糖化血红蛋白和空腹血糖用于早期筛查糖尿病的意义

探讨HbA1C和空腹血糖(FPG)在社区人群糖尿病筛查中的应用价值.对上海市杨浦区2个街道社区流行病学调查中的1 794名居民行口服葡萄糖耐量试验(OGTT),并检测HbA1C,根据世界卫生组织1999年糖尿病诊断标准,筛查出正常糖耐量(NGT)、空腹血糖受损(IFG)、糖耐量受损(IGT)、IFG合并IGT和糖尿病分别为1 411、111、73、33和166例.采用受试者工作特征(ROC)曲线判断,与诊断糖尿病相关的FPG最佳切点为6.15 mmol/L,敏感性和特异性分别为89.0%和92.8%,曲线下面积为0.959;与诊断糖尿病相关的HbA1C最佳切点为6.5%,敏感性和特异性分别为71.1%和80.2%,曲线下面积为0.822;以FPG≥6.1 mmol/L且HbA1C≥6.5%筛查糖尿病,其敏感性和特异性分别为66.9%和97.0%;以FPG≥16.1mmol/L或HbA1C≥6.5%筛查糖尿病,其敏感性和特异性分别为96.3%和76.7%.研究结果提示空腹血糖和HbA1C在社区糖尿病的筛查诊断中均有很好的价值,联合应用可提高诊断率.

Abstract：

The validity of HbA1C and fasting plasma glucose(FPG)for screening of diabetes in community population was investigated.A total of 1 794 subjects from two sub-districts of Yangpu District,Shanghai,underwent a 75 goral glucose tolerance test(OGTT)and HbA1C determination.Based on 1999 World Health Organization criteria,there were 1 411 subjects with normal glucose tolerance(NGT),111 impaired fasting glucose(IFG),73 impaired glucose tolerance(IGT),33 IFG+IGT,and 166 diabetes.According to the receiver operating characteristic curve,the optimal cut-point of FPG for diagnosing diabetes was 6.15 mmol/L with sensitivity of 89.0%,specificity of 92.8%,and area under the curve of 0.959.The cut-point of HbA1C for diagnosing diabetes was 6.5% with a sensitivity and specificity of 71.1% and 80.2%.The area under the curve was 0.822.The screening model using FPG ≥6.1mmol/L and HbA1C≥6.5% had sensitivity of 66.9% and specificity of 97.0%.When the model was FPG ≥6.1 mmol/L or HbA1C ≥6.5%,the sensitivity and specificity was 96.3% and 76.7% respectively.The results suggest that both FPG and HbA1C have good value for screening diabetes in community,and FPG combined with HbA1C may further promote diagnostic efficacy.     

南昌社区中老年人群糖尿病流行病学调查中HbA1C对诊断2型糖尿病的价值

选择南昌1 415例中老年人作为研究对象,分为正常糖耐量组、糖调节受损组及糖尿病组.结果 显示,HbA1C与空腹血糖(FPG)及餐后2 h血糖呈显著相关,HbA1C 6.3%诊断糖尿病的敏感度为85.19%,特异度为99.45%,HbA1C 6.5%诊断糖尿病的敏感度为75.56%,特异度为99.61%.在本研究的人群中,HbA1C 6.3%诊断糖尿病较HbA1C 6.5%及FPG 7.0 mmol/L具有更高的敏感性.

Abstract：

A total of1415 elderly individuals in Nanchang were included in the study and were divided into normal glucose tolerance group, impaired glucose regulation group, and diabetes mellitus group.The results showed that HbA1C was significantly correlated with fasting plasma glucose (FPG) and 2 h postprandial plasma glucose.When HbA1C 6.3% was applied as the cut point of diabetes, the sensitivity was 85.19% and the specifity was 99.45%.When HbA1C 6.5% was applied, the sensitivity was 75.56% and specifity was 99.61%.It seems that HbA1C 6.3% had higher specifity and sensitivity for diagnosing diabetes than HbA1C 6.5% and FPG 7.0mmol/L in studied population.     

