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目的探讨采用糖化血红蛋白(HbA1c)不同标准评估糖尿病及糖耐量异常的可行性。方法在北京某高校2010年度查体人群中行口服葡萄糖耐量试验(OGTT)进行糖尿病筛查,同时测定HbA1c、血脂、血尿酸、肝肾功能指标。以OGTT为标准,比较HbA1c与之对应工作特征曲线(ROC曲线)的可能切点并与美国糖尿病学会(ADA)推荐标准比较;分析影响HbA1c与年龄及代谢综合征高危因素的关系。结果 (1)本研究参检者共有1174人,经OGTT筛查新诊断糖尿病(NDD)15例,加上既往诊断糖尿病29例,总患病率为3.7%。(2)除外已有糖尿病和其他HbA1c检测的影响因素纳入研究1059人。参照OGTT结果依据ROC判断,本组人群HbA1c诊断糖尿病的最佳临界点为5.7%,敏感性66.7%,特异性86.7%;按此界点将漏诊33.4%NDD,另包括33例糖调节异常(IGR,44.0%),103例糖耐量正常(NGT,10.6%)。HbA1c筛查IGR(包括空腹血糖异常3例、糖耐量减低(68例)的切点为5.6%,敏感性55.8%,特异性82.8%,按此界点将漏诊IGR44.2%,另包括164例NGT(16.9%)及11例NDD(73.3%)。(3)按6.5%(NDD)和6.0%(IGR)界点,在本人群的敏感性和特异性分别为26.7%、99.9%和16.9%、98.6%。(4)本研究中HbA1c测定值有随年龄增长的趋势,当HbA1c≥6.0%和HbA1c≥5.7%时,分别有85.7%和70%的NDD存在两个及两个以上高危因素。结论在本组低发糖尿病人群中,HbA1c诊断糖尿病及IGR的ROC最佳切点分别为5.7%和5.6%,远低于ADA≥6.5%和6.0%的标准。按5.7%标准切分异常人群,将纳入约10%的NGT者,按ADA6.5%作为糖尿病诊断标准特异性高。
Objective To investigate the feasibility of using different criteria of glycosylated hemoglobin (HbA1c) to evaluate diabetes and impaired glucose tolerance. Methods OGTT was conducted in a college physical examination in Beijing in 2010 to screen for diabetes mellitus, and HbA1c, blood lipid, serum uric acid and liver and kidney were measured at the same time. The possible cut-points of HbA1c and its corresponding working characteristic curve (ROC curve) were compared with OGTT criteria and compared with the American Diabetes Association (ADA) recommendation criteria; the relationship between HbA1c and age and risk factors of metabolic syndrome was analyzed. Results (1) There were 1174 participants in this study. Fifteen patients were newly diagnosed with diabetes by OGTT screening. In addition, 29 cases were diagnosed with diabetes mellitus. The overall prevalence was 3.7%. (2) Excluding the influencing factors of diabetes and other HbA1c tests were included in the study of 1059 people. According to the results of OGTT, the best cut-off point of HbA1c in diagnosing diabetes was 5.7%, with a sensitivity of 66.7% and a specificity of 86.7%. According to this point, 33.4% of NDD were missed and 33 cases of abnormal glucose regulation IGR, 44.0%) and normal glucose tolerance was normal in 103 (NGT, 10.6%). HbA1c screening IGR (including fasting blood glucose abnormalities in 3 cases, impaired glucose tolerance (68 cases) cut-point was 5.6%, sensitivity 55.8%, specificity 82.8%, according to this point will miss IGR 44.2%, another including 164 (16.9%) and NDD (73.3%). (3) The sensitivity and specificity of this population were 26.7%, 99.9% and 6.5% (NDD) and 6.0% 16.9% and 98.6% respectively. (4) HbA1c in this study showed a trend of increasing with age. When HbA1c≥6.0% and HbA1c≥5.7%, 85.7% and 70% of NDD had two or more NDD Risk factors.Conclusion The best ROC cutoff points for HbA1c diagnosis of diabetes and IGR were 5.7% and 5.6% respectively in this group of patients with diabetes mellitus, much lower than the standard of ADA ≥6.5% and 6.0% Abnormal populations, will be included in about 10% of NGT, according to ADA 6.5% as a diagnostic criteria for diabetes high specificity.