎ ﻭﺟﻮﺩ ﺍﻳﻦ ﻛﻪ ﺷﻮﺍﻫﺪ ﺑﺴﻴﺎﺭﻱ ﺩﺍﻝ ﺑﺮ ﺍﻳﻦ ﻫﺴﺘﻨﺪ‬               ‫ﻳﺎﻓﺘﻪﻫﺎﻱ ﺣﺎﺻﻞ ﺍﺯ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪﻱ ﻣﻘﻄﻌﻲ ﺟﻤﻌﻴﺖ ﻣﺤﻮﺭ‬
‫ﻛﻪ ﺍﻧﺪﺍﺯﻩﮔﻴﺮﻱ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﭘﻴﺶﺑﻴﻨﻲﻛﻨﻨﺪﻩﻱ ﺑﻬﺘﺮ ﻭ‬             ‫ﻧﺸﺎﻥ ﻣﻲﺩﻫﺪ ﻛﻪ ﺗﻌﺮﻳﻒﻫﺎﻱ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺑﺮﺍﻱ ﺷﻨﺎﺳﺎﻳﻲ‬
‫ﺩﻗﻴﻖﺗﺮﻱ ﺑﺮﺍﻱ ﺷﺎﻧﺲ ﺧﻄﺮ ﺑﺮﻭﺯ ﺑﻴﻤﺎﺭﻱﻫﺎﻱ ﻗﻠﺒﻲ ﻋﺮﻭﻗﻲ‬                  ‫ﺍﻓﺮﺍﺩ ﺩﭼﺎﺭ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ، ﺣﺴﺎﺳﻴﺖ ﻭ ﻭﻳﮋﮔﻲ ﻗﺎﺑﻞ‬
                                                 ‫۷۱‬
‫ﺍﻧﺪﺍﺯﻩﮔﻴﺮﻱ ﺁﻥ ﺩﺭ ﻃﺐ ﺑﺎﻟﻴﻨﻲ ﺑﻪ ﺭﺍﺣﺘﻲ ﺍﻣﻜﺎﻥﭘﺬﻳﺮ‬         ‫ﺍﺳﺖ،‬       ‫ﻗﺒﻮﻟﻲ ﻧﺪﺍﺭﺩ ﻭ ﺍﺯ ﻃﺮﻓﻲ ﻣﻴﺰﺍﻥ ﺗﻮﺍﻓﻖ ﺑﻴﻦ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﻭ‬
‫ﻧﻴﺴﺖ. ﺍﺯ ﻃﺮﻑ ﺩﻳﮕﺮ، ﻧﻮﻉ ﺗﻜﻨﻴﻚ ﻭ ﺭﻭﺵ ﺳﻨﺠﺶ ﻣﻘﺎﻭﻣﺖ ﺑﻪ‬                ‫ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﻧﻴﺰ ﻧﺎﭼﻴﺰ ﻭ ﻛﻢ ﺍﺳﺖ. ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻳﺎﻓﺘﻪﻫﺎ،‬
‫ﺍﻧﺴﻮﻟﻴﻦ ﻭ ﺣﺪ ﻣﻤﻴﺰ ﺍﻧﺘﺨﺎﺑﻲ ﺑﺴﻴﺎﺭ ﺣﺎﻳﺰ ﺍﻫﻤﻴﺖ ﺍﺳﺖ. ﻫﺮﮔﺎﻩ‬            ‫ﺑﻪ ﻧﻈﺮ ﻣﻲﺭﺳﺪ ﺗﻔﺎﻭﺕ ﻗﺎﺑﻞ ﺗﻮﺟﻬﻲ ﺑﻴﻦ ﺩﻭ ﺗﻌﺮﻳﻒ‬
‫ﺍﺯ ﺭﻭﺵﻫﺎﻱ ﺍﺳﺘﺎﻧﺪﺍﺭﺩ ﻃﻼﻳﻲ‪ i‬ﻣﺜﻞ ﮔﻠﻮﻛﺰ ﻛﻼﻣﭗ ﺍﺳﺘﻔﺎﺩﻩ‬                 ‫‪ Modified ATP III‬ﻭ ‪ IDF‬ﺑﺮﺍﻱ ﺷﻨﺎﺳﺎﻳﻲ ﺍﻓﺮﺍﺩ ﺩﭼﺎﺭ‬
                                                                 ‫ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﻭﺟﻮﺩ ﻧﺪﺍﺭﺩ ﻭ ﺍﺭﺯﻳﺎﺑﻲ ﻣﻨﻔﺮﺩ‬
                                                                 ‫ﺷﺎﺧﺺﻫﺎﻳﻲ ﻣﺎﻧﻨﺪ ﺩﻭﺭ ﻛﻤﺮ ﻭ ﻗﻨﺪﺧﻮﻥ ﻧﺎﺷﺘﺎ ﻣﻤﻜﻦ ﺍﺳﺖ‬

‫‪i - Golden Standard‬‬

                                                                                                                 ‫‪www.SID.ir‬‬
‫۱۴۴‬      ‫ﺗﻮﺍﻓﻖ ﺗﻌﺮﻳﻒﻫﺎﻱ ﻣﺨﺘﻠﻒ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ‬   ‫ﺩﻛﺘﺮ ﺷﻴﻮﺍ ﺑﺮﺯﻭﺋﻲ ﻭ ﻫﻤﻜﺎﺭﺍﻥ‬

