糖代谢异常的糖化血红蛋白诊断切点值的研究  

Study on the cut-off value of glycosylated hemoglobin for the diagnosis of abnormal glucose metabolism

作　　者：黄丽霞 张静[1] 董彩霞[1] 何虎鹏[1] 席金恩[1] 任晓岚[1] HUANG Lixia;ZHANG Jing;DONG Caixia(Department of Community Health and Chronic non-Communicable Disease Prevention and Control,Gansu Provincial Center for Disease Control and Prevention,Lanzhou 730030,China)

机构地区：[1]甘肃省疾病预防控制中心社区卫生与慢性非传染性疾病防制科,兰州730030

出　　处：《中国糖尿病杂志》2023年第7期500-504,共5页Chinese Journal of Diabetes

基　　金：甘肃省卫生行业科研计划管理项目(GWGL2013-17)

摘　　要：目的探讨HbA_(1)c用于一般人群糖代谢异常诊断的切点值。方法采用分层整群抽样法,选取甘肃省≥18岁常住居民为7080名。按1999年WHO糖代谢异常诊断标准,分为正常对照组(NC,n=5424)、糖尿病前期组(Pre-DM,n=980)、DM组(n=676),比较各组一般资料及生化指标,Pearson相关分析FPG、2 hPG与其他指标的相关性,采用受试者工作特征(ROC)曲线分析HbA_(1)c对糖代谢异常的诊断价值,以约登指数最大判定切点值。结果与NC组比较,Pre-DM、DM组BMI、WC、SBP、DBP、FPG、2 hPG、TC、TG、LDL-C、HbA_(1)c升高(P<0.01),HDL-C降低(P<0.01)。Pearson相关分析显示,FPG、2 hPG与年龄、BMI、WC、SBP、DBP、HbA_(1)c、TC、TG、LDL-C呈正相关(P<0.01),与HDL-C呈负相关(P<0.01)。Logistic回归分析显示,HbA_(1)c是Pre-DM和DM的影响因素,校正各项混杂因素后,HbA_(1)c仍是DM的影响因素。ROC曲线分析显示,HbA_(1)c诊断Pre-DM的曲线下面积(AUC)为0.583,HbA_(1)c诊断DM的AUC为0.844。HbA_(1)c诊断DM切点值为5.8%,敏感度61.8%,特异度95.7%。结论HbA_(1)c诊断Pre-DM证据不足,但当诊断切点值为5.8%时,可用于一般人群DM诊断。Objective To explore the cut-off value of glycosylated hemoglobin(HbA_(1)c)for the diagnosis of abnormal glucose metabolism in general population.Methods Permanent residents≥18 years old in Gansu province were selected as study object by stratified cluster sampling method.Finally,a total of 7080 participants were enrolled in this study.All the participants were divided into three groups according to the WHO diagnostic criteria for abnormal glucose metabolism in 1999:normal control group(NC,n=5424),prediabetic state group(Pre-DM,n=980)and DM group(DM,n=676).The general data and biochemical indicators were compared among the groups.Pearson correlation analysis was used to analyze the correlation between FPG,OGTT-2 h and other indicators.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of HbA_(1)cfor abnormal glucose metabolism,and the maximum Youden index was used to determine the cut-off value.Results Compared with NC group,BMI,WC,SBP,DBP,FPG,2 hPG,TC,TG,LDL-C and HbA_(1)cwere increased(P<0.01),while HDL-C was decreased(P<0.01)in Pre-DM and DM groups.Pearson correlation analysis showed that FPG and 2 hPG were positively correlated with age,BMI,WC,SBP,DBP,TC,TG,LDL-C and HbA_(1)c(P<0.01),and negatively correlated with HDL-C(P<0.01).Logistic regression analysis showed that HbA_(1)cwas the risk factor for Pre-DM and DM.After adjusting for confounding factors,HbA_(1)cwas still the risk factor for DM.The area under the ROC curve for diagnosing Pre-DM and DM were 0.583 and 0.844,and the cut-off value of HbA_(1)cfor diagnosing DM was 5.8%,with a sensitivity of 61.8%and a specificity of 95.7%.Conclusion There is insufficient evidence for HbA_(1)cto diagnose Pre-DM,but when the diagnostic cut-off value is 5.8%,HbA_(1)ccan be used for the diagnosis of DM in the general population.

关 键 词：糖化血红蛋白 糖尿病 糖尿病前期 口服葡萄糖耐量试验 受试者工作特征曲线 

分 类 号：R587.1[医药卫生—内分泌] R446.1[医药卫生—内科学]