糖化血红蛋白用于筛检糖调节受损的适用性与局限性  

Feasibility and limitation of glycosylated hemoglobin in screening of impaired glucose regulation

作　　者：卢丽娟 

机构地区：[1]东莞市中医院检验科,广东东莞523000

出　　处：《广州医科大学学报》2015年第1期59-62,共4页Academic Journal of Guangzhou Medical University

摘　　要：目的:探讨糖化血红蛋白(Hb A1c)评估诊断糖调节受损(IGR)的适用性与局限性。方法:回顾性分析2012年2月至2013年7月东莞市中医院同期检测Hb A1c和口服葡萄糖耐量试验(OGTT)的663例样本资料。结果:663例中IGR 502例,其中IFG 134例(20.2%)、IGT 122例(8.4%)、IFG+IGT 246例(37.1%)、NGT 161例(24.3%)。283例FPG<5.6 mmol/L患者中122例为IGT;296例2h-PG<7.8mmol/L中134例为IFG。Hb A1c诊断IFG的最佳切点为5.39%,敏感性为0.567,特异性为0.596,AUCROC为0.569;Hb A1c诊断IGT的最佳切点为5.39%,敏感性为0.574,特异性为0.596,AUCROC为0.576;Hb A1c诊断IFG+IGT的最佳切点为5.39%,敏感性为0.703,特异性为0.596,AUCROC为0.674;Hb A1c诊断整体IGR的最佳切点为5.38%,敏感性为0.635,特异性为0.696,AUCROC为0.622。只测FPG,使用FPG≥5.60 mmol/L为切点时,其中有24.3%(122例)诊断为IGT的糖调节受损(IGR)会被遗漏;只测FPG,使用FPG≥6.10 mmol/L为切点时,在368例IGT、IFG+IGT数据中,有55.4%(204例)的属于IGT和IFG+IGT的IGR会被遗漏;只使用Hb A1c≥5.39%为切点时,有36.8%(185例)的IGR会被遗漏;使用Hb A1c≥5.39%和FPG≥5.60 mmol/L为切点时,有10.8%(54例)的IGR会被遗漏;但其假阳性率也增高至40.3%。使用Hb A1c≥5.39%和FPG≥6.10 mmol/L为切点时,有24.9%(125例)的IGR会被遗漏。结论:Hb A1c不适用于对IFG和IGT的诊断和筛查;而适用于对IFG+IGT的筛查,不适用于对IFG+IGT的诊断。FPG和Hb A1c的联合应用能大幅度提高有助于对IGR的筛查效果。Objective： To investigate the feasibility and limitation of glycosylated hemoglobin（ HbA1c） in the screening and assessment of impaired glucose regulation（ IGR）. Methods： The data 663 subjects,who tested Hb A1 c and oral glucose tolerance test（ OGTT） from a contemporary cohort between February 2012 and July 2013 in Dongguan Hospital of Traditional Chinese Medicine,were retrospectively analyzed. Results： In the 663 cases,there were 50 IGR,including 134 impaired fasting glucose（ IFG,20. 2%）,122 impaired glucose tolerance（ IGT,8. 4%）,246 IFG ＋ IGT（ 37. 1%）,and 161 normal glucose tolerance（ NGT,24. 3%）; 283 fasting plasma glucose（ FPG） 5. 6 mmol/L,including 122 IGT; and 296 2-hour postprandial blood glucose（ 2 h-PG） 〈7. 8 mmol/L,including 134 IFG. The optimal cut-off value,sensitivity,specificity and AUCROC,diagnosed by Hb A1 c in IFG were 5. 39%,0. 567,0. 596,and 0. 569,respectively. The optimal cut-off value,sensitivity,specificity and AUCROC,diagnosed by Hb A1 c in IGT were 5. 39%,0. 574,0. 596,and 0. 576,respectively. The optimal cut-off value,sensitivity,specificity and AUCROC,diagnosed by Hb A1 c in IFG ＋ IGT were 5. 39%,0. 703,0. 596,and0. 674,respectively. The optimal cut-off value,sensitivity,specificity and AUCROC,diagnosed by Hb A1 c in all IGR were 5. 38%,0. 635,0. 696,and 0. 622,respectively. Measuring FPG alone and using FPG≥ 5. 60 mmol / L as the cut-off value,24. 3% IGR diagnosed with IGT（ 122 cases） were missing; measuring FPG alone and using FPG≥ 6. 10 mmol / L as the cut-off value,55. 4% IGR belong to IGT and IFG ＋ IGT（ 204 cases） in the data of368 IGT and IFG ＋ IGT were missing; using HbA1c≥ 5. 39% as the cut-off value,36. 8% IGR（ 185 cases） were missing; using HbA1c≥ 5. 39% and FPG ≥ 5. 60 mmol / L as the cut-off value,10. 8% IGR（ 54 cases） were missing; whereas the false positive rate increased to 40. 3%. Using HbA1c≥ 5. 39% and FPG≥ 6. 10 mmol / L as the cut-off value,24. 9% IGR（ 125 cases） were missing. Concl

关 键 词：糖调节受损 糖化血红蛋白 空腹血浆葡萄糖 口服葡萄糖耐量试验 ROC曲线 葡萄糖负荷后2 h血糖 

分 类 号：R587.1[医药卫生—内分泌]