‫ﺣﺪ ﻣﻤﻴﺰ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﻧﻈﺮ ﻗﺎﻃﻊ ﻭ ﻭﺍﺣﺪﻱ ﻭﺟﻮﺩ‬                                                        ‫ﺎ‬
                                                                ‫ﺷﻮﺩ، ﻗﻄﻌﹰ ﺩﺭﺻﺪ ﺑﻴﺸﺘﺮﻱ ﺍﺯ ﺍﻓﺮﺍﺩ ﻣﺒﺘﻼ ﺑﻪ ﻣﻘﺎﻭﻣﺖ ﺑﻪ‬
                               ‫۸۱‬
‫ﺑﺮﺍﺳﺎﺱ ﺻﺪﻙ ۵۷، ﺣﺪ ﻣﻤﻴﺰ‬          ‫ﻧﺪﺍﺭﺩ. ﺩﺭ ﻣﻄﺎﻟﻌﻪﻱ ﻛﺎﻥ‬                                      ‫ﺍﻧﺴﻮﻟﻴﻦ ﺗﺸﺨﻴﺺ ﺩﺍﺩﻩ ﻣﻲﺷﻮﻧﺪ.‬
‫ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺩﺭ ﻳﻚ ﺟﻤﻌﻴﺖ ﻏﻴﺮﺩﻳﺎﺑﺘﻲ ۲۳/۲ ﺑﻮﺩ. ﺩﺭ‬            ‫ﺩﺭ ﻣﻄﺎﻟﻌﻪﻱ ﻣﺎ ﺑﺮﺍﺳﺎﺱ ﺭﻭﺵ ‪ HOMA-IR‬ﺑﻪ ﻋﻨﻮﺍﻥ‬
‫ﻣﻄﺎﻟﻌﻪﻱ ﺳﻨﺪﻫﻮﻓﺮ۹۱ ﻧﻴﺰ ﭼﺎﺭﻙ ۵۷ ﺑﺮﺍﻱ ﺣﺪ ﻣﻤﻴﺰ ﻣﻘﺎﻭﻣﺖ ﺑﻪ‬            ‫ﻳﻚ ﺭﻭﺵ ﺍﺳﺘﺎﻧﺪﺍﺭﺩ ﻧﺎﻛﺎﻣﻞ‪ i‬ﻭ ﺣﺪ ﻣﻤﻴﺰ ۵/۲، ﺑﺮﺍﺳﺎﺱ ﺻﺪﻙ‬
‫ﺍﻧﺴﻮﻟﻴﻦ ﺩﺭ ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ. ﺍﺳﺘﺮﺍﺯﻭﻟﻮ۰۲ ﻧﻴﺰ ﺣﺪ ﻣﻤﻴﺰ ۷۷/۲‬           ‫۵۹، ۸/۴۲% ﺍﻓﺮﺍﺩ ﺩﭼﺎﺭ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺑﻮﺩﻧﺪ ﻛﻪ ﺑﻴﻦ ﻣﺮﺩ‬
‫ﺑﺮﺍﺳﺎﺱ ﺻﺪﻙ ۰۸ ﺩﺭ ﻳﻚ ﺟﻤﻌﻴﺖ ﻏﻴﺮﺩﻳﺎﺑﺘﻲ ﻭ ﻏﻴﺮﭼﺎﻕ‬                    ‫ﻭ ﺯﻥ ﺗﻔﺎﻭﺕ ﻣﻌﻨﻲﺩﺍﺭﻱ ﻭﺟﻮﺩ ﻧﺪﺍﺷﺖ ﻭﻟﻲ ﺣﺴﺎﺳﻴﺖ‬
‫ﺑﺮﺍﻱ ﺗﺸﺨﻴﺺ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺑﻪ ﻛﺎﺭ ﺭﻓﺖ. ﺍﻫﻤﻴﺖ‬                  ‫ﻣﻌﻴﺎﺭﻫﺎﻱ ‪ ATP III‬ﻭ ‪ IDF‬ﺑﻪ ﺗﺮﺗﻴﺐ ۳/۲۵% ﻭ ۰۶% ﻭ‬
‫ﭼﮕﻮﻧﮕﻲ ﺍﻧﺘﺨﺎﺏ ﺍﻳﻦ ﺣﺪ ﻣﻤﻴﺰ ﻏﻴﺮﻗﺎﺑﻞ ﺍﻧﻜﺎﺭ ﺍﺳﺖ ﺑﻪ ﻭﻳﮋﻩ‬             ‫ﻭﻳﮋﮔﻲ ﺍﻳﻦ ﺗﻌﺮﻳﻒﻫﺎ ﻧﻴﺰ ﺑﻪ ﺗﺮﺗﻴﺐ ۵۶% ﻭ۹۵% ﺑﻮﺩ. ﺿﺮﻳﺐ‬
‫ﺁﻥﻛﻪ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﭼﻮﻟﮕﻲ‪ iii‬ﻣﺜﺒﺖ ﻣﻨﺤﻨﻲ ﺗﻮﺯﻳﻊ ‪ HOMA‬ﺩﺭ‬               ‫ﺗﻮﺍﻓﻖ ﻛﺎﭘﺎ ﻧﻴﺰ ﺑﻪ ﺗﺮﺗﻴﺐ ۴۱/۰ ﻭ ۵۱/۰ ﺑﻮﺩ ﻛﻪ ﺣﺎﻛﻲ ﺍﺯ ﺗﻮﺍﻓﻖ‬
‫ﺟﺎﻣﻌﻪﻱ ﻣﻮﺭﺩ ﺑﺮﺭﺳﻲ، ﺗﻐﻴﻴﺮ ﻛﻢ ﺻﺪﻙ ﺍﻧﺘﺨﺎﺑﻲ ﺑﻪ ﺳﻤﺖ‬                      ‫ﻧﺎﭼﻴﺰ ﻭ ﻛﻢ ﺑﻴﻦ ﺍﻳﻦ ﺗﻌﺮﻳﻒﻫﺎ ﻭ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺍﺳﺖ.‬
‫ﻣﻘﺎﺩﻳﺮ ﺑﻴﺸﺘﺮ، ﻣﻤﻜﻦ ﺍﺳﺖ ﺗﺄﺛﻴﺮ ﺯﻳﺎﺩﻱ ﺩﺭ ﻗﺪﺭ ﻣﻄﻠﻖ ﺣﺪ ﻣﻤﻴﺰ‬          ‫ﺩﺭ ﻣﻄﺎﻟﻌﻪﻱ ﺳﻲﻳﺮﺍ ـ ﺟﺎﻧﺴﻮﻥ،۷ ﻛﻪ ۶۵۲ ﻓﺮﺩ ﺳﺎﻟﻢ ﻏﻴﺮﺩﻳﺎﺑﺘﻲ‬