青少年人群诊断糖尿病前期不宜采用糖化血红蛋白标准

目的 探索2010年美国糖尿病协会(ADA)推荐的糖尿病前期HbA1C诊断标准在中国青少年人群中的适用性.方法 随机抽取辽阳市初中和高中学生933人(13～16岁,女性46.5%),测定HbA1C和空腹血糖,对HbA1C5.7%～6.4%的部分受试者进行口服葡萄糖耐量试验(OGTT),以受试者工作特性(ROC)曲线评价HbA1C对糖尿病前期的诊断价值.结果 符合ADA 2010年推荐的糖尿病前期诊断标准者213人,其中同时符合HbA1C和空腹血糖标准者仅占4.7%.HbA1C诊断空腹血糖升高的ROC曲线下面积为0.50(P=0.97).由HbA1C标准诊断糖尿病前期并行OGTF的68人中18人确定为糖耐量受损或空腹血糖受损,HbA1C诊断糖尿病前期的ROC曲线下面积为0.53(P=0.69).结论 在中国青少年人群中HbA1C不宜作为糖尿病前期的诊断方法.

Abstract：

Objective To evaluate the performance of HbA1C in diagnosis of pre-diabetes in Chinese adolescents.Methods A total of 933 students(aged 13-16 year,46.5% female)without known history of diabetes were selected from junior and senior middle schools in Liaoyang city.HbA1C and fasting plasma glucose(FPG)levels were determined in all participants.Pre-diabetes was diagnosed as according to 2010 American Diabetes Association (ADA)criteria[HbA1C 5.7%-6.4%,FPG(5.6-6.9)mmol/L].The individuals with HbA1C ≥5.7% underwent oral glucose tolerance test(OGTT)and were classified into impaired glucose tolerance(IGT)and impaired fasting glucose(IFG)according to 1999 World Health Organization(WHO)criteria.The performance of HbA1C in diagnosing pre-diabetes by the new criteria was evaluated by the traditional OGTT results based on receiver operating characteristic(ROC)curves.Results Among all participants,213(22.8%)individuals were diagnosed as prediabetic subjects.72.3% of individuals with pre-diabetes were identified by HbA1C alone,23.0% by FPG alone,and only 4.7% by both tests simultaneously.The ROC curve for HbA1C to identify impaired fasting glucose diagnosed by new criteria had an area under the curve(AUC)of 0.50 without statistical significance(P = 0.97).Of the 164 participants with HbA1C 5.7% -6.4%,68 individuals received OGTT,among which 18 subjects were diagnosed as IGT(n= 14)or IFG(n = 4).The ROC curve for HbA1C to identify pre-diabetes diagnosed by OGTT had an AUC of 0.53,without statistical significance(P = 0.69).Conclusion In Chinese adolescents,HbA1C is not suitable for diagnosis or screening of pre-diabetes.     

糖尿病高风险人群糖化血红蛋白与微血管并发症的关系

目的 探讨在广州地区的糖尿病高风险人群中HbA1C与糖尿病微血管并发症之间的关系,并评价其对糖尿病的诊断价值.方法 对208例糖尿病高风险患者进行HbA1C、血糖、眼底彩色照相及微量白蛋白尿测定.以受试者工作特征(ROC)曲线比较HbA1C、空腹血糖(FPG)、餐后2 h血糖(2hPG)的诊断效果.结果 高风险人群中糖尿病视网膜病变患病率为14.9%,微量白蛋白尿患病率为12%.HbA1C、FPG和2hPG分别为5.8%、7.0 mmol/L和10.9 mmol/L时视网膜病变的发病率显著增加.HbA1C、FPG和2hPG分别为5.8%、6.4mmol/L和10.7mmol/L时微量白蛋白尿发病率明显增加.结论 HbA1C为5.8%时糖尿病高风险人群微血管并发症患病率显著增加,HbA1C和2hPG判断微血管并发症的效果无明显差异,FPG相对偏低.

