糖化血红蛋白检测对中国成年人糖尿病前期诊断的意义  

Diagnostic value of HbA_(1C) as a screening tool for prediabetes in Chinese adults

作　　者：吴洁[1] 邱玲[1] 程歆琦[1] 赵丽娜[1] 国秀芝[1] 吴卫[1] 王青[2] 倪兰[2] 徐涛[3] 朱广瑾[3] 

机构地区：[1]中国医学科学院北京协和医院检验科,北京100730 [2]宁夏医科大学总医院医学实验中心,银川750004 [3]中国医学科学院基础医学研究所,北京100005

出　　处：《临床检验杂志（电子版）》2012年第4期228-232,共5页Clinical Laboratory Journal(Electronic Edition)

基　　金：国家重点基础研究发展计划(973计划)项目(2006FY110300);国家科技支撑计划(2012BAI37B02)

摘　　要：目的探讨糖化血红蛋白(HbA_1C)在中国成年人糖尿病前期筛查中的诊断价值。方法选取宁夏回族自治区有代表性的城区和郊区进行横断面调查,抽取不同年龄和职业的城乡居民共3362人（年龄18⁸3岁,男性1691人,女性1671人）,进行问卷调查和体格检查,采集空腹静脉血测定其糖化血红蛋白((HbA_1C),空腹血糖（FPG）及各项生化指标,并对结果进行分析。结果初筛符合2010年ADA推荐糖尿病前期诊断标准者613人（18.2%）,单独符合(HbA_1C标准((HbA_1C 5.7%⁶.4%)和FPG标准（FPG 5.6-6.9 mmol/L）者分别为327人（9.7%）和428人（12.7%）,同时符合(HbA_1C和FPG标准者为142人（4.2%）。(HbA_1C诊断FPG升高的R0C曲线下面积为0.743（P【0.001）。将空腹血糖受损（IFG）作为糖尿病前期诊断标准,以(HbA_1C5.7%为糖尿病前期诊断临界值,其诊断灵敏度为33.2%,特异度为93.7%,阳性预测值为43.4%,阴性预测值为90.6%。(HbA_1C与心血管风险因子存在显著相关性。结论 (HbA_1C在中国成人糖尿病前期的筛查诊断中具有良好的价值,且与心脏代谢性疾病紧密相关。Objective To explore the diagnostic value of HbA_(1C) as a screening tool for prediabetes in Chinese adults.Methods A population based investigation was carried out cross-sectionally in a sample of 3362(1691 men and 1671 women,aged from 18-83) in Ningxia Hui Autonomous Region.Questionnaires and physical examinations were performed by standard operation procedure.Fasting blood was collected for HbA_(1c),FPG and other biochemistry markers testing and the results were analyzed.Results According to 2010 ADA recommended diagnostic criteria,613(18.2%) individuals were diagnosed as prediabetic subjects,327(9.7%) individuals with prediabetes were identified by HbA_(1C) alone,428(12.7%) individuals by FPG alone,and 142(4.2%) by both tests simultaneously among all participants.The ROC curve for HbA_(1C) to identify impaired fasting glucose had an area under the curve(AUC) of 0.743(P<0.001).Using IFG as the reference standard,pre-diabetes by the HbA_(1C)criterion has 33.2%sensitivity,93.7%specificity,43.4%positive predictive value,and 90.6%negative predictive value.Significant correlation was found between HbAlc and cardiometabolic risk factors.Conclusions HbA_(1C) is suitable to be ascreening and diagnosis tool for prediabetes in Chinese adults and closely related to cardiometabolic disease.

关 键 词：糖化血红蛋白 空腹血糖 糖尿病前期 

分 类 号：R587.1[医药卫生—内分泌]