美国糖尿病学会新版糖尿病诊断标准对择期冠状动脉造影患者糖代谢异常的筛查意义  

The values of the new American Diabetes Association Diagnostic Criteria for screening of pre-diabetes and diabetes in patients undergoing elective coronary angiography

作　　者：赵昔良 叶益聪[2] 张抒扬[2] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院内科,100730 [2]中国医学科学院北京协和医学院北京协和医院心内科,100730

出　　处：《中华内科杂志》2015年第4期302-306,共5页Chinese Journal of Internal Medicine

摘　　要：目的 比较1999年WHO（WHO 1999）和新版美国糖尿病学会（ADA）糖尿病诊断标准在中国非急性冠状动脉综合征患者中糖代谢异常检出的效果.方法 2013年10月至2014年4月期间,连续入选北京协和医院心内科拟行冠状动脉造影的非急性冠状动脉综合征患者,所有患者既往无明确糖尿病病史.根据冠状动脉造影前的空腹血糖（FPG）、75 g口服葡萄糖耐量试验糖负荷后2h血糖（2hPG）以及糖化血红蛋白（HbA1c）的结果,分别采用WHO 1999和新版ADA标准对患者进行糖代谢状态评估,并进行对比.结果 本研究共纳入139例患者（男88例,占63.3％）,年龄（61.9±10.1）岁.根据WHO 1999标准,正常血糖34例（24.4％）,糖尿病前期57例（41.0％）,其中空腹血糖受损1例、糖耐量减低56例,新诊断糖尿病48例（34.5％）;根据新版ADA标准,正常血糖14例（10.1％）,糖尿病前期69例（49.6％）,糖尿病56例（40.3％）;在糖代谢异常的诊断中,相对于新版ADA标准,WHO 1999标准将遗漏12例糖尿病前期和8例糖尿病患者.与根据WHO 1999标准诊断的48例糖尿病患者相比,这8例依赖HbA1c水平诊断的患者,女性比例较高,且具有较低的血红蛋白[（124.88±17.74）g/L比（140.15±15.17）g/L,P=0.013]及较高的纤维蛋白原[（3.47±0.41）g/L比（3.02±0.68） g/L,P=0.024]水平.结论 与WHO 1999诊断标准相比,新版ADA标准可以发现额外的糖代谢异常患者.对于进行择期冠状动脉造影的患者,应考虑常规行HbA1c检测筛查糖代谢异常.Objective Glycosylated hemoglobin A1c （HbA1c） has become one of key components in new American Diabetes Association （ADA） diagnostic criteria for pre-diabetes and diabetes,which is not included in the World Health Organization （WHO） 1999 criteria.Thus,we aimed to compare the two criteria in diagnosis of pre-diabetes and diabetes in patients with non-acute coronary syndrome （non-ACS） in Chinese.Methods Non-ACS patients who had undergone elective coronary angiography （CAG） in Peking Union Medical College Hospital without previously known diabetes were enrolled consecutively from October 2013 to April 2014.Fasting plasma glucose （FPG）,2-hour plasma glucose after a 75 g oral glucose load （2hPG） and HbA1c levels before CAG were measured.Both WHO and new ADA criteria were applied for pre-diabetes and diabetes screening.Results One hundred and thirty-nine patients were included,aged （61.9 ± 10.1） years and 88（63.3%） were men among them.According to WHO 1999 criteria,34 patients （24.4%） were normal glucose regulation,57 （41.0%） pre-diabetes （including one impaired fasting glucose and 56 impaired glucose tolerance）,and 48 （34.5%） newly diagnosed diabetes mellitus.ADA criteria identified 12 more patients with pre-diabetes and eight more with diabetes than WHO criteria.Compared with those diagnosed by both criteria,the proportion of women was higher in diabetic patients diagnosed with HbA1c alone.They also had lower hemoglobin [（124.88 ± 17.74） g/L vs （140.15 ± 15.17） g/L,P =0.013] and higher fibrinogen levels [（3.47 ± 0.41） g/L vs （3.02 ± 0.68） g/L,P =0.024] than those diagnosed by both criteria.Conclusion Compared with WHO 1999,new ADA criteria with HbA1c assessment are able to identify more previously unknown pre-diabetes and diabetes patients.Measurement of HbA1c might be needed to carry out routinely for screening patients with glucose metabolism abnormalities before elective CAG.

关 键 词：糖尿病 血红蛋白A 糖基化 冠状动脉造影 

分 类 号：R587.1[医药卫生—内分泌]