应用国际糖化血红蛋白诊断标准对中国长沙地区成年人糖代谢异常筛查的比较研究  

Application International HbAlc Diagnostic Criteria in Screening Abnormal Glucose Metabolism in Changsha Adults Populations

作　　者：莫喜明[1] 刘茵茵[1] 李影[1] 唐爱国[1] 

机构地区：[1]中南大学湘雅二医院检验科,长沙410011

出　　处：《现代检验医学杂志》2013年第2期18-22,共5页Journal of Modern Laboratory Medicine

摘　　要：目的探讨国际糖化血红蛋白（HbA1c）诊断标准是否适用于长沙地区人群糖尿病（DM）的诊断和筛查。方法2012年1～4月在中南大学湘雅二医院体检中心进行体检的人员，排除已明确诊断的DM患者，共3258例。测定3258例体检标本的空腹血糖和HbA1c水平，分析比较目前国内包玉倩等建议的HbA1c标准和WHO专家推荐的HbA1c标准对长沙地区成年人群DM的诊断效能，并通过绘制ROC曲线找出适合长沙地区人群DM诊断和筛查的HbA1c切点。结果HbA1c的国内建议标准、WHO推荐标准在长沙地区人群DM的诊断和筛查中，均与空腹血糖诊断标准有显著性差异（χ^2值分别为413．34和90．94，P均〈0．05）。应用ROC曲线得到的HbA1c诊断DM的长沙地区最佳切点为6．3％，其灵敏度为85．2％，特异度为93．6％，曲线下面积为0．950。HbA1c筛查糖代谢异常的长沙地区最佳切点为6．0％，其灵敏度为80．3％，特异度为71．5％，曲线下面积为0．837。结论目前国内建议和WHO推荐的HbA1c诊断与筛查DM的标准均不适合于长沙地区成年人群DM的诊断和筛查，不同地方有必要建立适合于当地人群的HbA1c诊断与筛查标准。Objective To investigate the optimal hemoglobin A1c （HbA1c） threshold suitable for the population diagnostic or screening DM in the changsha area. Methods 3 258 health examination people＇s fasting glucose and HbA1c concentration were analyzed. The performance of different HbA1c criteria to find or screen DM was compared. The cutoff value of HbA1c suitable diagnostic or screening diabetes in Changsha region were found by drawing ROC curve. Results The performance of diagnosis and screening in DM by currently domestic recommended standards, WHO recommended criteria, or fasting plasma glucose,were significant difference （χ^2 values of 413.34 and 90. 94, respectively, P〈0.05）. Using ROC curve, the best threshold of glycated hemoglobin diagnosis of DM was 6.3 %, with a sensitivity of 85.2 %, a specificity of 93.6 %, and the area under the curve of 0. 950. Glycated hemoglobin screening for abnormal glucose metabolism, the optimal cut point was 6.0 %,with a sensitivity of 80.3 %,a specificity of 71.5 %,and the area under the curve of 0. 837. Conclusion The current criteria of domestic proposals or WHO recommended the HbA1c diagnostic and screening DM are not suitable for the Changsha population. It is need to establish appropriate HbA1c diagnostic and screening criteria in the different region people.

关 键 词：糖化血红蛋白 空腹血糖 诊断 筛查 糖尿病 

分 类 号：R587.1[医药卫生—内分泌] R446.112[医药卫生—内科学]