Abstract：

Objective To explore the association of HbA1C with microvascular complications,and to evaluate the diagnostic value of HbA1C in diabetes mellitus in high-risk populations of Guangzhou.Methods HbA1C,blood glucose,fundus photography,and microalbuminuria were detected in 208 permanent residents with high-risk factors of diabetes.The receiver operating characteristiC(ROC)curves were used to estimate the area of HbA1C,fasting plasma glucose(FPG),postprandial 2 h plasma glucose(2hPG)under the curve for discriminating microvascular complications.Results There were 14.9% adults suffering from diabetic retinopathy and 12% microalbuminuria in high risk populations of diabetes.The optimal cutoff points of HbA1C,FPG,and 2hPG in detecting retinopathy were 5.8%,7.0 mmol/L,and 10.9 mmol/L respectively.The thresholds for increasing prevalence of microalbuminuria were5.8% for HbA1C,6.4 mmol/L for FPG,and 10.7 mmol/L for 2hPG.Conclusions The prevalence of diabetic microvascular complications increases dramatically at the concentration of HbA1C 5.8%.As a diagnostic value for microvascular complications,there is no significant difference between HbA1C and 2hPG.     

HbA1C:临床应用中的几个问题

自20世纪80年代,HbA1C作为糖尿病血糖控制的临床指标以来,几项重要的大型研究已证明以HbA1C表示的强化血糖控制可明显降低糖尿病并发症.近年,HbA1C又被推荐为糖尿病的诊断标准之一.但是.在我国,HbA1C测定的标准化仍是一项重要而艰巨的工作.

Abstract：

HbA1C has been used clinically since 1980s as the index of glycemic control in individuals with diabetes mellitus.Several significant clinical trials demonstrated that the intensive blood glucose control reduced the chronic complications in diabetes.In recent years,HbA1C has been recommended as one of the diagnostic criteria for diabetes mellitus.However,the standardization of HbA1C measurement still remains to be an important and arduous task in China.     

Post-load hyperglycaemia and diagnostic criteria for diabetes

The evolution of 2 h post-load glucose tolerance test for diagnosis of diabetes and its clinical implication was reviewed and discussed. Post-load hyperglycemia is a risk factor for both microand macro-vascular diseases. According to its relationship with retinopathy,the current cut-off values for diabetes was defined since 1979. Recently,strong evidence has shown that post-load hyperglycemia is also an important risk factor for cardiovascular disease （ CVD）, the relation is linear and no a threshold was found. There are large discrepancies between fasting and 2 h glucose criteria in the classification of diabetes and impaired glucose tolerance （IGT）/impaired fasting glucose （IFG）. For early diagnosis and intervention administrating a 2 h OGTT to suspect individuals is necessary.     

糖化血红蛋白在诊断糖尿病中的意义——过去、现在和未来

糖尿病是一种合并多种并发症的慢性代谢疾病,是引起患者工作或生活能力丧失、甚至死亡的主要原因.目前,我国糖尿病的患病率达9.7%,患者数量位居世界前列.糖尿病一旦出现慢性并发症后,往往医疗花费巨大,而治疗效果甚微.因此,糖尿病的早期诊断、早期治疗极为重要.空腹血糖(FPG)、口服葡萄糖耐量试验(OGTT)是诊断糖尿病的常用方法,但是无论是检测FPG还是进行OGTT均有时间及采样要求,需要空腹或多次取血,受试者的依从性较差,限制了其在临床的广泛应用,使得相当一部分患者不能得到及时诊断.HbA1C作为评估患者长期血糖控制状况的临床指标,与糖尿病慢性并发症密切相关.由于HbA1C的检测方便、易行,不受进餐时间以及短期生活方式改变的影响,变异性小,所反映的血糖状况相对稳定,故近年有部分专业学术组织将其引入到糖尿病的诊断领域,为临床医生提高糖尿病的诊断效率提供了新的补充方法.

Abstract：

Diabetes mellitus is a chronic metabolic disease with complications associated with long-term damage,dysfunction,and failure of various organs,and has become one of the leading causes of impairment of human health.At present,the prevalence of diabetes mellitus reaches 9.7%in China,which is considered one of the countries in the world with heavy diabetes burden.Patients with established diabetic complications will be at higher risk of poor health outcomes and with higsh healthcare costs.These realities support the critical need to identify diabetes and its precursors more efficiently and earlier.The current diagnostic criteria,fasting plasma glucose(FPG),and oral glucose tolerance test(OGYT),that require fasting and multiple blood samplings,may not be acceptable to patients and may limit the clinical application so as to impede the effort to diagnose diabetes in timely fashion.HbA1C,which accurately reflects longer term glycaemia,Can be done at any time without fasting or other preparation of the patient and may not be affected by short term lifestyle changes.Given the recognized need,some panels have been considering the possible utility of HbA1C as a supplementary screening tool to make the diagnosis of diabetes efficiently.     