                                                                            ‫‪D‬‬
‫ﺍﻧﺘﺨﺎﺑﻲ ﺑﮕﺬﺍﺭﺩ ﻭ ﻣﻮﺟﺐ ﻛﺎﻫﺶ ﺗﻌﺪﺍﺩ ﺍﻓﺮﺍﺩ ﺩﭼﺎﺭ ﻣﻘﺎﻭﻣﺖ ﺑﻪ‬           ‫ﺑﺮﺭﺳﻲ ﺷﺪﻧﺪ، ﺍﺯ ﻣﺪﻝ ﺣﺪﺍﻗﻠﻲ ﺑﺮﺍﻱ ﺗﻌﻴﻴﻦ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ‬
‫ﺍﻧﺴﻮﻟﻴﻦ ﺷﻮﺩ. ﺑﻪ ﻋﺒﺎﺭﺕ ﺩﻳﮕﺮ، ﻭﻳﮋﮔﻲ ﻛﺎﻫﺶ ﻭ ﻣﻮﺍﺭﺩ ﻣﻨﻔﻲ‬             ‫ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪ. ۶۲% ﺍﻓﺮﺍﺩ ﻣﻘﺎﻭﻡ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﻭ ﺣﺴﺎﺳﻴﺖ ‪،ATP III‬‬
                                                                ‫۲۴% ﻭ ﻭﻳﮋﮔﻲ ﺁﻥ ۴۹% ﮔﺰﺍﺭﺵ ﺷﺪ. ﺩﺭ ﻣﻄﺎﻟﻌﻪ ﻟﻴﺎﺋﻮ۸ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ‬


                                                              ‫‪SI‬‬
‫ﻛﺎﺫﺏ ﺍﻓﺰﺍﻳﺶ ﻣﻲﻳﺎﺑﺪ. ﺩﺭ ﻫﺮ ﺣﺎﻝ ﺑﻪ ﻧﻈﺮ ﻣﻲﺭﺳﺪ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ‬
‫ﻟﺰﻭﻡ ﺷﻤﻮﻝ ۵۹% ﺍﻓﺮﺍﺩ ﻫﺮ ﺟﺎﻣﻌﻪ ﺩﺭ ﮔﺮﻭﻩ ﻃﺒﻴﻌﻲ، ﺻﺪﻙ ۵۹‬              ‫ﺭﻭﺵ ﺍﺳﺘﺎﻧﺪﺍﺭﺩ ﮔﻠﻮﻛﺰ ﻛﻼﻣﭗ ﺩﺭ ﻳﻚ ﺟﻤﻌﻴﺖ ۴۷ ﻓﺮﺩ ﻏﻴﺮﺩﻳﺎﺑﺘﻲ،‬
‫ﺩﺭ ﻣﻄﺎﻟﻌﻪﻱ ﻣﺎ ﺑﻪ ﻋﻨﻮﺍﻥ ﺣﺪ ﻣﻤﻴﺰ، ﺍﻧﺘﺨﺎﺏ ﻣﻨﺎﺳﺒﻲ ﺑﻮﺩﻩ‬              ‫۸/۳۳% ﺍﻓﺮﺍﺩ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺑﻮﺩﻧﺪ ﻭ ﺣﺴﺎﺳﻴﺖ ‪ATP III‬‬
                                                  ‫ﺍﺳﺖ.‬                                     ‫ﻛﻤﺘﺮ ﺍﺯ ۰۵% ﻭ ﻭﻳﮋﮔﻲ ﺁﻥ ۰۹% ﺑﻮﺩ.‬
                                                  ‫‪of‬‬
‫ﻧﻜﺘﻪﻱ ﺩﻳﮕﺮ ﺍﻳﻦﻛﻪ ﺩﺭ ﻣﻄﺎﻟﻌﻪﻫﺎﻱ ﺫﻛﺮ ﺷﺪﻩ ﻃﺒﻖ ‪ATP‬‬                   ‫ﺩﺭ ﻣﻄﺎﻟﻌﻪﻱ ﭼﻴﻞ۹ ﻧﻴﺰ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺭﻭﺵ ‪ iiSSPG‬ﺩﺭ‬
‫‪ III‬ﺳﺎﻝ ۱۰۰۲، ﺣﺪ ﻣﻤﻴﺰ ﻗﻨﺪ ﺧﻮﻥ ﻧﺎﺷﺘﺎ ۰۱۱ ﻣﻴﻠﻲﮔﺮﻡ ﺩﺭ‬              ‫۳۴۴ ﺩﺍﻭﻃﻠﺐ ﺳﺎﻟﻢ، ۰۲% ﺍﻓﺮﺍﺩ ﻣﺒﺘﻼ ﺑﻪ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ‬
‫ﺩﺳﻲﻟﻴﺘﺮ ﺑﻮﺩ ﻭﻟﻲ ﺩﺭ ﻣﻄﺎﻟﻌﻪﻱ ﻣﺎ ﺣﺪ ﻣﻤﻴﺰ ﻗﻨﺪ ﺧﻮﻥ ﻧﺎﺷﺘﺎ‬             ‫ﺑﻮﺩﻧﺪ ﻭ ﺣﺴﺎﺳﻴﺖ ‪ %۴۶ ،ATP III‬ﻭ ﻭﻳﮋﮔﻲ ﺁﻥ ۳۹% ﮔﺰﺍﺭﺵ‬
                         ‫‪ive‬‬

