在中国人群中应用糖化血红蛋白诊断糖尿病：横断面流行病学调查  

Glycated haemoglobin Alc for diagnosing diabetes in Chinese population： cross sectional epidemiological survey

作　　者：包玉倩[1] 马晓静[1] 李华婷[1] 周密[1] 胡承[1] 吴海娅[1] 唐峻岭[1] 侯旭宏[1] 项坤三[1] 贾伟平[1] 

机构地区：[1]上海交通大学附属第六人民医院、上海市糖尿病临床医学中心、上海市糖尿病研究所,200233

出　　处：《英国医学杂志中文版》2010年第5期296-302,共7页The BMJ Chinese Edition

摘　　要：目的评估糖化血红蛋白（HbA1c）在中国人群中诊断糖尿病的效率，确定HbA1c在中国人群中诊断糖尿病的最佳切点。设计多级分层横断面调查。背景中国上海，2007-2008年。参与者4886例，年龄≥20岁，无明确糖尿病史。结局评估指标分析不同HbA1c切点判断糖尿病的效率。结果HbA1c和单纯空腹血糖判断糖尿病的受试者工作特征曲线（ROC）下面积分别为0．856（95％C10．828—0．883）和0．920（0．900～0．941）。在HbA1c切点处于6．3％（正常均值的2SD）时特异性较高（96．1％，95％CI95．5％-96．7％），相应的敏感性为62．8％（57．1％-68．3％），与单纯空腹血糖≥7．0mmol／L诊断糖尿病的敏感性相似（57．5％，95％CI51．7％-63．1％）。在糖尿病高危人群中，HbA1c切点处于6．3％的敏感性（66．9％，95％CI61．0％～72．5％）较空腹血糖≥7．0mmol／L（54．4％，95％CI48．3％-60．4％）及HbA1c≥65％（53．7％，95％CI47．6％一59．7％）相比显著升高（P〈0.01）。结论在中国人群中应用HbA1c≥6．3％切点检出未经诊断的糖尿病具有较高的特异性，其敏感性与单纯空腹血糖≥7．0mmol／L相似。该最佳切点在空腹血糖及OGTT不适用的情况下可作为中国成人糖尿病的诊断标准。Objectives To evaluate haemoglobin A1c （HbA1c） in diagnosing diabetes and identify the optimal HbA1c threshold to be used in Chinese adults. Design Multistage stratified cross sectional epidemiological survey.Setting Shanghai, China, 2007-8. Participants 4886 Chinese adults over 20 years of age with no history of diabetes. Main outcome measures Performance of HbA1c at increasing thresholds for diagnosing diabetes. Results The area under the receiver operating characteristics curve for detecting undiagnosed diabetes was 0. 856 （95% confidence interval 0. 828 to 0. 883 ） for HbA1c alone and 0. 920 （ 0. 900 to 0. 941 ） for fasting plasma glucose alone. Very high specificity （ 96. 1% , 95% confidence interval 95.5% to 96. 7%） was achieved at an HbAlo threshold of 6. 3% （2 SD above the normal mean）. Moreover, the corresponding sensitivity was 62. 8% （57.1% to 68. 3% ）, which was equivalent to that of a fasting plasma glucose threshold of 7.0 mmol/L （57.5%, 51.7% to 63. 1%） in detecting undiagnosed diabetes. In participants at high risk of diabetes, the HbA1c threshold of 6.3% showed significantly higher sensitivity （66.9% , 61.0% to 72. 5% ） than both fasting plasma glucose ≥ 7.0 mmol/L （ 54.4%, 48. 3% to 60. 4% ） and HbA1c≥6.5% （53.7%, 47.6% to 59.7%） （P 〈 0.01）. Conclusions An HbA1c threshold of 6. 3% was highly specific for detecting undiagnosed diabetes in Chinese adults and had sensitivity similar to that of using a fasting plasma glucose threshold of 7.0 mmol/L. This optimal HbA1c threshold may be suitable as a diagnostic criterion for diabetes in Chinese adults when fasting plasma glucose and oral glucose tolerance tests are not available.

关 键 词：糖化血红蛋白 糖尿病史 诊断标准 中国人群 横断面调查 流行病学调查 应用 受试者工作特征曲线 

分 类 号：R587.1[医药卫生—内分泌]