肝移植术后三年及以上患者糖代谢异常情况及其发病机制初探

目的 评估肝移植术后3年及以上患者糖代谢异常情况,初步探讨移植后糖尿病的发病机制.方法 收集2001年4月至2008年12月在中山医院进行肝移植患者的临床资料,排除术前已确诊糖尿病、死亡及失访患者,对肝移植术后≥3年的199例患者完成随访,统计根据空腹血糖诊断的移植后糖尿病(PTDM)发生率;对肝移植≥3年且根据空腹血糖未达到糖尿病诊断标准的的32例患者进行口服75 g葡萄糖耐量试验(OGTT),检测其空腹及糖负荷后2 h血糖和胰岛素,根据血糖情况分为血糖正常组、糖调节受损(IGR)组和PTDM组,计算其PTDM构成比和稳态模型评估(HOMA)指数.结果 肝移植术后≥3年的患者中,根据空腹血糖诊断的PTDM发生率为34.67%.对肝移植≥3年且根据空腹血糖未达到糖尿病诊断标准的32例患者进行OGTT得到:PTDM构成比为9.38%,IGR[包括空腹血糖受损和(或)糖耐量受损]为56.25%,血糖正常为34.37%.稳态模型评估胰岛β细胞功能指数(HOMA-β)在血糖正常组、IGR组、PTDM组依次递减,且PTDM组与血糖正常组、IGR组比较均有显著下降(均P＜0.01).稳态模型评估胰岛素抵抗指数(HOMA-IR)在IGR组最高,PTDM组次之,IGR组相对血糖正常组升高有统计学意义.结论 本院肝移植≥3年患者PTDM总发生率为44.05%,肝移植患者在糖代谢异常早期即存在胰岛素抵抗,胰岛β细胞功能则随糖代谢异常加重而进行性衰退.

Abstract：

Objective To evaluate the status of abnormal glucose metabolism in patients being alive over 3years after liver transplantation and discuss the possible mechanism of post-transplant diabetes mellitus ( PTDM ).Methods In this study, the clinical data of patients with liver transplantation were collected from April 2001 to December 2008. Patients with diabetes mellitus before operation and those who had died and failed to appear during follow-up were exluded. 199 patients living over 3 years after liver transplantation were follow-up. The prevalence of PTDM was evaluated according to fasting plasma glucose(FPG). Among those without diabetes according to FPG,32patients underwent 75 g oral glucose tolerance test (OGTT) , and fasting and 2 h plasma glucose and insulin were determined. 32 patients were divided into three groups [normal, impaired glucose regulation ( IGR ) , and PTDM groups], proportion of PTDM and homeostasis model assessment ( HOMA ) index were calculated. Results In patients alive over 3 years after liver transplantation, the prevalence of PTDM was 34.67% according to FPG. The OGTT result showed that the proportion of PTDM was 9.38%, IGR, including impaired fasting glucose(IFG) and impaired glucose tolerance ( IGT ) , was 56. 25% , while 34. 37% remained normal. The homeostasis model assessment β cell function index( HOMA-β ) decreased progressively from normal group, IGR group to PTDM group,and that in PTDM group was significantly lower than those in normal and IGR group( P＜0.01 ). IGR group had the highest homeostasis model assessment for insulin resistance (HOMA-IR) and PTDM group the next, and HOMA-IR in IGR group was significantly higher than normal group. Conclusion In patients alive over 3 years after liver transplantation, the prevalence of PTDM reached 44.05%. Insulin resistance existed during early period of impaired glucose regulation, while the degeneration of β cell progressed with the worsening of impaired glucose regulation.     

