糖化血红蛋白在2型糖尿病诊断与防治中的临床意义  

The application value of glycated hemoglobin (HbA1c) for type 2 diabetes in diagnosis and prevention

作　　者：黄琼[1] 刘梦兰[1] 李璐[1] 张日化 陶然[2] 武鸣[2] 刘云[1] 

机构地区：[1]南京医科大学第一附属医院内分泌科,江苏南京210029 [2]江苏省疾病预防控制中心慢性非传染病防制所,江苏南京210008

出　　处：《南京医科大学学报（自然科学版）》2014年第10期1363-1366,共4页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金(81070684);江苏省卫生厅兴卫工程重点个人项目(RC2011069);江苏省社会发展科技支撑计划项目(BE 2011802);南京医科大学第一附属医院创新团队(20113012)

摘　　要：目的:研究糖化血红蛋白(HbA1c)检测在2型糖尿病(T2DM)早期筛查中的应用。方法:2013年在江苏省淮安地区随机选择40岁及以上在该地区居住6个月以上的居民作为调查对象,共1 089例。采用统一的流行病学调查表收集调查对象的人口学特征、饮食生活习惯、对糖尿病认知度及患病史。对调查对象进行身体测量,内容包括:身高、体重、腰围和血压。采集所有调查对象晨尿、空腹静脉血和口服82.5 g葡萄糖粉后2 h静脉血(有糖尿病病史者不服糖粉)。检测指标包括尿常规、血糖、生化全套、胰岛素、HbA1c、糖化白蛋白等。结果:调查中空腹血糖(FPG)诊断T2DM敏感性73.89%,误诊率26.11%;HbA1c诊断T2DM敏感性73.22%,误诊率26.78%;FPG与HbA1c联合起来共同诊断T2DM,则敏感性89.59%,误诊率为10.41%,FPG与HbA1c两种诊断结果的差异无统计学意义(P=0.830),两种诊断方法的吻合度有统计学意义,吻合度一般(k=0.374,Pk<0.01)。采用稳态模型评估胰岛素抵抗指数(HOMA-IR),HbA1c≥6.5%受试者的HOMA-IR均大于诊断标准(HOWA-IR≥2.68)且HbA1c水平与HOMA-IR大小呈正相关(r=0.375)。结论:FPG联合HbA1c不仅可大大提高对T2DM诊断的准确性,还可以评价胰岛素抵抗情况和糖尿病的治疗效果。Objective：To explore the application value of glycated hemoglobin（HbA1c） in type 2 diabetes early screening.Methods： A total of 1 089 inhabitants for 40 years old and above were from Huaian area of Jiangsu province. A questionnaire survey was established to collect demographic characteristics, dietary habits, the prevalence of diabetes awareness, and illness history. The measurement of body included： height, weight, waist circumference and blood pressure. Collection of morning urine, fasting venous blood and venous blood was obtained 2 hours after oral glucose powder 82.5 g（except who has a history of diabetes）. Detection indexes included routine urine, blood sugar, biochemical full, insulin and glycosylated hemoglobin and glycosylated albumin.Results： FPG diagnosed T2 DM sensitivity was 73.89%, while the misdiagnosis rate was 26.11%; HbA1 c diagnosed T2 DM sensitivity73.22%, while the misdiagnosis rate was 26.78%; according to FPG joint HbA1 c to diagnosis T2 DM, the sensitivity was 89.59%,while the misdiagnosis rate was 10.41%. The diagnosis difference of FPG and HbA1 c had no statistical significance（P=0.830）. The diagnosis alignment was statistically significant, inosculation general（k =0.374, Pk〈 0.01）. Using HOMA-IR to assess insulin resistance（HOMA-IR）, the result of HbA1c≥6.5% subjects were greater than the HOMA- IR diagnostic criteria（HOWA-IR≥2.68）and HbA1 c level was positive correlated with HOWA-IR（r = 0.375）. Conclusion： FPG joint HbA1 c not only greatly improves the diagnostic accuracy of T2 DM, also evaluates insulin resistance and the therapeutic effect of diabetes.

关 键 词：糖尿病 糖化血红蛋白 筛查 胰岛素抵抗 

分 类 号：R587.1[医药卫生—内分泌]