摘要
目的：探讨评价糖化血红蛋白（HbA1c）在糖尿病（DM）高危受试者筛查中的应用及意义。方法对2013年1月~2014年6月来湖北省十堰市太和医院体检或门诊筛查的DM高危人群586例口服葡萄糖耐量试验（OGTT），并测定HbA1c、胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、空腹血糖（FPG）和2 h血糖（2 h PG），根据WHO的OGTT DM诊断标准，分为糖耐量正常组（NGT）、糖耐量受损（IGT）组、空腹血糖受损（IFG）组、IFG合并IGT组和DM组，利用ROC曲线分析HbA1c和FPG诊断DM的最佳切点，并评价诊断效果。结果根据ROC曲线，HbA1c诊断DM的最佳临界值为6.32%，曲线下面积（A UC）为0.914（95%CI 0.872～0.935），灵敏度为93.3%，特异度为90.7%；FPG诊断DM的最佳临界值为6.95 mmol/L，A UC为0.906（95%CI 0.854～0.942），灵敏度为91.8%，特异度为89.3%。 HbA1c和FPG的DM诊断准确度差异无统计学意义（Z=1.55，P〉0.05）。结论 HbA1c对DM诊断具有重要的价值，最佳切点为6.35%，这与以往的报道有一定的出入，分析原因可能与当地受试者的饮食和生活习惯有关。 HbA1c对DM的诊断仍需进一步收集大样本资料，确定HbA1c对湖北省DM高危人群的诊断最佳切点、灵敏度和特异性。
Objective To explore and evaluate the application and value of glycated hemoglobin （HbA1c） for screening of diabetes mellitus （DM） among the high risk of DM population. Methods The 586 enrolled subjects taken physical examination or out-patient screening in Taihe Hospital of Shiyan City from January 2013 to June 2014 were received oral glucose tolerance test （OGTT） and the level of HbA1c, fast plasma glucose （FPG）, 2 h plasma glucose （2 h PG）, cholesterol （TC）, triglyceride （TG）, low-density lipoprotein-cholesterol （LDL-C） and high-density lipoprotein-choles-terol （HDL-C） were determined. The subjects were classified into normal glucose tolerance （NGT） group, impaired glu-cose tolerance （IGT） group, impaired fasting glucose group （IFG） group, IFG combined IGT group and DM group ac-cording to the OGTT results. The optimal cut-points of HbA1c and FPG in diagnosis of DM were acquired using a re-ceiver operating characteristic curve （ROC curve） and the effect of diagnosis was evaluated. Results The optimal cut-point of HbA1c for diagnosing DM was 6.32%, with the sensitivity of 93.3%, specificity of 90.7%. The ROC curve showed that the area under the curve （A UC） of HbA1c was 0.914 （95%CI： 0.872-0.935）. The optimal cut-point of FPG for diagnosing DM was 6.95 mmol/L, with the sensitivity of 91.8%, specificity of 89.2%. The ROC curve showed that the A UC of FPG was 0.906 （95%CI： 0.854-0.942）. No significant difference of the accuracy of DM diagnosis was ob-served between HbA1c and FPG （Z=1.55, P〉0.05）. Conclusion The optimal cut-point of HbA1c for diagnosing DM is 6.32% and the value of HbA1c is important. The diet and lifestyle may be associated with the differences between this study and the previous reports. It is necessary to collect the large samples to define the optimal cut-point, sensitivity and specificity.
出处
《中国医药导报》
CAS
2015年第1期86-89,共4页
China Medical Herald
关键词
糖化血红蛋白
糖尿病
筛查
ROC
Glycated hemoglobin
Diabetes mellitus
Screening
ROC
