深圳社区糖尿病高危人群主动筛查方法探讨  

Study on Active Screening Method for High-risk Diabetes Population in Shenzhen Community

作　　者：刘雪婷 石金霞 李海燕[1,2,3] 吕凌波 覃舒怡[1,2,3] 阎德文 LIU Xue-ting;SHI Jin-xia;LI Hai-yan;LYU Ling-bo;TAN Shu-yi;YAN De-wen(Shenzhen Second People's Hospital,The First Affiliated Hospital of Shenzhen University,Guangdong Shenzhen 518035;Shenzhen Diabetes Prevention Center,Guangdong Shenzhen 518035;Shenzhen Clinical Research Center for Metabolic Diseases,Guangdong Shenzhen 518035;Sanxi Gaoyuan Community Health Service Center of Kwai Chung People's Hospital of Dapeng New District,Guangdong Shenzhen 518000)

机构地区：[1]深圳市第二人民医院,深圳大学第一附属医院,广东深圳518035 [2]深圳市糖尿病防治中心,广东深圳518035 [3]深圳市代谢性疾病临床医学研究中心,广东深圳518035 [4]深圳市大鹏新区葵涌人民医院三溪高源社区健康服务中心,广东深圳518000

出　　处：《深圳中西医结合杂志》2022年第11期21-25,共5页Shenzhen Journal of Integrated Traditional Chinese and Western Medicine

基　　金：深圳市大鹏新区医疗健康集团科技计划项目(2019JTLCYJ010);深圳市卫生健康委员会医防融合项目(深卫健体改-2019-25)。

摘　　要：目的:为基层机构和社区推荐合适的筛查方法和路径,以提高基层医疗机构或社区健康服务中心糖尿病筛查能力,改善糖尿病防控现状。方法:纳入2019年4月至2021年4月间在深圳市大鹏新区7家社区日常就诊的2083例糖尿病高危居民,采用即时检验(POCT)糖化血红蛋白(HbA1c)对其进行糖尿病主动筛查,检测其POCT HbA1c,并以POCT HbA1c筛查结果为基准,计算中国糖尿病风险评分表法(简称“评分法”)和SENSIBLE non-lab模型法(简称“模型法”)的诊断效能。利用POCT HbA1c的筛查结果计算糖尿病前期发现率和糖尿病发现率。定义POCT HbA1c≥5.7%为筛查阳性,否则为阴性,比较评分法与模型法的灵敏度、特异度、准确度和约登指数。结果:研究人群的男性占比为38.84%(809/2083),平均年龄(50.08±9.64)岁,平均POCT HbA1c(5.75±1.01)%。糖尿病前期发现率为31.83%(663/2083),糖尿病发现率为15.99%(333/2083)。评分法的灵敏度、特异度、准确度和约登指数分别为61.24%、40.02%、50.17%和0.013;模型法的灵敏度、特异度、准确度和约登指数分别为38.76%、60.17%、49.93%和-0.011。除特异度外,评分法的灵敏度和准确度均高于模型法,差异均具有统计学意义(P<0.05)。结论:在社区进行糖尿病高危人群主动筛查是可行的,推荐有条件的社区使用POCT HbA1c作为筛查方法之一,在医疗服务能力相对较弱地区也可选择评分法。Objective To recommend appropriate screening methods and paths for grassroots institutions and communities,so as to improve the diabetes screening ability of grassroots medical institutions or community health service centers and improve diabetes prevention and control status.Methods A total of 2083 high-risk diabetes population in 7 communities in Shenzhen Dapeng New District from April 2019 to April 2021 were screened for diabetes by point-of-care testing(POCT)glycosylated hemoglobin(HbA1c).Based on the screening results of POCT HbA1c,the diagnostic efficacy of Chinese diabetes risk score scale(referred to as"scoring method")and SENSIBLE non-lab model(referred to as"model method")were calculated.The prediabetes detection rate and diabetes detection rate were calculated by the screening results of POCT HbA1c.POCT HbA1c≥5.7% was defined as positive for screening,otherwise negative,and the sensitivity,specificity,accuracy and Youdon index of the scoring method and the model method were compared.Results The proportion of males in the study population was 38.84%(809/2083),the mean age was(50.08±9.64)years old,and the mean POCT HbA1c was(5.75±1.01)%.Prediabetes was found in 31.83%(663/2083)and diabetes was found in 15.99%(333/2083).The sensitivity,specificity,accuracy and Yuden index were 61.24%,40.02%,50.17% and 0.013,respectively.The sensitivity,specificity,accuracy and Yuden index of the model method were 38.76%,60.17%,49.93% and-0.011,respectively.Except for specificity,the sensitivity and accuracy of the scoring method were higher than those of the model method,and the differences were statistically significant(P<0.05).Conclusion POCT HbA1c is recommended to be used as one of the screening methods in eligible communities.Scoring method can also be used in areas with relatively weak medical service capacity.

关 键 词：糖尿病 糖尿病高危人群 糖化血红蛋白 主动筛查 基层医疗机构 

分 类 号：R587.1[医药卫生—内分泌]