糖化血清白蛋白用于诊断糖尿病及糖调节异常的价值研究  

Study of Glycated Albumin Cut-off Point in Diabetes Mellitus and Impaired Glucose Regulation

作　　者：张亭[1] 何訸[2] 杨惠岚[1] 黄亨健[2] 张明峰[3] 安振梅[1] 李双庆[3] 

机构地区：[1]四川大学华西医院内分泌代谢科,成都610041 [2]四川大学华西医院实验医学科,成都610041 [3]四川大学华西医院全科医学科,成都610041

出　　处：《四川大学学报（医学版）》2014年第2期274-277,298,共5页Journal of Sichuan University(Medical Sciences)

基　　金：四川省科技厅项目(No.2013FZ0011)资助

摘　　要：目的探讨糖化血清白蛋白（GA）作为诊断糖尿病（DM）及糖调节异常（IGR）的可能切点值，并分析GA对于诊断DM及IGR的应用价值。方法392例为明确DM诊断而就诊者和DM高危人群接受筛查者，年龄20～84岁，行口服葡萄糖耐量试验（OGTT），并测定糖化血红蛋白（HbAlc）和GA，以受试者工作特征曲线（ROC）评价GA诊断DM和IGR的敏感性和特异性。结果①按WH01999年DM诊断标准判断，392例就诊者中DM131例，IGR126例，糖耐量正常（NGT）135例，3组GA水平呈递增趋势（P〈0．05）。②Spearman相关分析显示GA与HbA1c（t-=0．9421，P〈0．05）、空腹血糖（FPG，r=0．8566，P〈0．05）、餐后2h血糖（2-hPG，r=0．8137，P〈0．05）呈正相关。③DM组GA／HbAlc为2．58±0．37，IGR组为2．44±0．37，NGT组为2．17±0．25，三者比较差异有统计学意义。④GA诊断DM的最佳切点值为16．6％，曲线下面积（AUC）为0．888（95％CI：0．855～0．920），敏感性为71．8％，特异性为87．4％，诊断价值中等。GA诊断IGR的AUC较小（0．510），诊断价值较低。结论GA可作为单一方法诊断DM，其最佳切点值为16．6％，敏感性和特异性分别为71．8％和87．4％。GA可能不适合用于单独诊断IGR。Objective To investigate the cut-off point of glycated albumin （GA） in the detection of diabetes mellitus （DM） and impaired glucose regulation （IGR）. Methods This study was conducted in 20-84 years-old adults who had risk factors of diabetes but no previously diagnosed diabetes. There were finally 392 individuals included and received the measurement of GA and HbAlc. Receiver operating characteristic curve （ROC） was plotted to determine the performance of GA. Results OBased on the diabetes diagnosis criteria of WHO （1999）, the subjects were divided into DM group （n= 131）, IGR group （n= 126）, and normal glucose tolerance （NGT） group （n= 135）. The GA level in the three groups tended to increase （P〈0.05）. QSpearman correlation analysis demonstrated that GA was positively correlated with glycated haemoglobin Alc （HbAlc） （r=0. 942 1, P〈0.05）, fasting plasma glucose （FPG） （r=0. 856 6, P〈0.05） and 2 h post-load plasma glucose （2-hPG） （r=0. 813 7, P〈 0.05）. （3）The mean levels of serum GA/HbAlc were 2.58±0.37, 2.44±0.37 and 2.17±0.25 for DM, IGR and NGT respectively. OThe optimal cut-off points for detecting diabetes were 16.6 % in GA [area under the carve （AUC）=0. 888], producing the sensitivity of 71.8% and the specificity of 87.4%. Conclusion GA as a single screening test shows adequate to detect newly diagnosed DM, and the optimal GA cut-off point was 16.6 % in this study.

关 键 词：糖尿病 糖调节异常 糖化血清白蛋白 切点 诊断 

分 类 号：R587.1[医药卫生—内分泌]