與代謝症候群有關的常用實驗室檢查之探討

The Laboratory Data Associated with Metabolic Syndrome

代謝症候群(metabolic syndrome)可以預測未來第二型糖尿病(type 2 diabetes mellitus)及心臟血管疾病(cardiovascular disease; CVD)的發生，因此是近年來受到重視的預防醫學主題，過去醫學界對其不了解，因此有各式各樣的名稱及定義，直到1998年世界衛生組織(World Health Organization; WHO)才正式統一了代謝症候群的命名。2001年美國國家膽固醇教育計劃成人治療第三次小組之報告(National Cholesterol Education Program's Adult Treatment Panel III Report; NCEP ATP III)亦注意了代謝症候群的重要性且首次提供了這個症候群的操作性定義(working definition)。目前之研究發現代謝症候群除了與第二型糖尿病及心臟血管疾病有關外，可能亦與某些實驗室檢查及某些疾病有關，本文根據過去的一些研究文獻，探討一些常用之實驗室檢查如血液常規之白血球(white blood cell)數目、生化檢查之尿酸(uric acid)、肝功能指數(liver enzyme)、C- reactive protein (CRP)及ferritin 等與代謝症候群的相關性。過去對代謝症候群預防的最大挑戰是診斷工具的缺乏，因此要診斷此症候群，醫師必須仰賴臨床的警覺性和一個高度的猜測，代謝症候群診斷標準之建立使重視預防醫學的家庭醫學科醫師對於糖尿病、CVD及相關疾病的預防提供了一大利器，然本文探討的這些常用實驗室檢查大部份與氧化壓力(oxidative stress)、發炎反應及胰島素阻抗性有關，因此如果有幸地其能取代代謝症候群而成爲預測第二型糖尿病及心臟血管疾病發生的危險因子，則更是方便實用且簡單便宜，然或許其與代謝症候群可能只是共患現象而已，因此尚待未來投入更多的研究來驗證。

The metabolic syndrome is most important because of its association with subsequent development of type 2 diabetes mellitus and cardiovascular disease. Various definitions were noted in the past until 1998, the World Health Organization proposed a unifying definition for the syndrome and chose to call it the metabolic syndrome and the National Cholesterol Education Program's Adult Treatment Panel III report has published a working definition for metabolic syndrome in 2001, either. Beyond type 2 diabetes mellitus and cardiovascular disease, metabolic syndrome is associated with some laboratory data and disorders. The aim of this article was to explore the association of some common used laboratory data, including white blood cell, biochemical examination of uric acid, liver enzyme, C-reactive protein and ferritin, with metabolic syndrome. The most challenge for metabolic syndrome was lack of definition in the past. To the physician, keeping high alert and suspicion for metabolic syndrome is very important. The established definition of metabolic syndrome offered an excellent tool to predict type 2 DM, CVD and the associated disorders for family physician who emphasizes prevention medicine. The laboratory data of this article explored are associated with oxidative stress, inflammation and insulin resistance. If they can substitute the metabolic syndrome to predict type 2 DM and CVD, we will get not only much benefit but also inexpensive of it. Nevertheless where they are 'innocent bystanders' or 'partners in crime' to predict DM and CVD cannot be answered on recent studies.