2型糖尿病患者血浆1,5-AG测定的临床意义  

Cliniacal significance of 1,5-anhydro-D-glucitol assay in type 2 diabtes mellitus

作　　者：李蓉[1] 张素华[1] 李晨钟[1] 李萍[1] 

机构地区：[1]重庆医科大学附属第一医院内分泌科,400016

出　　处：《重庆医学》2005年第1期24-26,共3页Chongqing medicine

摘　　要：目的　评价血浆 1,5 脱水山梨醇 (1,5 AG)对糖尿病诊断和血糖监测的临床价值。方法　对 96例 2型糖尿病、13例糖调节受损及 5 5例正常对照进行研究 ,测定了血浆 1,5 AG、空腹及餐后 2h血糖、HbA1c等指标 ,糖尿病患者还检测了 2 4h尿糖和尿白蛋白排泄率 (AER)。结果　糖尿病组血浆 1,5 AG水平显著低于正常对照和IGR组 (P <0 .0 1) ,IGR组血浆 1,5 AG也低于正常对照 (P <0 .0 5 )。多元逐步回归分析提示FPG、2 4h尿糖与 1,5 AG呈显著负相关 ,标准偏回归系数分别为 - 0 .6 0 9(P <0 .0 1)和 - 0 .2 35 (P <0 .0 5 )。在糖尿病患者 ,正常白蛋白尿组和微量白蛋白尿组 1,5 AG水平与FPG、2hPG、HbA1c、2 4h尿糖均呈显著负相关 (P <0 .0 1) ,而与AER无相关性 (P >0 .0 5 )。糖尿病组和对照组在空腹、服糖后 1h、2h的 1,5 AG水平无明显波动。1,5 AG诊断糖尿病的ROC曲线下面积为 0 .95 6 ,最佳切点位于 14mg/L ,其诊断的敏感度和特异度分别为 88.5 %和89.0 %。结论　 1,5 AG可作为糖尿病的诊断和短期血糖监测指标 ,且不受进餐的影响 ,还可用于微量白蛋白尿的糖尿病患者。Objective To evaluate the clinical significance of 1,5-anhydro-D-glucitol(1,5-AG) as a new marker for diagnosis and monitoring glucose metabolism in type 2 diabetes mellitus. Methods Plasma 1,5-AG, fasting plasma glucose(FPG),2h postprandial plasma glucose(2hPG) and HbA1c were determined in 96 type 2 diabetes mellitus,13 patients with impaired glucose regulation(IGR) and 55 control subjects. Albumin excretion rate (AER) and 24h urinary glucose(24h UG)were also studied in diabetic patients. Results Plasma 1,5-AG was obviously lower in the diabetes than that in IGR and controls(P<0.01).Compared with controls, IGR patients had lower plasma 1,5-AG(P<0.05).Stepwise multiple regression analysis showed 1,5-AG had significantly inverse correlation with FPG and 24h UG,and standardized coefficients were -0.609(P<0.01) and -0.235(P<0.05) respectively. Among diabetes, either in normal urinary albumin or in microalbuminuria subsection, plasma 1,5-AG had negative correlation with FPG,2hPG,HbA1c and 24h UG(P<0.01), but had no correlation with AER(P>0.05). Both in diabetic patients and controls,no significant fluctuation of 1,5-AG was found as fasting,1h and 2h after taking 75g glucose. The area under the ROC curve was 0.956 for 1,5-AG in the diagnosis of diabetes, 1,5-AG 14mg/L had the best equilibrium between sensitivity and specificity for diagnosing diabetes,and the sensitivity and specificity were 88.5% and 89.0% respectively. Conclusion Plasma 1,5 -AG can be used as a marker of diagnosis and monitoring glucose control in diabetes.No significant influence of diet is observed, and 1,5-AG can be used in diabetic patients with microalbuminuria.

关 键 词：1 5-脱水山梨醇 糖尿病 监测指标 诊断 

分 类 号：R587.1[医药卫生—内分泌] R446.112[医药卫生—内科学]