通过口服葡萄糖耐量试验估算平均血糖的数学模型  

A mathematical model to estimate mean blood glucose by oral glucose tolerance test

作　　者：刘肖肖 李强[1] 何洪波[1] 李英莎[1] 杨莉琴[1] 祝之明[1] 闫振成[1] LIU Xiaoxiao;LI Qiang;HE Hongbo;LI Yingsha;YANG Liqin;ZHU Zhiming;YAN Zhencheng(Department of Hypertension and Endocrinology,Center for Hypertension and Metabolic Diseases,Chongqing Institute of Hypertension,Daping Hospital,Army Medical University(Third Military Medical University),Chongqing,400042,China)

机构地区：[1]陆军军医大学(第三军医大学)大坪医院高血压内分泌科,全军高血压代谢病中心,重庆市高血压研究所,重庆400042

出　　处：《第三军医大学学报》2021年第21期2389-2394,共6页Journal of Third Military Medical University

基　　金：重庆市自然科学基金面上项目(cstc2019jcyj-msxmX0152)。

摘　　要：目的建立利用口服葡萄糖耐量试验估算平均血糖的方法。方法回顾分析2014年1月至2017年12月于本科住院治疗的2型糖尿病患者36例,所有患者完善动态血糖监测及口服葡萄糖耐量试验(oral glucose tolerance test,OGTT),收集患者人口学基本特征和实验室检查结果,建立数学模型并予以修正。根据拟合优度公式进行外部验证。结果纳入满足入组条件的糖尿病患者36例,应用OGTT试验估计全天平均血糖(MBG_(OGTT))为(9.66±3.34)mmol/L,应用动态血糖监测仪计算24 h平均葡萄糖水平(24 hour mean glucose,24 h MBG)为(9.40±2.67)mmol/L。MBG_(OGTT)与糖化血红蛋白(HbA1c)(r=0.582,P<0.001)、24 h MBG(r=0.674,P<0.001)均呈显著正相关。应用线性回归模型建立OGTT估计的24 h动态血糖的模型:24 h MBG_(mmol/L)=4.166+0.545×MBG_(OGTT),(R=0.674,P<0.001)。进一步将HbA1c纳入回归分析,得到修正模型:24 h MBG_(mmol/L)=1.797+0.359×MBG_(OGTT)+0.565×HbA1c(R=0.768,P<0.001)。选取本科住院的患者18例进行外部验证,得到R_(NL)=0.81,说明模型拟合优度较高。结论成功建立了一种应用OGTT试验评估全天平均血糖的模型,可作为评估糖尿病患者血糖谱变化的简易方法。Objective To establish a method for estimating mean blood glucose using oral glucose tolerance test(OGTT).Methods A retrospective study was conducted on the patients with type 2 diabetes mellitus(T2DM)in our department between January 2014 and December 2017.All the patients underwent continuous glucose monitoring(CGM)and OGTT.The basic demographic characteristics and results of laboratory tests of the patients were collected.Then relevant mathematical models were established and modified.In the end,external validation was carried out according to the goodness of fit formula.Results Thirty-six diabetic patients who met the enrollment criteria were recruited.The 24-hour mean blood glucose(24 h MBG)was estimated to be 9.66±3.34 mmol/L by OGTT(MBG_(OGTT)),to be 9.40±2.67 mmol/L through CGM calculation.MBG_(OGTT)showed significantly positive correlation with both glycosylated hemoglobin(HbA1c,r=0.582,P<0.001)and 24 h MBG(r=0.674,P<0.001).We used linear regression model and established following equation to estimate 24 h MBG by OGTT:24 h MBG_(mmol/L)=4.166+0.545×MBG_(OGTT),(r=0.674,P<0.001).Furthermore,a modified model incorporating HbA1c effect was also obtained:24 h MBG_(mmol/L)=1.797+0.359×MBG_(OGTT)+0.565×HbA1c(R=0.768,P<0.001).We selected 18 patients admitted to our department for external validation.In this verification result,we obtained a R_(NL)value of 0.81,which implied a high fit degree.Conclusion A model to evaluate mean blood glucose by OGTT is successfully established,and can be used as a simple method to evaluate blood glucose status in diabetic patients.

关 键 词：糖尿病 口服葡萄糖耐量试验 血糖监测 数学模型 

分 类 号：R311[医药卫生—基础医学] R446.112