糖化血红蛋白≥6.2%作为诊断阈值对糖尿病筛查的价值  

Value of HbA_1c>or =6.2% Used as Diagnostic Cut-off Point in Screening for Diabetes Mellitus

作　　者：马付坚[1,2] 黄承乐[1,3] 黎荣能[1,3] 

机构地区：[1]右江民族医学院附属西南医院 [2]百色市人民医院内分泌科,百色市533000 [3]百色市人民医院检验科,百色市533000

出　　处：《广西医学》2013年第12期1642-1645,共4页Guangxi Medical Journal

摘　　要：目的比较不同浓度的糖化血红蛋白(HbA1c)与空腹血糖(FPG)、餐后2 h血糖(2hPG)在糖尿病诊断中的相关性,探讨HbA1c对糖尿病的诊断效率及最佳阈值,对人群进行糖尿病筛查的效益。方法 2型糖尿病患者1 294例,采用高效液相色谱法(HPLC法)测定HbA1c,根据HbA1c水平分为HbA1c≥6.5%和HbA1c≥6.2%两组,探讨HbA1c水平与血糖浓度的相关性;用受试者工作特征曲线(ROC)判断不同浓度的HbA1c诊断糖尿病的效率。结果 FPG≥7.0 mmol/L和2hPG≥11.1 mmol/L分别检出糖尿病748例(57.89%)和828例(64.18%)。用美国糖尿病学会(ADA)推荐的HbA1c≥6.5%作为糖尿病诊断阈值,则该组患者糖尿病的检出699例(54.01%),其敏感度和特异度分别为54.0%、100.0%,该阈值与FPG、2hPG相比诊断相关度差异均有统计学意义(P<0.01)。而用HbA1c≥6.2%作为诊断阈值则该组患者糖尿病的检出953例(73.65%),与FPG相比检出率差异有统计学意义(P<0.01);与2hPG检出率相比差异无统计学意义(P>0.05)。HbA1c≥6.2%时ROC曲线下面积为0.922,最大诊断指数1.73,其敏感度和特异度分别是73.64%、99.0%。结论以HbA1c≥6.2%作为诊断阈值时糖尿病诊断符合率较高,优于单纯检测FPG≥7.0 mmol/L及HbA1c≥6.5%作为糖尿病诊断阈值,而与2hPG≥11.1 mmol/L诊断符合率相近似。以HbA1c≥6.2%作为诊断阈值对糖尿病高危人群的诊断效率高,可用于人群的糖尿病筛查。Objective To study the diagnostic validity and find out the optimum diagnostic cut-off point of glycosylated hemoglobin （HbA1 c） for the purpose of large population screening for diabetes by comparing the correlations between the blood levels of HbA1 c and fasting plasma glucose （FPG）, plasma glucose 2 hours after meal （2hPG） in the diagnosis of diabetes mellitus. Methods The blood levels of HbAlc of 1294 patients with type 2 diabetes mellitus were determined by high pressure liquid chromatography （HPLC）. Then the patients were divided into two groups of HbA1c 〉 or =6.5% and HbA1c 〉 or =6.2% ,and the correlation between HbAlc and blood glucose was studied. The validities of HbA1c of different levels as the tool for the diagnosis of diabetes were analyzed by receiver-operating characteristic （ROC） curve. Results FPG 〉 or = 7.0 mmol/L was found in 748 （ 57. 89% ） diabetic patients ,and 2hPG 〉 or = 11.1 mmol/L in 828（64. 18% ） diabetic patients. For HbAlc at a diagnostic cut-off point of〉or =6.5% which was reconamended by ADA,699 （54.01%） diabetes patients were detected, and the sensitivity and specificity were 54.0% and 100. 0%, respectively. There was significant difference among HbAlc 〉 or = 6.5% ,FPG and 2hPG in the diagnosis of correlation（ P 〈 0. 01 ）. For HbA1c at a diagnostic cut-off point of 〉or =6.2% ,953（73.65% ） diabetic patients were detected,which was significantly different from FPG（P 〈0.01）,but wasn＇t significantly different from 2hPG（P 〉0.05）,in the detection rate. For HbA1c at a diagnostic cut-off point of 〉 or = 6.2%, the maximal area under ROC curve was 0.992 while the maximal diagnostic index was 1.73, and the sensitivity and specificity were 73.64% and 99.0%, respectively. Conclusion For HbA1 c at a diagnostic cut-off point of 〉 or = 6.2% ,its validity for the diagnosis of diabetes is superior to that of HbAlc at a diagnostic cut-off point of 〉 or = 6.5% or FPG at a cut-off point of 〉 or = 7.0 mmol/L, and is similar t

关 键 词：糖尿病 糖化血红蛋白 血糖 诊断阈值 ROC曲线 

分 类 号：R581.1[医药卫生—内分泌]