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糖化血红蛋白用于诊断2型糖尿病及糖尿病前期的临床研究

王晨秀1,霍亚南2   

  1. 1. 江西省南昌大学研究生院医学部 江西省人民医院内分泌科
    2. 江西省人民医院内分泌科
  • 收稿日期:2011-06-16 修回日期:2011-08-23 出版日期:2012-05-15 发布日期:2012-05-15
  • 通讯作者: 霍亚南

The clinical reseatch of Glycated Hemoglobin(HbA1c) for the diagnosis of Diabetes Mellitus and Pre-diabetes.

  • Received:2011-06-16 Revised:2011-08-23 Published:2012-05-15 Online:2012-05-15

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摘要： 目的：评估糖化血红蛋白（HbA1c）对糖尿病（DM）及糖尿病前期的诊断价值。方法：至我院包括为明确DM诊断而就诊者及DM高危人群共457例，其中男297例，女160例，平均年龄61.4±13.1岁，均行口服葡萄糖耐量试验（OGTT），并测定HbA1c。按照1999年WHO糖尿病的诊断标准， 将受试者 分为糖耐量正常组（NGT 81例）、空腹血糖受损组（IFG 7例）、糖耐量异常组（IGT 76例）、 IFG+IGT组（13例）、DM组（280例）。采用受试者工作曲线(ROC曲线)来判断其最佳切点。结果：1. HbA1c诊断DM的切点为6.45%,敏感性为0.794，特异性为0.825，曲线下面积为0.871（95% C10.839～0.903)。2. HbA1c诊断糖尿病前期的切点为5.85%，敏感性为0.583，特异性为0.531，曲线下面积为0.587（95% C1 0.504～0.671)。 3.依据HbA1c≥6.45%来诊断糖尿病时，敏感性为0.794，特异性为0.825，漏诊率为21.1%；应用FPG≥7.0mmol/L或HbA1c≥6.45%时，敏感性为 0.871，特异性为0.623，漏诊率为12.9%。结论：1.建议HbA1c诊断DM的切点为6.45%，其敏感性和特异性较高。诊断糖尿病前期HbA1c的切点为5.85%，但敏感性及特异性均较低，诊断意义较小。2.在筛查糖尿病时，同时检测HbA1c和FPG可减少漏诊率。

关键词: 糖化血红蛋白, 口服葡萄糖耐量试验, 糖尿病, 空腹血糖, ROC曲线

Abstract: Objective To assess the validity of using fasting plasma glucose(FPG)and HbA1c for the screening of diabetes and pre-diabetes。Methods 457 subjects，（ 297men,160 women，average age 61.4士13.1years） in our hospital underwent an oral glucose tolerance test(OGTT) for screening diabetes．HbA1c was examined at the same time.Based on 1999 WHO criteria，81 had normal glucose tolerance (NGT)，7 had impaired fasting glucose(IFG)，76 had impaired glucose tolerance (IGT),13 had IGT and IFG，280 had diabetes．Using a receiver oerating characteristic curve(ROC curve)to judge the optimal cut-point.Result 1.the optimal cut-point of HbA1c for DM was 6.45% that was associated with a sensitivity and specificity of 0.794 and 0.825 respectively.Area under the curve was 0.871(95%CI0.839～0.903).2. The cut-point of HbAlc for pre-diabetes was 5.85% ，which was associated with a sensitivity and specificity of 0.583 and 0.531 respectively．Area under the curve was 0.587（95% C1 0.504～0.671).3 When only used HbA1c to screening DM, the sensitivity and specificity are 0.794 and 0.825 respectively, the rate of misdiagnosis is 21.3%;When only used FPG to screening DM, the sensitivity is 0.646,the rate of misdiagnos is 35.3%;But when using FPG or HbA1c to screening DM,the sensitivitiy and specificity are 0.871 and 0.623 respectively,the rate of misdiagnosis is 12.9%。 Conclusions 1.Suggest the optimal cut-point of HbA1c for diabetes was 6.45% ,because it have the high sensitivity and specificity.2.The cut-point of HbA1c for pre-diabetes is 5.85%.But the sensitivity and specificity are lower,so it have little diagnose meaning.3.The detection of FPG and HbA1c may reduce erroneous misdiagnosis rate.

Key words: Fasting plasma glucose, HbAlc, Oral glucose tolerance test, Diabetes mellitus, Receiver operator characteristic curve(R0C curve)