                 ‫۶‬         ‫۵‬
‫ﺑﺮﺍﺳﺎﺱ ‪ Modified ATP III‬ﻭ ‪ ۱۰۰ ،IDF‬ﻣﻴﻠﻲﮔﺮﻡ ﺩﺭ‬                   ‫ﺷﺪ. ﺩﺭ ﺗﻤﺎﻡ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪﻫﺎ، ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﻃﺒﻖ ﻣﻌﻴﺎﺭﻫﺎﻱ‬
‫ﺩﺳﻲﻟﻴﺘﺮ ﺩﺭ ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ ﻭ ﺑﻪ ﻫﻤﻴﻦ ﺩﻟﻴﻞ ﺣﺴﺎﺳﻴﺖ ﺩﺭ‬                ‫‪ ATP III‬ﺍﺯ ﺣﺴﺎﺳﻴﺖ ﭘﺎﻳﻴﻦ ﻭ ﻭﻳﮋﮔﻲ ﺑﺎﻻﻳﻲ ﺑﺮﺍﻱ ﺗﺸﺨﻴﺺ‬
 ‫ﻣﻄﺎﻟﻌﻪﻱ ﻣﺎ ﺣﺪﺍﻗﻞ ﻛﻤﺘﺮ ﺍﺯ ﺣﺴﺎﺳﻴﺖ ﻣﻄﺎﻟﻌﻪﻫﺎﻱ ﺩﻳﮕﺮ ﻧﺒﻮﺩ.‬                                    ‫ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺑﺮﺧﻮﺭﺩﺍﺭ ﺑﻮﺩ.‬
                       ‫۷‬
‫ﺩﺭ ﻣﻄﺎﻟﻌﻪﻱ ﺳﻴﺮﺍ ـ ﺟﺎﻧﺴﻮﻥ، ﺩﻗﺖ ﺗﺸﺨﻴﺼﻲ ﺷﻤﺎﺭﺵ‬                      ‫ﻣﻘﺎﻳﺴﻪﻱ ﻳﺎﻓﺘﻪﻫﺎﻱ ﻣﻄﺎﻟﻌﻪﻱ ﻣﺎ ﺑﺎ ﻣﻄﺎﻟﻌﻪﻫﺎﻱ ﺫﻛﺮ ﺷﺪﻩ‬
                       ‫‪ch‬‬



‫ﺍﺟﺰﺍﻱ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺑﺮﺍﺳﺎﺱ ﺳﻄﺢ ﺯﻳﺮﻣﻨﺤﻨﻲ ﺭﻭﻙ‬                             ‫ﺎ‬
                                                                ‫ﻧﺸﺎﻥ ﻣﻲﺩﻫﺪ ﻛﻪ ﺣﺴﺎﺳﻴﺖ ﺑﻪ ﺩﺳﺖ ﺁﻣﺪﻩ ﺗﻘﺮﻳﺒﹰ ﻣﻌﺎﺩﻝ ﺑﺎ‬
‫ﻧﺴﺒﻲ )۶۷/۰( ﺑﻮﺩ ﻛﻪ ﺩﺭ ﻣﺮﺩﺍﻥ ﺑﺎﻻﺗﺮ ﺍﺯ ﺯﻧﺎﻥ ﮔﺰﺍﺭﺵ ﺷﺪ ﻭ‬            ‫ﺣﺴﺎﺳﻴﺖ ﻣﻄﺎﻟﻌﻪﻫﺎﻱ ﺫﻛﺮ ﺷﺪﻩ ﻭﻟﻲ ﻭﻳﮋﮔﻲ ﺁﻥ ﺑﺴﻴﺎﺭ ﻛﻤﺘﺮ‬
‫ﻭﻗﺘﻲ ﻛﻪ ﻫﺮ ﻳﻚ ﺍﺯ ﺍﺟﺰﺍﻱ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺑﻪ ﻋﻨﻮﺍﻡ ﻣﻘﺎﺩﻳﺮ‬           ‫ﺑﻮﺩﻩ ﺍﺳﺖ. ﻳﻜﻲ ﺍﺯ ﺩﻻﻳﻞ ﻭﻳﮋﮔﻲ ﭘﺎﻳﻴﻦ ﺍﻳﻦ ﺍﺳﺖ ﻛﻪ ﺑﺮﺧﻼﻑ‬
           ‫‪Ar‬‬




