基于医院内分泌科就诊人群评估糖化血红蛋白作为糖尿病诊断切点的研究  

Value of haemoglobin A1c as the cut-off point for diabetes diagnosis based on the population in the department of endocrinology

作　　者：李晓君 鲍春丹[2] 王威[3] 洪旭[1] Li Xiaojun;Bao Chundan;Wang Wei;Hong Xu(Department of Endocrinology,Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing 100050,China;Department of Epidemiology,School of Public Health,Harbin Medical University,Harbin 150086,China;Department of Endocrinology,the Second Affiliated Hospital of Harbin Medical University,Harbin 150086,China)

机构地区：[1]首都医科大学附属北京友谊医院内分泌科,100050 [2]哈尔滨医科大学公共卫生学院流行病教研室,150086 [3]哈尔滨医科大学附属第二医院内分泌科,150086

出　　处：《中国医师进修杂志》2019年第12期1096-1102,共7页Chinese Journal of Postgraduates of Medicine

摘　　要：目的糖化血红蛋白(HbA1c)是诊断糖尿病和监测血糖控制水平的临床指标。评估HbA1c用于高血糖状态人群中的诊断切点。方法随机选择2010年1月1日至2012年12月31日哈尔滨医科大学附属第二临床医学院门诊和住院处就诊病例。符合入选标准的2853例患者(16~85岁)的临床数据进入研究,均采集血液测量HbA1c和进行口服葡萄糖耐量试验(OGTT)而未给予临床干预。选择标准:OGTT均是在无合并酮症的状态下进行,数据收集不考虑是否有糖尿病病史、糖尿病分型、是否应用口服降糖药和胰岛素治疗以及合并的基础疾病。排除妊娠病例。以空腹血糖和OGTT 2 h血糖作为诊断糖尿病和糖尿病前期的金标准,通过比较HbA1c与两者的单独受试者工作特征(ROC)曲线下面积、敏感度、特异度和Youden指数,确定HbA1c用于诊断糖尿病和糖尿病前期的诊断切点;通过分析HbA1c在研究人群中的分布评估其诊断效力。结果HbA1c的单独ROC曲线下面积为0.902(95%CI 0.890~0.914),空腹血糖的单独曲线下面积为0.915(95%CI 0.906~0.925)。HbA1c 6.5%作为糖尿病的诊断切点,表现出最高的Youden指数64.4%,与空腹血糖≥7.0 mmol/L(69.8%,67.8%~71.8%)相比具有较高的敏感度(81.1%,79.3%~82.7%)(P<0.01)。以此单独用于诊断糖尿病前期的ROC曲线下面积为0.725(0.689~0.762),用于诊断糖尿病前期的HbA1c切点为5.6%,其敏感度为74.1%,特异度为60.3%。结论HbA1c 6.5%、5.6%是就诊人群中诊断糖尿病和糖尿病前期的最佳切点。Objective To investigate the value of haemogobin A1c(HbA1c)for diagnosing various hyperglycemias in the Second Affiliated Hospital of Harbin Medical University.Methods This study is based on the data randomly selected from patients without clinical intervention in the endocrinology department and admission office in the Second Affiliated Hospital of Harbin Medical University from January 1st of 2010 to December 31th of 2012.In this study,2853 patients aged 16-85 year were selected,who performed OGTT and HbA1c on the same day.Their data of HbA1c and OGTT were collected.Selection criteria:the OGTT and HbA1c were performed simultaneously unless the patients had acidosis,and patients with past history of diabetes and oral hypoglycemic drugs or insulin treatment,or other basic combined diseases were included in this study.People in pregnancy were ruled out.Area under the receiver operating characteristics curve(ROC),sensitivity,and specificity were adopted to evaluate the diagnosis effect of HbA1c using FPG and OGTT as golden standard for diabetes and pre-diabetes.Results The area under the ROC were 0.902(95%confidence interval 0.890-0.914)for HbA1c alone and 0.915(0.906-0.925)for FPG alone.The HbA1c threshold of 6.5%showed the highest Youden index of 64.4%and significantly higher sensitivity 81.1%compared with FPG≥7.0 mmol/L(69.8%,P<0.01)in detecting diabetes.The optimal HbA1c thresholds for diagnosing pre-diabetes was 5.6%(the area under the ROC:0.725;sensitivity:74.1%;specificity:60.3%).Conclusions These findings suggest that HbA1c 6.5%and 5.6%can be used as the diagnosing criterions for diabetes and pre-diabetes among the population who visit department of endocrinology.

关 键 词：血糖 糖尿病 糖化血红蛋白 诊断切点 

分 类 号：R58[医药卫生—内分泌]