探讨糖化血清蛋白和糖化白蛋白在糖尿病高危人群的最佳切点  

Optimal cut point of glycosylated serum protein and glycated albumin in diagnosis of diabetes mellitus in high risk populations

作　　者：郑华[1] 贾春晖[1] 马芳玲[1] 汪保安[1] 邹效漫[1] 母义明[1] 

机构地区：[1]解放军总医院内分泌科,北京100853

出　　处：《军医进修学院学报》2011年第5期428-429,466,共3页Academic Journal of Pla Postgraduate Medical School

摘　　要：目的探讨以糖化血红蛋白(HbA1c)诊断糖尿病时,糖化血清蛋白(GSP)、糖化白蛋白(GA-L)和空腹血糖(FPG)的ROC曲线最佳切点。方法 88名可疑糖尿病患者(男54名、女34名),以2010年美国糖尿病学会(ADA)标准为诊断标准。通过绘制受试者工作特征曲线(ROC曲线),分析比较GSP、GA-L和FPG的诊断最佳切点及灵敏度和特异度。结果 GSP的ROC曲线最佳切点为186.1μmol/L,灵敏度55%,特异度98%,曲线下面积0.804,阳性似然比27.63,阴性似然比0.46,阳性预测值95%,阴性预测值74%;GA-L的ROC曲线最佳切点为16.86%,灵敏度61%,特异度98%,曲线下面积0.849,阳性似然比30.26,阴性似然比0.40,阳性预测值96%,阴性预测值77%;FPG的ROC曲线最佳切点为5.67mmol/L,灵敏度58%,特异度78%,曲线下面积0.736。结论三者相比,GA-L的特异度和灵敏度最高,ROC曲线下面积为GA-L>GSP>FPG,所以GA-L的诊断价值最好。Objective To study the optimal cut point of receiver operating characteristic（ROC） curves for glycosylated serum protein（GSP）,glycated albumin（GA-L） and fasting plasma glucose（FPG） when glycated hemoglobin（HbA1c） was used in diagnosis of diabetes mellitus（DM）.Methods ROC curves were plotted for 88 patients（54 males and 34 females） with suspicious DM diagnosed following the 2010 American Diabetes Association（ADA） diagnostic criteria.The optimal cut point,sensitivity and specificity of GSP,GA-L and FPG in diagnosis of DM were comparatively analyzed.Results The optimal cut point of ROC curves for GSP in diagnosis of DM was 186.1μmol/L,with a sensitivity of 55%,a specificity of 98%,area of 0.804 under the curve,a positive likelihood ratio of 27.63,a negative likelihood ratio of 0.46,a positive predictive value of 95% and a negative predicative value of 74%.The optimal cut point of ROC curves for GA-L in diagnosis of DM was 16.86%,with a sensitivity of 61%,a specificity of 98%,area of 0.849 under the curve,a positive likelihood ratio of 30.26,a negative likelihood ratio of 0.40,a positive predictive value of 96% and a negative predicative value of 77%.The optimal cut point of ROC curves for FPG in diagnosis of DM was 5.67mmol/L,with a sensitivity of 58%,a specificity of 78% and area of 0.736 under the curve.Conclusion Among the GA-L,GSP and FPG,the specificity and sensitivity of GA-L are the highest in diagnosis of DM.The accuracy of GA-L in diagnosis of DM is higher than that of GSP and FPG since the area under the curve is GA-LGSP FPG.

关 键 词：糖化血红蛋白 糖化血清蛋白 糖化白蛋白 空腹血糖 受试者工作特征曲线 糖尿病 

分 类 号：R587.1[医药卫生—内分泌]