                                             ‫‪‬‬
‫ﻛﻤﻲ ﺩﺭ ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪﻧﺪ، ﺩﻗﺖ ﺩﻭﺭ ﻛﻤﺮ ﺑﻪ ﺗﻨﻬﺎﻳﻲ ﺩﺭ‬                 ‫ﻣﻄﺎﻟﻌﻪﻫﺎﻱ ﻳﺎﺩ ﺷﺪﻩ، ﺩﺭ ﻣﻄﺎﻟﻌﻪﻱ ﻣﺎ ‪ ،HOMA-IR‬ﻣﺮﺟﻊ‬
‫ﺗﺸﺨﻴﺺ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺍﺯ ﺷﻤﺎﺭﺵ ﺍﺟﺰﺍﺀ ﺳﻨﺪﺭﻡ‬                    ‫ﺍﺳﺘﺎﻧﺪﺍﺭﺩ ﻧﺎﻛﺎﻣﻞ ﺑﺮﺍﻱ ﺗﺸﺨﻴﺺ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﻭﺟﻮﺩ‬
‫ﻣﺘﺎﺑﻮﻟﻴﻚ ﺑﻴﺸﺘﺮ ﺑﻮﺩ. ﺩﺭ ﻣﻄﺎﻟﻌﻪﻱ ﻣﺎ ﻧﻴﺰ ﺩﻭﺭ ﻛﻤﺮ ﻭ ﻗﻨﺪ ﺧﻮﻥ‬         ‫ﺩﺍﺷﺖ ﻭ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﻣﺮﺟﻊ ﺍﺳﺘﺎﻧﺪﺍﺭﺩ ﻧﺎﻛﺎﻣﻞ ﻣﻨﺠﺮ ﺑﻪ ﺗﺨﻤﻴﻦ‬
‫ﻧﺎﺷﺘﺎ ﺑﻪ ﺗﻨﻬﺎﻳﻲ، ﺩﻗﺖ ﺗﺸﺨﻴﺼﻲ ﻣﻌﺎﺩﻝ ﻭ ﺣﺘﻲ ﺑﻴﺸﺘﺮ ﺍﺯ ﺗﻌﺪﺍﺩ‬          ‫ﻛﻤﺘﺮ ﺍﺯ ﺣﺪ ﺣﺴﺎﺳﻴﺖ ﻭ ﻭﻳﮋﮔﻲ ﻣﻲﺷﻮﺩ. ﻫﻤﻴﻦ ﺟﺎ ﺑﺎﻳﺪ ﻣﺘﺬﻛﺮ‬
‫ﺍﺟﺰﺍﻱ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺩﺍﺷﺘﻨﺪ ﺩﺭ ﺣﺎﻟﻲﻛﻪ ﻓﺸﺎﺭ ﺧﻮﻥ،‬                 ‫ﺷﺪ ﻛﻪ ﻭﻗﺘﻲ ﺍﺯ ﻣﺮﺟﻊ ﺍﺳﺘﺎﻧﺪﺍﺭﺩ ﻧﺎﻛﺎﻣﻞ ﺍﺳﺘﻔﺎﺩﻩ ﺷﻮﺩ ﮔﺰﺍﺭﺵ‬
‫ﺗﺮﻱﮔﻠﻴﺴﺮﻳﺪ ﻭ ‪ HDL‬ﻛﻠﺴﺘﺮﻭﻝ ﺍﺯ ﺍﺭﺯﺵ ﻛﻤﺘﺮﻱ ﺑﺮﺧﻮﺭﺩﺍﺭ‬                 ‫ﺿﺮﻳﺐ ﺗﻮﺍﻓﻖ ﻛﺎﭘﺎ ﺍﻟﺰﺍﻣﻲ ﺍﺳﺖ ﻛﻪ ﺩﺭ ﻣﻄﺎﻟﻌﻪﻱ ﻣﺎ ﺿﺮﻳﺐ‬
‫ﺑﻮﺩﻧﺪ. ﺑﻪ ﻧﻈﺮ ﻣﻲﺭﺳﺪ ﺍﻧﺪﺍﺯﻩﮔﻴﺮﻱ ﺳﺎﺩﻩﻱ ﻳﻚ ﻣﺘﻐﻴﺮ ﻣﺜﻞ ﺩﻭﺭ‬                                        ‫ﺗﻮﺍﻓﻖ ﻛﺎﭘﺎ ﻧﻴﺰ ﻛﻢ ﻭ ﻧﺎﭼﻴﺰ ﺑﻮﺩ.‬
‫ﻛﻤﺮ ﻳﺎ ﻗﻨﺪ ﺧﻮﻥ ﻧﺎﺷﺘﺎ ﻣﻨﺠﺮ ﺑﻪ ﺍﻓﺰﺍﻳﺶ ﺩﻗﺖ ﺗﺸﺨﻴﺺ ﻧﺴﺒﺖ‬              ‫ﻳﻜﻲ ﺩﻳﮕﺮ ﺍﺯ ﺩﻻﻳﻞ ﭘﺎﻳﻴﻦ ﺑﻮﺩﻥ ﻭﻳﮋﮔﻲ، ﺣﺪ ﻣﻤﻴﺰ ﺍﻧﺘﺨﺎﺑﻲ‬
‫ﺑﻪ ﺷﻤﺎﺭﺵ ﺗﻌﺪﺍﺩ ﺍﺟﺰﺍﻱ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺷﻮﺩ ﻭﻟﻲ ﺩﺭ ﻋﻴﻦ‬              ‫ﺍﺳﺖ ﻛﻪ ﺩﺭ ﺗﻌﻴﻴﻦ ﻭﻳﮋﮔﻲ ﺑﺴﻴﺎﺭ ﺩﺧﻴﻞ ﺍﺳﺖ. ﺩﺭ ﻣﻮﺭﺩ ﺍﻋﻤﺎﻝ‬
‫ﺣﺎﻝ ﺑﺎﻳﺪ ﺗﻮﺟﻪ ﺩﺍﺷﺖ ﻛﻪ ﺭﻭﺵﻫﺎﻱ ﻣﺨﺘﻠﻒ ﺁﺯﻣﺎﻳﺸﮕﺎﻫﻲ ﻭ‬

