糖化血红蛋白评估中青年院校人群糖代谢异常的切点分析  

Correlativity study of the glycosylated hemoglobin to evaluate diabetes mellitus and impaired glucose regulation

作　　者：李晨曦[1] 田慧[1] 方福生[1] 李春霖[1] 李楠[1] 成小玲[1] 苗新宇[1] 杨彦[1] 王良宸[1] 孙般若[1] 邹效漫[1] 马芳玲[1] 

机构地区：[1]解放军总医院老年内分泌科,北京100853

出　　处：《中华临床医师杂志（电子版）》2011年第8期2286-2292,共7页Chinese Journal of Clinicians(Electronic Edition)

基　　金：全军医药卫生科研基金课题:糖尿病与代谢综合征的综合防治(07BJZ03)

摘　　要：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 identify the optimal HbA1c threshold which as a diagnostic test for type 2 diabetes in middle-age adults.Methods This study included 1059 adults from one institution of higher learning.Without known diabetes who had an oral glucose tolerance test and HbA1c,serum biochemistry indicators were measured on the same day.Make use of receiver operating characteristics curve to detect optimal HbA1c threshold.Results(1)HbA1c levels with age increasing.Under the age of 30,the average of HbA1c is(5.2±0.3)%,while,at the age of 50-80,the average of HbA1c is(5.6±0.6)%.(2)According to ROC,the optimal cut-off point of HbA1c for the diagnosis of diabetes is 5.7%(sensitivity 66.7%,specificity 86.7%),this result mean that 66.7% of diabetic subjects show an HbA1c≥5.7%,while 10.6% NGT and 44.0% IGR subjects have an HbA1c≥5.7%.(3)Similarly,the optimal cut-off point of HbA1c for the diagnosis of IGR is 5.6%(sensitivity 55.8%,specificity 82.8%),this result mean that 56.0% of IGR subjects show an HbA1c≥5.6%,while 16.9% NGT and 73.3% NDD subjects have an HbA1c≥5.6%.(4)The risk factors of metabolic syndrome with HbA1c levels increasing.When HbA1c≥6.0% and HbA1c≥6.2%,there are two or more risk factors of metabolic syndrome in 85.7% NDD and 75% IGR subjects,respectively.Conclusions The optimal cut-off points of HbA1c for the diagnosis of diabetes and IGR is 5.7%,5.6%,respectively.If use the HbA1c 5.7% to separating NDD from NGT,about 10% NGT subjects will be diagnosed NDD.The risk factors of metabolic syndrome is increased obviously when HbA1c≥6.0%.

关 键 词：血红蛋白A 糖基化 葡糖耐量试验 糖尿病 代谢综合征 

分 类 号：R587.1[医药卫生—内分泌]