空腹血浆葡萄糖、口服葡萄糖耐量试验和糖化血红蛋白筛查糖代谢异常的观察  

Screening for abnormal glucose metabolism using FPG,OGTT,and HbA1c test

作　　者：苏伟[1] 王莉[1] 尚有全 刘向宁[1] 刘洋[1] 白媛媛[1] 

机构地区：[1]陕西省宝鸡市中心医院糖尿病科,宝鸡721008

出　　处：《中国糖尿病杂志》2013年第2期154-156,共3页Chinese Journal of Diabetes

摘　　要：目的评价FPG、OGTT和HbA1c在筛查糖尿病和IGR时的应用价值。方法选取研究对象222例,同时行FPG、OGTT和HbA1c检测。进行χ2检验、绘制ROC曲线,分别研究以OGTT为"金标准"时FPG、HbA1c诊断糖尿病及IGR相对应的临界点。结果诊断NGT 43名(19.3%),糖尿病86例(38.9%),IGR 96例(43.2%)。单独应用FPG诊断糖尿病,检出45例,会产生显著的漏诊率(P<0.05)。通过ROC曲线发现,与OGTT诊断糖尿病相关的FPG的临界点为6.3mmol/L,敏感性、特异性为84.6%和77.1%;以OGTT诊断糖尿病相关的HbA1c临界点为6.3%,敏感性、特异性为66.2%和81.5%;以OGTT诊断IGT时,FPG的临界点为5.6mmol/L时,敏感性、特异性为71.2%和61.2%;以OGTT诊断IGT时,相关的HbA1c临界点为5.7%时,敏感性、特异性为76.3%和67.5%。结论本研究以FPG和HbA1c诊断糖尿病的切点为6.3mmol/L及6.3%。当FPG≥6.3mmol/L,HbA1c≥6.3%时要考虑是否患有糖尿病的可能性,并进行OGTT以确定诊断。Objective To evaluate the application values of FPG,OGTT,and HbA1c in screening DM and IGR.Methods The 222 subjects with risk factors for DM underwent the tests of FPG,OGTT,and HbA1c simultaneously.Through the chi square test and making the receiver operating characteristic curve（ROC curve）,the optimal cut points for FPG and HbA1c for diagnosis of DM and DM risks were established using 75 g OGTT as the gold standard.Results There were 43 cases（19.3%） having normal glucose tolerance（NGT）,86 cases（38.9%） having DM,and 96 cases（43.2%） having increased risks for diabetes.Using only FPG as diagnosis criteria,there were 45 cases diagnosed as diabetes,with a high missed diagnosis rate（P0.05）.In using only the ROC curve the optimal cut-point of FPG for diagnosis of DM was 6.3 mmol/L,and its sensitivity and specificity were 84.6% and 77.1% respectively;the optimal cut-point of HbA1c for diagosis of DM was 6.3%,and its sensitivity and specificity were 66.2% and 81.5% respectively.In using OGTT the optimal cut-point of FPG relating to IGT was 5.6 mmol/L,and its sensitivity and specificity were 71.2% and 61.2% respectively;the optimal cut-point of HbA1c for IGT was 5.7%,and its sensitivity and specificity were 76.3% and 67.5% respectively.Conclusion Using only FPG as diagnosis criteria may create a high false negative rate.When highly suspecting DM in case of FPG≥6.3 mmol/L or HbA1c≥6.3%,the OGTT should be carried out for final diagnosis.

关 键 词：糖尿病 糖耐量异常 空腹血糖 糖化血红蛋白 口服糖耐量试验 ROC曲线 筛查 

分 类 号：R587.1[医药卫生—内分泌]