Abstract: Objective　To evaluate the value of serum uric acid （SUA） in predicting metabolic syndrome （MS） in obese male children.Methods　We enrolled 256 obese male children from Department of Endocrinology，The Children's Hospital，Zhejiang University School of Medicine，Department of Pediatrics，The First Affiliated Hospital of Huzhou University，Department of Pediatrics，Huzhou Maternal & Child Care Hospital between June 2008 and October 2015，including 118 with MS and 138 without.We collected and compared their data about physical examination and laboratory findings.Performance analysis of different combinations of markers for the prediction of MS was conducted using area under the ROC curve （AUC），sensitivity，specificity and Cohen's Kappa coefficient（κ）．Results　For the prediction of MS，the AUC of SUA 〔0.631，95%CI（0.562，0.970）〕was significantly different from that of triglycerol（TG）〔0.878，95%CI（0.833，0.932），Z=5.898，P<0.001〕and high-density lipoprotein cholesterol （HDL-C）〔0.787，95%CI（0.730，0.844），Z=3.432，P<0.001〕，but similar to that of systolic blood pressure （SBP）〔0.688，95%CI（0.621，0.754），Z= 1.168，P= 0.243〕，diastolic blood pressure （DBP）〔0.592，95%CI（0.251，0.667），Z=0.777，P=0.437〕，low-density lipoprotein cholesterol（LDL-C）〔0.664，95%CI（0.598，0.731），Z=0.676，P= 0.449〕，fasting plasma glucose（FPG） 〔0.642，95%CI（0.571，0.713），Z=0.219，P=0.827〕，2 h-postprandial plasma glucose（2 h PG）〔0.647，95%CI（0.576，0.718），Z=0.319，P=0.750〕.The sensitivity of TG in serial combination with SUA was significantly different from that of TG in serial combination with FPG or 2 h PG，TG in serial combination with HDL-C or LDL-C and TG in serial combination with hypertension（P<0.001）；TG in serial combination with SUA showed obviously different specificity compared with TG in serial combination with FPG or 2 h PG（P=0.001） as well as TG in serial combination with hypertension（P<0.001），but was similar to that of TG in serial combination with HDL-C or LDL-C（P=0.324）．The κ of TG in serial combination with SUA did not significantly differ from that of TG in serial combination with FPG or 2 h PG，TG in serial combination with HDL-C or LDL-C，TG in serial combination with hypertension（Z=1.913，0.389，1.057；P=0.056，0.697，0.291）．The κ for measuring the extent of agreement was 0.357 between TG in serial combination with SUA and TG in serial combination with FPG or 2 h PG，0.554 between TG in serial combination with SUA and TG in serial combination with HDL-C or LDL-C，0.459 between TG in serial combination with SUA and TG in serial combination with hypertension.Conclusion　SUA can be used as a predictor of MS，and the prediction effect will be better if it is used in combination with TG.

Key words: Uric acid, Metabolic syndrome X, Obesity, Child

摘要： 目的　评价血尿酸预测肥胖男童代谢综合征（MS）的价值。方法　选取2008年6月—2015年10月在浙江大学医学院附属儿童医院内分泌科、湖州师范学院附属第一医院儿科、湖州市妇幼保健院儿科就诊的256例肥胖男童为研究对象，分为非MS组138例，MS组118例。对男童进行体格检查和实验室检查，并进行比较。采用受试者工作特征（ROC）曲线下面积、灵敏度、特异度、Kappa值评价尿酸及各指标联合预测肥胖男童MS的价值。结果　血尿酸、收缩压（SBP）、舒张压（DBP）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FPG）、餐后2 h血糖（2 h PG）预测肥胖男童MS曲线下面积分别为0.631〔95%CI（0.562，0.970）〕、0.688〔95%CI（0.621，0.754）〕、0.592〔95%CI（0.251，0.667）〕、0.878〔95%CI（0.833，0.932）〕、0.787〔95%CI（0.730，0.844）〕、0.664〔95%CI（0.598，0.731）〕、0.642〔95%CI（0.571，0.713）〕、0.647〔95%CI（0.576，0.718）〕。血尿酸与TG、HDL-C预测男童MS曲线下面积比较，差异有统计学意义（Z值分别为5.898、3.432，P值分别为<0.001、0.001）；与SBP、DBP、LDL-C、FPG、2 h PG预测男童MS曲线下面积比较，差异无统计学意义（Z值分别为1.168、0.777、0.676、0.219、0.319，P值分别为0.243、0.437、0.449、0.827、0.750）。TG串联血尿酸、TG串联FPG或2 h PG、TG串联HDL-C或LDL-C、TG串联高血压的灵敏度比较，差异有统计学意义（P值均为0.001）。TG串联血尿酸与TG串联FPG或2 h PG、TG串联高血压的特异度比较，差异有统计学意义（P值分别为0.001、<0.001）；与TG串联HDL-C或LDL-C的特异度比较，差异无统计学意义（P=0.324）。TG串联血尿酸的Kappa值与TG串联FPG或2 h PG、TG串联HDL-C或LDL-C、TG串联高血压的Kappa值比较，差异无统计学意义（Z值分别为1.913、0.389、1.057，P值分别为0.056、0.697、0.291）。TG串联血尿酸与TG串联FPG或2 h PG的诊断结果一致性Kappa值为0.357，与TG串联HDL-C或LDL-C的诊断结果一致性Kappa值为0.554，与TG串联高血压的诊断结果一致性Kappa值为0.459。结论　血尿酸可以作为肥胖男童MS的预测指标之一，且与TG联合预测MS具有较好的预测效果。

关键词: 尿酸, 代谢综合征X, 肥胖症, 儿童