HbA_1c和空腹血糖在糖尿病筛查中的应用价值  

The value of glycated hemoglobin versus fasting plasma glucose for the screening of diabetes mellitus

作　　者：俞丹[1] 向爱华[2] 邓红英[2] 陈素芬[2] 蔡亚华[2] 刘璇[1] 单珊[1] 钱莉[1] 付麒[1] 王知笑[1] 范红旗[1] 张梅[1] 王虹[3] 杨涛[1] 朱广家[2] 

机构地区：[1]南京医科大学第一附属医院内分泌科,210029 [2]南京医科大学第一附属医院预防保健科,210029 [3]南京医科大学第一附属医院呼吸科,210029

出　　处：《中国糖尿病杂志》2011年第11期809-811,共3页Chinese Journal of Diabetes

基　　金：江苏省科技支撑计划(社会发展)(BE2009687;BE2009613);江苏省卫生厅指导性科研项目(Z200901)

摘　　要：目的探索HbA_1c及FPG筛查糖尿病(DM)的应用价值。方法南京地区参加体检的未诊断糖尿病1330例,测定FPG和HbA_1c,予标准化早餐后测定餐后2小时血糖(2hPG),用受试者工作特征曲线(ROC)评价FPG和HbA_1c筛查糖尿病的效果。结果按1999年WHO的糖尿病诊断标准,本研究人群DM患病率为6.8%。采用ROC曲线判断,与DM状态相关的FPG临界点为6.1mmol/L,敏感性和特异性分别为81.3%和96.3%;HbA_1c临界点为6.1%,敏感性和特异性分别为83.5%和88.8%。当采用FPG≥6.1mmol/L或HbA_1c≥6.1%作为标准时,敏感性达到92.3%,同时有较好的特异性81.2%。结论单独使用FPG较HbA_1c在筛查DM中具有稍高的价值,为了最大限度的筛查DM患者,建议对6.1mmcl/L≤FPG≤7.0mmol/L或HbA_1c≥6.1%的患者行OGTT以明确有无糖尿病。Objective To explore the optimal cut-off point of the glycosylated hemoglobin （HbA1 c） versus fasting plasma glucose （FPG） for screening diabetes （DM）, and to validate the current HbA1c diagnostic criteria from large-scale epidemiologicaI survey. Methods A total of 1330 non-diabetic subjects who participated in health examination in Nanjing were included. All subjects underwent standardized breakfast and HbA1 c measurement. Receiver operating characteristic （ROC） curve analysis was used to examine the sensitivity and specificity of FPG and HbA1 c for diagosing diabetes, which was defined by the standard from WHO in 1999. Results DM prevalence was 6.8%. Based on the ROC curve, the optimal cut-point of FPG related to the OGTT-diagnostic criteria for diabetes was 6.1 mmol/L which was associated with a sensitivity and specificity of 81.30~ and 96.3% respectively. The optimal cut-point of HbAlc related to diabetes diagnosis by OGTT was 6.1%, which was associated with a sensitivity and specificity of 83.5% and 88. 8% respectively. If the proposed use of HbA1 c≥ 6.5 % of ADA as a diagnostic criteria for DM was adopted, the sensitivity and specificity were 59.3% and 97.4%. If the newly proposed HbA1c≥ 6.3% as a diagnostic criteria of DM for the Chinese population was adopted, the sensitivity and specificity were 71.4% and 94. 7%： The screening model using FPG≥ 6. lmmol/L or HbA1c ≥ 6.1% had sensitivities of 92.3% for detecting undiagnosed diabetes. Conclusions Compared with HbA1 c in screening DM, FPG has a slightly higher diagnostic value. The simultaneous measurement of FPG and HbAlc might be a more sensitive and specific screening tool for identifying high-risk individuals for diabetes at an early stage.

关 键 词：糖化血红蛋白 糖尿病 受试者工作特征曲线 

分 类 号：R587.1[医药卫生—内分泌]