糖化血红蛋白在筛查和诊断糖尿病中的价值研究  

The Value of Glycated Hemoglobin in Screening and Diagnosis of Diabetes Mellitus

作　　者：张震[1] 李军[2] 李思源[1] 吴媛媛[1] 周婷[3] 叶婷[2] 

机构地区：[1]新疆石河子大学医学院,新疆石河子市832000 [2]新疆石河子大学医学院第一附属医院内分泌代谢科 [3]新疆石河子大学医学院第一附属医院中心实验室

出　　处：《中国全科医学》2013年第14期1590-1592,共3页Chinese General Practice

摘　　要：目的评估糖化血红蛋白(HbA1c)筛查和诊断糖尿病(DM)的价值。方法选择2011年6月—2012年6月在石河子大学医学院第一附属医院内分泌代谢科门诊及住院部确诊DM者251例,均行口服葡萄糖耐量试验(OGTT),并测定空腹血糖(FPG)、OGTT 2 h血糖(2 hPG)及HbA1c。采用SPSS 17.0统计软件进行单因素方差分析、SNK-q检验。采用MedCalc 9.0统计软件绘制受试者工作特征曲线(ROC曲线),获得HbA1c和FPG分别诊断DM的最佳临界值及ROC曲线下面积(AUC)等指标。结果 (1)OGTT结果显示,251例受检者中,确诊为DM 168例(66.9%),糖调节异常(IGR)70例(27.9%),糖耐量正常(NGT)13例(5.2%)。3组受检者FPG、2 hPG、HbA1c水平比较,差异均有统计学意义(P<0.01);其中IGR组2 hPG水平高于NGT组,DM组FPG、2 hPG、HbA1c水平均高于NGT组、IGR组,差异均有统计学意义(P<0.05)。(2)根据ROC曲线,HbA1c诊断DM的最佳临界值为7.0%,此时HbA1c诊断DM的灵敏度为91.07%〔95%CI(0.857,0.949)〕,特异度为92.77%〔95%CI(0.849,0.973)〕,AUC=0.971〔95%CI(0.942,0.988)〕,Youden指数为0.84,阳性预测值(+PV)为96.2%,阴性预测值(-PV)为83.7%,阳性似然比(+LR)为12.60,阴性似然比(-LR)为0.10。FPG诊断DM的最佳临界值为6.9 mmol/L,此时FPG诊断DM的灵敏度为80.95%,特异度为100.00%,AUC=0.944〔95%CI(0.908,0.969)〕,Youden指数为0.81,+PV为100.0%,-PV为72.2%。结论 HbA1c≥7.0%可作为新疆石河子地区筛查及诊断DM的一种方法,且诊断的敏感度较FPG高,但特异度较FPG低。Objective To evaluate the value of glycosylated hemoglobin （HbA1,） in the screening and diagnosis of di- abetes mellitus （DM）. Methods A total of 251 patients requiring detection of DM in our department between June 2011 and June 2012 underwent oral glucose tolerance test （ oGTr）, and determination of fasting plasma glucose （ FPG）, 2 hours plasma glucose （2 hPG）, and HbAlc. SPSS 17.0 was used to conduct univariate analysis and SNK -q test. MedCalc 9.0 was used to plot receiver operating characteristic （ROC） curve to obtain the best critical point of HbA1c and FPG in diagnosing DM, and the area under the curve （AUC）. Results OGTI＇ resuhs showed 168 eases （66.9%） of DM, 70 cases （27.9%） of impaired glucose regulation （IGR）, and 13 eases （5.2%） of normal glucose tolerance （NGT）. Significant difference was observed a- mong the three groups in levels of FPG, 2 hPG, and HbA1o （P 〈0.01 ）. To be specific, level of 2 hPG of the IGR group was significantly higher than that of the NGT group, levels of FPG, 2 hPG, and HbA1c of the DM group were significantly higher than those of the NGT and IGR group （ P 〈 0. 05 ）. The optimal cut - point of HbA1c in ROC curve was 7.0%, with sensitivity of 91.07% ~95% CI （0.857, 0.949）3, specificity of 92.77% ~95% CI （0.849, 0.973）1, AUC of 0.971 （95% CI （0. 942, 0. 988 ） 3, Youden index of 0. 84, positive predictive value （ ＋ PV） of 96. 2%, negative predicative value （ - PV） of 83.7%, positive likelihood ratio （ ＋ LR） of 12.60, and negative likelihood ratio （ - LR） of 0. 10. The optimal cut - point of FPG in ROC curve was 6. 9 retool/L, with sensitivity of 80. 95%, specificity of 100, 00%, AUC of 0. 944 [95% CI （0. 908, 0.969）3, Youdenindex of 0. 81, ＋PV of 100.0%, and -PV of 72.2%. Conclusion HbA^o can be used as a screening and diagnostic criterion for DM and the optimal cut - point is 7.0%. HbA1c has higher sensitivity but lower sensitivity than FPG.

关 键 词：糖化血红蛋白 糖尿病 空腹血糖 口服葡萄糖耐量试验 受试者工作特征曲线 

分 类 号：R587.1[医药卫生—内分泌]