血清胎球蛋白A水平对糖耐量减低的预测价值  

The predictive value of the levels of alpha Heremans Schmid glycoprotein for impaired glucose tolerance

作　　者：张凤丽[1] 何立娟[2] 崔清华[1] 矫杰[1] 袁慧[2] ZHANG Fengli;HE Lijuan;CUI Qinghua;JIAO Jie;YUAN Hui(Department of Endocrinology ＆ Metabolism,Department of Clinical Laboratory,Beijing Anzhen Hospital Affiliated to Capital Medical University,Beijing100029,China)

机构地区：[1]首都医科大学附属北京安贞医院内分泌代谢科,北京100029 [2]首都医科大学附属北京安贞医院检验科,北京100029

出　　处：《疑难病杂志》2018年第5期464-467,共4页Chinese Journal of Difficult and Complicated Cases

基　　金：国家自然科学基金项目(81770353)

摘　　要：目的评价应用血清胎球蛋白A(AHSG)水平预测糖耐量减低(IGT)的临床价值。方法选择2015年2月—2017年10月北京安贞医院进行体检的78例非糖尿病患者,根据口服葡萄糖耐量试验(OGTT)结果分为IGT组18例和健康对照组60例,比较2组患者临床资料间的差异,应用线性回归模型分析AHSG水平与胰岛素抵抗指数(HOMA-IR)的相关性,应用多因素Logistic回归模型探究IGT的独立危险因素,使用受试者工作曲线(ROC曲线)评估AHSG预测IGT的价值。结果与健康对照组比较,IGT组患者的体质量指数(BMI)、腰臀比、糖化血红蛋白(HbA_(1c))、C反应蛋白(CRP)和AHSG水平均明显升高,差异具有统计学意义(t=2.105、2.057、2.443、2.010、6.457,P=0.039、0.043、0.017、0.048、0.000)。直线回归分析显示,血清AHSG水平与HOMA-IR呈明显正相关(r=0.780,P=0.000)。多因素Logistic回归分析显示,BMI、HbA_(1c)和AHSG是IGT的独立危险因素(P<0.05)。ROC曲线显示,应用AHSG和HbA_(1c)预测IGT的诊断价值较高,其中,AHSG的曲线下面积(AUC)明显高于HbA_(1c)(0.879 vs.0.731,P<0.05)。应用ROC曲线得出的最佳截点,以AHSG≥298.62 mg/L诊断IGT时其准确率为90.00%,灵敏度为88.89%,特异度为93.33%,阳性预测值为80.00%,阴性预测值为96.55%。结论 IGT患者的AHSG水平明显升高,且与胰岛素抵抗指数呈正相关,应用AHSG预测IGT具有较高的预测价值,AHSG≥298.62 mg/L为最佳截点。Objective To observe the predictive value of alpha Heremans Schmid glycoprotein （AHSG） for impaired glucose tolerance （IGT）. Methods A total of 78 non-diabetic patients who underwent physical examination in Beijing Anzhen Hospital from February 2015 to October 2017 were divided into IGT group （18 cases） and control group （60 cases） according to oral glucose tolerance test （OGTT）. The differences of clinical data between the two groups were compared. The linear regression model was used to analyze the correlation between AHSG and insulin resistance index （HOMA-IR）. Multivariate Logistic regression model was used to explore the independent risk factors of IGT. The receiver operating characteristic curve （ROC curve） evaluates the value of AHSG in predicting IGT. Results Compared with the control group,body mass index （BMI）, waist hip ratio,HbA 1c ,CRP and AHSG levels in IGT group were significantly increased,the difference was statistically significant （ t = 2.105, t =2.057, t =2.443, t =2.010, t =6.457, P = 0.039, P =0.043, P =0.017, P =0.048, P = 0.000 ）. Linear regression analysis showed a significant positive correlation between serum AHSG level and HOMA IR （ r = 0.780 , P = 0.000）. Multivariate Logistic regression analysis showed that BMI,HbA 1c and AHSG were independent risk factors of IGT （ P 〈0.05）. The ROC curve showed that the diagnostic value of AHSG and HbA 1c in predicting IGT was higher. The area under the curve of AHSG was significantly higher than that of HbA 1c （0.879 vs. 0.731, P 〈0.05）. The best cutoff point obtained by ROC curve was 90.00% when the AHSG≥298.62 mg/L,the sensitivity was 88.89%,the specificity was 93.33%,the positive predictive value was 80.00%,the negative predictive value was 96.55 %. Conclusion The AHSG levels in patients with IGT were significantly increased and positively correlated with insulin resistance index. Prediction of IGT with AHSG has higher predictive value,AHSG≥298.62 mg/L was the best cut-off point.

关 键 词：糖耐量减低 胎球蛋白A 糖尿病 筛查 诊断效能 

分 类 号：R587.1[医药卫生—内分泌]