                                                                ‫‪i - Imperfect Reference Standard‬‬
‫‪iii - Skewness‬‬                                                  ‫‪ii - Steady-State Plasma Glucos‬‬

                                                                                                             ‫‪www.SID.ir‬‬
                                            ۱۳۸۷ ‫ﺩﻭﺭﻩﻱ ﺩﻫﻢ, ﺷﻤﺎﺭﻩﻱ ۵، ﺩﻱ‬            ‫ﻣﺠﻠﻪﻱ ﻏﺪﺩ ﺩﺭﻭﻥﺭﻳﺰ ﻭ ﻣﺘﺎﺑﻮﻟﻴﺴﻢ ﺍﻳﺮﺍﻥ‬           ۴۴۲

‫ﺍﻧﺴﻮﻟﻴﻦ ﻣﻲﺗﻮﺍﻧﺪ ﺩﺭ ﺩﻭ ﺟﻨﺲ ﻣﺘﻔﺎﻭﺕ ﺑﺎﺷﺪ، ﺗﻌﻴﻴﻦ ﺣﺪ ﻣﻤﻴﺰ‬             ‫ﺗﻌﻴﻴﻦ ﺣﺪ ﻣﻤﻴﺰ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﻭ ﺑﻪ ﻛﺎﺭﮔﻴﺮﻱ ﻣﻘﺎﺩﻳﺮ‬
                    .‫ﺑﻪ ﺗﻔﻜﻴﻚ ﺟﻨﺲ ﻣﻨﻄﻘﻲﺗﺮ ﺑﻪ ﻧﻈﺮ ﻣﻲﺭﺳﺪ‬           ‫ﻣﺨﺘﻠﻒ ﺑﻪ ﻋﻨﻮﺍﻥ ﺣﺪ ﻣﻤﻴﺰ ﺍﺟﺰﺍﻱ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺑﻪ‬
‫ﺍﺯ ﻧﻘﺎﻁ ﻗﻮﺕ ﻣﻄﺎﻟﻌﻪﻱ ﻣﺎ ﺍﻳﻦ ﺍﺳﺖ ﻛﻪ ﺣﺪ ﻣﻤﻴﺰ ﻣﻘﺎﻭﻣﺖ‬                 ‫ﺧﺼﻮﺹ ﺩﺭ ﻣﻮﺭﺩ ﺩﻭﺭ ﻛﻤﺮ ﻛﻪ ﺣﺪ ﻣﻤﻴﺰ ﺁﻥ ﺩﺭ ﺑﻴﺸﺘﺮ ﺟﻮﺍﻣﻊ‬
‫ ﺩﺭ ﺍﻓﺮﺍﺩ ﻧﺮﻣﺎﻝ ﻳﻌﻨﻲ ﻧﻤﺎﻳﻪﻱ‬HOMA ‫ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺍﺯ ﺗﻮﺯﻳﻊ‬              ‫ﺩﻧﻴﺎ ﻫﻨﻮﺯ ﻳﻚ ﻣﺸﻜﻞ ﺗﻠﻘﻲ ﻣﻲﺷﻮﺩ ﻭ ﺍﺧﺘﻼﻑﻫﺎﻱ ﻧﮋﺍﺩﻱ ﻭ‬
‫ﺗﻮﺩﻩﻱ ﺑﺪﻥ ﻛﻤﺘﺮ ﺍﺯ ۵۲ ﻛﻴﻠﻮﮔﺮﻡ ﺑﺮ ﻣﺘﺮ ﻣﺮﺑﻊ، ﻗﻨﺪ ﺧﻮﻥ‬                                   .‫ﻣﻨﻄﻘﻪﻱ ﺟﻐﺮﺍﻓﻴﺎﻳﻲ ﺩﺭ ﻳﺎﻓﺘﻪﻫﺎ ﺑﺴﻴﺎﺭ ﺗﺄﺛﻴﺮ ﮔﺬﺍﺭﻧﺪ‬
