糖化血红蛋白与糖调节受损血糖水平相关性的研究  

Correlation of glycosylated hemoglobin and blood glucose levels of impaired glucose regulation

作　　者：孟作龙[1] 李坤山[2] 方莹[3] 周颖[1] 赵艳[1] 韩月香[1] 王晓敏[1] 

机构地区：[1]兰州大学附属白银医院内分泌科,730900 [2]兰州大学附属白银医院医教科研科,730900 [3]兰州大学附属白银医院检验科,730900

出　　处：《中华糖尿病杂志》2010年第1期-,共5页CHINESE JOURNAL OF DIABETES MELLITUS

摘　　要：目的 探讨研究糖化血红蛋白(HbAlc)与糖调节受损血糖水平的相关性.方法 2009年2-3月在兰州大学附属白银医院在岗职工中开展口服75 g葡萄糖耐量试验(OGTT)和HbAlc普查,测定空腹血糖、服糖后2 h血糖及HbAlc,采用葡萄糖氧化酶法测定静脉血浆血糖,采用高效液相色谱分析法测定HbAlc.研究资料纳入标准:空腹血糖<7.0 mmol/L且服糖后2 h血糖<11.1mmol/L者,无糖尿病、血红蛋白病、肝、肾疾患等.进入结果分析的对象共726例,男197例,女529例,平均年龄(39±10)岁.其中正常糖耐量636例(87.6%),糖调节受损90例(12.4%),糖调节受损诊断采用1999年世界卫生组织糖尿病诊断标准.率间比较采用χ~2检验,双变量分析采用Pearson相关分析.结果 (1)糖调节受损占HbAlc≤5.7%人群的2.3%,占HbAlc≥5.8%的人群中89.3%.HbAlc≥5.8%时预测OGTT诊断的糖调节受损状态的敏感度、特异度、阳性预测值、阴性预测值分别为83%、99%、0.89和0.98;(2)OGTT诊断的空腹血糖受损、糖耐量减低及糖调节受损状态的患病率,在HbAlc为5.8%组与5.7%组比较差异具有统计学意义(χ~2值分别为10.077、22.219和27.780,P<0.01或P<0.001);(3)HbAlc水平与空腹血糖受损、糖耐量减低、糖调节受损的患病率之间呈显著性正相关(r值分别为0.957、0.928和0.936,均P<0.01).结论 (1)HbAlc预测糖调节受损与OGTT具有一致性,与OGTT诊断的糖调节受损状态相关的HbAlc最佳临界值为5.8%;(2)HbAlc与OGTT诊断空腹血糖受损、糖耐量减低、糖调节受损状态的血糖水平呈显著性正相关,且HbAlc为5.8%与其相关性极其密切.建议当HbAlc≥5.8%时均应行OGTY检查,以明确有无糖调节受损.Objective To investigate the correlation of glycosylated hemoglobin (HbAlc) and impaired glucose regulation(IGR). Methods Seventy-five g oral glucose tolerance test(OGTT)and HbAlc levels were carried out among our hospital staffs. The subjects were determined fasting plasma glucose (FPG), oral glucose 2 h plasma glucose(2 h PG)and HbAlc, plasma glucose levels and HbAlc levels were determined by glucose oxidase method and high performance liquid chromatogram ( HPLC). The inclusion criteria of subjects was FPG<7.0 mmol/L and 2 h PG<11.1 mmol/L, without diabetes, hemoglobin disease, hepatopathy and renopathy. The selected object contained 726 subjects (197 male, 529 female, mean age (39±10)), including NGT 636 subjects(87.6% ) , IGR 90 subjects( 12.4% ). The diagnostic criteria of IGR selected 1999 WHO diagnostic criteria for diabetes. χ~2 test was used for rate comparison. Pearson correlation analysis was used for bivariate analysis selected. Results (1)2.3% occurred IGR among HbAlc≤5.7% subjects, while 89. 3% occurred IGR among HbAlc≥5.8% subjects. When HbAlc ≥5.8% ,the sensibility, specificity, PV + , and PV - were 83% , 99% , 0.89, 0.98, respectively. (2) Between HbAlc level 5.8% group and HbAlc 5.7% group, the difference of prevalence of the OGTT diagnosed IFG,IGT,IGR had statistically significance(χ~2 value was 10. 077,22. 219 and 27. 780, P<0.01 or P<0.001), (3) HbAlc levels was significant positive correlation with the prevalence of IFG,IGT,IGR(rralue was 0.957,0.928 and 0.936, all P<0.01).Conclusions (1) Compared with OGTT, HbAlc had consistency for predicting IGR, and the optimal critical value of HbAlc with OGTT diagnosed IGR was 5.8%. (2) HbAlc levels was significant positive correlation with the blood sugar level of the OGTT diagnosed IFG, IGT, IGR, and when HbAlc =5.8%, its relevance is most closely. The present study suggests that the HbAlc ≥5.8% patients should be examined OGTT in order to identify whether the IGR.

关 键 词：糖化血红蛋白 糖调节受损 葡萄糖耐量试验 

分 类 号：R587[医药卫生—内分泌] R44[医药卫生—内科学]