青少年人群诊断糖尿病前期不宜采用糖化血红蛋白标准  

Poor performance of HbA1c in diagnosis of pre-diabetes in Chinese adolescents

作　　者：厉平[1] 姜冉华 李雪 王子楠[1] 李亮[1] 刘聪[1] 李玲[1,3] 

机构地区：[1]中国医科大学附属盛京医院内分泌科,沈阳110004 [2]辽阳市糖尿病医院 [3]辽宁省内分泌疾病重点实验室、国家重点实验室培育基地

出　　处：《中华内分泌代谢杂志》2011年第5期386-389,共4页Chinese Journal of Endocrinology and Metabolism

基　　金：辽宁省科学技术计划项目（2008225009,21）

摘　　要：目的探索2010年美国糖尿病协会（ADA）推荐的糖尿病前期HbA1c，诊断标准在中国青少年人群中的适用性。方法随机抽取辽阳市初中和高中学生933人（13～16岁，女性46．5％），测定HbA1c和宅腹血糖，对HbA1c 5．7％～6．4％的部分受试者进行口服葡萄糖耐量试验（OGTT），以受试者工作特性（ROC）曲线评价HbA1c对糖尿病前期的诊断价值。结果符合ADA2010年推荐的糖尿病前期诊断标准者213人，其中同时符合HbA1c和空腹血糖标准者仅占4．7％。HbA1c诊断空腹血糖升高的ROC曲线下面积为0．50（P=0．97）。由HbA1c标准诊断糖尿病前期并行OGTT的68人中18人确定为糖耐量受损或空腹血糖受损，HbA1c诊断糖尿病前期的ROC曲线下面积为0．53（P=0．69）。结论在中国青少年人群中HbA1c不宜作为糖尿病前期的诊断方法。Objective To evaluate the performance of HbA1c in diagnosis of pre-diabetes in Chinese adolescents. Methods A total of 933 students （ aged l 3-16 year, 46.5% female） without known history of diabetes were selected from junior and senior middle schools in Liaoyang city. HbA1c and fasting plasma glucose （FPG） levels were determined in all participants. Pre-diabetes was diagnosed as according to 2010 American Diabetes Association （ADA） criteria [ HbA1c 5.7 % -6.4%, FPG （ 5.6-6.9 ） mmol/L ]. The individuals with HbA1c≥ 5.7% underwent oral glucose tolerance test （OGTT）and were classified into impaired glucose tolerance （IGT）and impaired fasting glucose（IFG） according to 1999 World Health Organization（WHO） criteria. The performance of HbA1c in diagnosing pre-diabetes by the new criteria was evaluated by the traditional OGTT results based on receiver operating characteristic （ ROC ） curves. Results Among all participants, 213 （ 22. 8% ） individuals were diagnosed as prediabetic subjects. 72.3% of individuals with pre-diabetes were identified by HbA1c alone ,23.0% by FPG alone, and only 4.7% by both tests simultaneously. The ROC curve for HbA1c to identify impaired fasting glucose diagnosed by new criteria had an area under the curve （ AUC ） of 0.50 without statistical significance （ P = 0.97 ）. Of the 164 participants with HbA1c5.7% -6.4%, 68 individuals received OGTT, among which 18 subjects were diagnosed as IGT （ n = 14 ） or IFG （ n-= 4 ）. The ROC curve for HbA1c to identify pre-diabetes diagnosed by OGTT had an AUC of 0.53, without statistical significance（ P= 0.69）. Conclusion In Chinese adolescents, HbA1c is not suitable for diagnosis or screening of pre-diabetes.

关 键 词：糖化血红蛋白 口服葡萄糖耐量试验 青少年 糖尿病前期 

分 类 号：R587.1[医药卫生—内分泌]