‫ﻧﺎﺷﺘﺎﻱ ﻛﻤﺘﺮ ﺍﺯ ۰۰۱ ﻣﻴﻠﻲﮔﺮﻡ ﺩﺭ ﺩﺳﻲﻟﻴﺘﺮ ﻭ ﻗﻨﺪ ﺧﻮﻥ ﺩﻭ‬               ‫ﻣﻄﺎﻟﻌﻪﻱ ﻣﺎ ﻣﺤﺪﻭﺩﻳﺖﻫﺎﻳﻲ ﻧﻴﺰ ﺩﺍﺷﺖ ﻛﻪ ﺍﺯ ﺟﻤﻠﻪﻱ ﺁﻥﻫﺎ‬
‫ﺳﺎﻋﺘﻪﻱ ﻛﻤﺘﺮ ﺍﺯ ۰۴۱ ﻣﻴﻠﻲﮔﺮﻡ ﺩﺭ ﺩﺳﻲﻟﻴﺘﺮ ﺑﻪ ﺩﺳﺖ ﺁﻣﺪ، ﺩﺭ‬             ‫ ﺳﻨﺠﻴﺪﻩ‬HOMA-IR ‫ﺍﻳﻦ ﻛﻪ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺑﺎ ﺭﻭﺵ‬
                                                                 i
                     ‫ﻻ‬
‫ﺣﺎﻟﻲﻛﻪ ﺩﺭ ﺑﻴﺸﺘﺮ ﻣﻄﺎﻟﻌﻪﻫﺎ ﻣﻌﻤﻮ ﹰ ﺩﺭ ﺍﻓﺮﺍﺩ ﻏﻴﺮﺩﻳﺎﺑﺘﻲ ﻭ‬             ‫ﺷﺪ، ﺩﺭ ﺣﺎﻟﻲﻛﻪ ﮔﻠﻮﻛﺰ ﻛﻼﻣﭗ ﺑﻪ ﻋﻨﻮﺍﻥ ﺍﺳﺘﺎﻧﺪﺍﺭﺩ ﻃﻼﻳﻲ‬
‫ﻏﻴﺮﭼﺎﻕ ﺗﻌﻴﻴﻦ ﻣﻲﺷﻮﺩ. ﺩﻳﮕﺮ ﺍﻳﻦ ﻛﻪ ﺍﻓﺮﺍﺩ ﻣﻮﺭﺩ ﺑﺮﺭﺳﻲ‬                 HOMA- ‫ﺗﺸﺨﻴﺺ ﻣﻄﺮﺡ ﺍﺳﺖ. ﺍﻟﺒﺘﻪ ﺑﺎﻳﺪ ﻣﺘﺬﻛﺮ ﺷﺪ ﻛﻪ ﺑﻴﻦ‬
                                                                          ۲۱
‫ﻧﻤﻮﻧﻪﻫﺎﻱ ﻳﻜﺴﺎﻥ ﺑﺪﻭﻥ ﻋﻼﻣﺖ ﻭ ﻏﻴﺮﺩﻳﺎﺑﺘﻲ ﺍﻧﺘﺨﺎﺏ ﺷﺪﻩ ﺍﺯ‬               ‫ﻭ‬         ‫ ﻭ ﺭﻭﺵ ﻛﻼﻣﭗ ﻫﻤﺒﺴﺘﮕﻲ ﺯﻳﺎﺩﻱ ﻭﺟﻮﺩ ﺩﺍﺭﺩ‬IR
                 .‫ﻳﻚ ﻣﻄﺎﻟﻌﻪﻱ ﺑﺰﺭﮒ ﻣﺒﺘﻨﻲ ﺑﺮ ﺟﻤﻌﻴﺖ ﺑﻮﺩﻧﺪ‬           ‫ ﺭﻭﺵ ﺳﺎﺩﻩﺗﺮ ﻭ ﻛﻢ ﻫﺰﻳﻨﻪﺗﺮ ﺍﺳﺖ. ﺩﻳﮕﺮ ﺁﻥﻛﻪ‬HOMA-IR




                                                                                   D
Modified ‫ﺑﻪ ﻃﻮﺭ ﺧﻼﺻﻪ ﻣﻲﺗﻮﺍﻥ ﮔﻔﺖ ﺗﻌﺮﻳﻒﻫﺎﻱ‬                         ‫ﺍﺯ ﻳﻚ ﺣﺪ ﻣﻤﻴﺰ ﻗﺮﺍﺭﺩﺍﺩﻱ ﻣﻌﺎﺩﻝ ﺻﺪﻙ ۵۹ ﺑﺮﺍﻱ ﺗﻌﺮﻳﻒ‬
‫ ﺑﺮﺍﻱ ﺗﺸﺨﻴﺺ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺍﺯ‬IDF ‫ ﻭ‬ATP III                    ‫ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪ. ﺩﺭ ﻫﻤﻴﻦ ﺭﺍﺳﺘﺎ ﭘﻴﺸﻨﻬﺎﺩ‬



