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目的评价空腹血糖(FPG)和糖化血红蛋白(HbA1c)在自然人群中糖尿病(DM)的筛查效果,为DM流行病学调查中DM筛查方法的选择提供参考依据。方法于2010年10—12月采用多阶段分层随机整群抽样方法抽取云南省6个国家级死因登记报告县/区的3 489名≥18岁自然人群进行FPG、服糖后2 h血糖(2h PG)和HbA1c实验室检测,并应用受试者工作特征(ROC)曲线获得FPG、HbA1c与DM的最佳临界点及其灵敏度、特异度和曲线下面积。结果按照世界卫生组织1999年标准,云南省3 489名≥18岁自然人群中正常血糖、空腹血糖受损(IFG)、糖耐量减低(IGT)和DM者分别为2 975人(85.3%)、230例(6.6%)、176例(5.0%)和108例(3.1%);FPG诊断DM的最佳临界点为6.4 mmol/L,灵敏度和特异度分别为86.1%和96.5%,曲线下面积为0.926(95%CI=0.887~0.965),阳性似然比为24.60,阴性似然比为0.14,约登指数为0.83;HbA1c诊断DM的最佳临界点为6.15%,灵敏度和特异度分别为66.7%和87.1%,曲线下面积为0.814(95%CI=0.762~0.867),阳性似然比为5.18,阴性似然比为0.38,约登指数为0.53。结论在DM流行病学调查中采用FPG筛查DM效果优于HbA1c。
Objective To evaluate the screening effect of fasting blood glucose (FPG) and glycosylated hemoglobin (HbA1c) on diabetic patients in the natural population and provide a reference for the selection of DM screening methods in the epidemiological survey of DM. Methods From March to December in 2010, a total of 3 489 natural population aged 18 years or older were selected from multistage stratified random cluster sampling in 64 counties in Yunnan Province for FPG. Blood glucose 2h PG) and HbA1c laboratory test. The best critical point of FPG, HbA1c and DM and its sensitivity, specificity and area under the curve were obtained by using receiver operating characteristic (ROC) curves. Results According to the WHO standard in 1999, 2,975 (85.3%) of normal blood glucose, impaired fasting glucose (IFG), impaired glucose tolerance (IGT) 230 cases (6.6%), 176 cases (5.0%) and 108 cases (3.1%). The best cutoff point of FPG was 6.4 mmol / L and the sensitivity and specificity were 86.1% and 96.5% respectively. The area under the curve (0.926, 95% CI = 0.887-0.965). The positive likelihood ratio was 24.60, the negative likelihood ratio was 0.14, and the Youden index was 0.83. The best critical point for HbA1c diagnosis was 6.15%, the sensitivity and specificity were 66.7%, and 87.1% respectively. The area under the curve was 0.814 (95% CI = 0.762-0.867). The positive likelihood ratio was 5.18, the negative likelihood ratio was 0.38, and the Youden index was 0.53. Conclusion The use of FPG to screen DM in epidemiological survey of DM is better than that of HbA1c.