                                                                SI
‫ﺣﺴﺎﺳﻴﺖ ﻛﻤﻲ ﺑﺮﺧﻮﺭﺩﺍﺭ ﺑﻮﺩﻩ، ﺗﻮﺍﻓﻖ ﻧﺎﭼﻴﺰﻱ ﺑﻴﻦ ﺍﻳﻦ‬                   ‫ﻣﻲﺷﻮﺩ ﻛﻪ ﻣﻄﺎﻟﻌﻪﻫﺎﻳﻲ ﺩﺭ ﺁﻳﻨﺪﻩ ﺍﻧﺠﺎﻡ ﺷﻮﺩ ﻛﻪ ﺩﺭ ﺁﻥﻫﺎ ﺍﺯ‬
‫ﻣﻌﻴﺎﺭﻫﺎ ﻭ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﻭﺟﻮﺩ ﺩﺍﺭﺩ. ﺑﻪ ﻧﻈﺮ ﻣﻲﺭﺳﺪ‬              ‫ﺭﻭﺵﻫﺎﻱ ﺩﻗﻴﻖﺗﺮ ﻣﺎﻧﻨﺪ ﮔﻠﻮﻛﺰ ﻛﻼﻣﭗ ﺑﺮﺍﻱ ﺳﻨﺠﺶ ﻣﻘﺎﻭﻣﺖ‬
‫ﺍﻧﺪﺍﺯﻩﮔﻴﺮﻱ ﺩﻭﺭ ﻛﻤﺮ ﻳﺎ ﻗﻨﺪ ﺧﻮﻥ ﻧﺎﺷﺘﺎ ﺳﺎﺩﻩﺗﺮ ﺍﺳﺖ ﻭ ﻣﻤﻜﻦ‬            ‫ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺍﺳﺘﻔﺎﺩﻩ ﺷﻮﺩ ﻭ ﺑﻪ ﻛﻤﻚ ﺁﻥ ﺑﻬﺘﺮﻳﻦ ﺣﺪ ﻣﻤﻴﺰ‬
‫ﺍﺳﺖ ﺑﺮﺍﻱ ﺗﺸﺨﻴﺺ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺩﻗﺖ ﺑﻴﺸﺘﺮﻱ ﺩﺍﺷﺘﻪ‬                ‫ ﺑﺮﺍﻱ ﺗﻌﺮﻳﻒ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﻭ ﻧﻴﺰ ﺑﻬﺘﺮﻳﻦ ﺣﺪ‬HOMA
                                                       of
                                                       .‫ﺑﺎﺷﺪ‬     HOMA ‫ﻣﻤﻴﺰ ﺍﺟﺰﺍﻱ ﺳﻨﺪﺭﻡ ﻣﺘﺎﺑﻮﻟﻴﻚ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺍﻳﻦ‬
                                                                 ‫ﺗﻌﻴﻴﻦ ﺷﻮﺩ. ﻫﻢﭼﻨﻴﻦ، ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺍﻳﻦ ﻛﻪ ﺣﺪ ﻣﻤﻴﺰ ﻣﻘﺎﻭﻣﺖ ﺑﻪ‬
 i- Gold Standard
                           ive


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                                                                                                                       www.SID.ir
                              Vol 10 No.5 Jaunary 2009           Iranian Journal of Endocrinology & Metabolism / 544




  Original Article



Agreement Level of Definitions of the Metabolic Syndrome by
 Modified ATP III and IDF with Insulin Resistance In The
            Lipid and Glucose Study (TLGS)

                                          Borzouei Sh1, Hosseinpanah F1, Azizi F2




                                                                         D
            Research Centre, Research Institute for Endocrine Sciences, Shahid Beheshti University of (M.C), 2Endocrine
     1Obesity

        Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University (M.C.) Tehran, I.R.Iran
                                              e-mail: fhospanah@endocrine.ac.ir

       Abstract


                                                              SI
       Introduction: The aim of the present study was to assess the diagnostic accuracy of the
    modified ATP III and IDF definitions of the metablic syndrome in identifying of insulin resistant
    individuals by HOMA_IR and to assess levels of agreement between these definitions and insulin
    resistance. Materials and Methods: The sample consisted of 347 nondiabetic subjects from the
                                                 of
    TLGS population (140 men and 207 women; aged 27-87 years). The reference standard for insulin
    resistance was determined by HOMA-IR and insulin resistance was defined as HOMA-IR≥2.5.
    Results: According to ATP III and IDF criteria 38.9%, 45% had metabolic syndrome respectively.
    The sensitivity and specificity of ATP III was 52.3% and 65% respectively, and this was 60% and
    59% for IDF criteria respectively. Kappa agreement between modified ATP III and IDF with HOMA-IR
    was 0.14 and 0.15. Based on the area under the receiver operating characteristic curve constructed
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    by counting metabolic syndrome components as recommended by modified ATP III and IDF
    diagnostic accuracy was fair. When each component of metabolic syndrome measures were
    considered as continous traits, waist circumference and fasting plasma glucose each separately
    had diagnostic accuracy equal or grater than at all the metabolic syndrome as a whole by ATP III
    and IDF criteria. Conclusion: ATP III and IDF definition, have low sensitivities for detecting insulin
    resistance and there is poor agreement between those criteria and insulin resistance. Measuring
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    just waist circumference and fasting plasma glucose is simpler and may provide greater accuracy
    for identifying insulin resistance.
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Keywords: Insulin Resistance, Metabolic syndrome, HOMA-IR, Modified ATP III, IDF, Agreement , TLGS




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