不同糖代谢状态人群糖化血清白蛋白与HbA1c的相关性分析

ObjeclJve To definine the corresponding value to glycated albumin(GA)for a specific target of HbAlc,and to elvaluate the relationship between GA and HbA1c.Methods From Oct.2006 TO Apr.2009, 2 532 subjects were enrolled who accepted oral glucose tolerance test(OGtt)in out-patient department,including 898 with normal glucose regulation,695 with impaired glucose regulation,and 939 with newly-diagnosed diabetes.GA was measured with liquid enzymatic method.HbA1c was measured with high performance liquid chromatography method.The plasma glucose was measured at fasting,0.5 h,1 h,2 h,and 3h after glucose load.The correlation among GA,HbA1c and the other parameters monitored was analyzed.Results (1)The levels of HbA1c and GA in 2 532 subjects were(6.3±1.1)% and(17.9±4.5)%.The ratio of GA/HbA1c was 2.85±0.51.(2)HbAlc and GA were positively correlated with fasting,0.5 h,1 h,2 h and 3 h plasma glucose(r was in 0.567-0.776,atl P<0.01).(3)GA was significantly correlated with HbA1c(r=0.701,P<0.01).Linear regression analysis,using GA and HbA1c summarized by patient(n=2 532),produced a relationship of GA=2.871×HbA1c-0.112.The change in GA per increase of 1% HbA1c was 2.87%.When HbA1c level was 6.5%,the expected value of GA was 18.5%.The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy with GA≤18.5% to predict HbA1c≤6.5% were 82.32%,72.49%,86.48%.65.73%,and 79.19%,respectively.When HbA1c level was 7.0%,the expected value of GA was 20.O%.When HbA1c level was 7.5%.the expected value of GA was 21.4%.Conclusions We initially establish the corresponding value to GA for a specific target of HbA1c and provide the basis for clinical application.     

不同糖代谢状态人群糖化血清白蛋白与HbA1c的相关性分析

ObjeclJve To definine the corresponding value to glycated albumin(GA)for a specific target of HbAlc,and to elvaluate the relationship between GA and HbA1c.Methods From Oct.2006 TO Apr.2009, 2 532 subjects were enrolled who accepted oral glucose tolerance test(OGtt)in out-patient department,including 898 with normal glucose regulation,695 with impaired glucose regulation,and 939 with newly-diagnosed diabetes.GA was measured with liquid enzymatic method.HbA1c was measured with high performance liquid chromatography method.The plasma glucose was measured at fasting,0.5 h,1 h,2 h,and 3h after glucose load.The correlation among GA,HbA1c and the other parameters monitored was analyzed.Results (1)The levels of HbA1c and GA in 2 532 subjects were(6.3±1.1)% and(17.9±4.5)%.The ratio of GA/HbA1c was 2.85±0.51.(2)HbAlc and GA were positively correlated with fasting,0.5 h,1 h,2 h and 3 h plasma glucose(r was in 0.567-0.776,atl P<0.01).(3)GA was significantly correlated with HbA1c(r=0.701,P<0.01).Linear regression analysis,using GA and HbA1c summarized by patient(n=2 532),produced a relationship of GA=2.871×HbA1c-0.112.The change in GA per increase of 1% HbA1c was 2.87%.When HbA1c level was 6.5%,the expected value of GA was 18.5%.The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy with GA≤18.5% to predict HbA1c≤6.5% were 82.32%,72.49%,86.48%.65.73%,and 79.19%,respectively.When HbA1c level was 7.0%,the expected value of GA was 20.O%.When HbA1c level was 7.5%.the expected value of GA was 21.4%.Conclusions We initially establish the corresponding value to GA for a specific target of HbA1c and provide the basis for clinical application.     

2型糖尿病HbA1c筛查值和诊断值的探讨

目的评估HbA1c在筛查和诊断T2DM中的有效性。方法对497例（男361例,女136例）体检FPG≥5．6mmol／L者行OGTT并测定HbA1c、血脂、尿酸、血压等代谢指标。结果（1）应用受试者工作特性曲线（ROC）进行统计分析,与OGTT诊断DM的相关HbA1c最佳切点为6．3％,敏感性和特异性分另U是79．60％和82．20％,曲线下面积（AUC）为0．873（95％CI0．831-0．916）,HbA1c为6．5％时的敏感性和特异性分别是62．70％和93．50％。（2）按2010年ADA的DM诊断标准,分别按HbA1c≥6．5％或OGTT标准诊断DM,无论是否去除两组重叠部分,以HbA1c≥6．5％标准诊断的DM组的HbA1c水平显著高于以OGTT标准诊断的DM组,而FPG、2hPG均显著低于以OGTT标准诊断的DM组,其余代谢指标如血压、血脂、尿酸等均无统计学差异。结论当HbA1c≥6．3％时应进一步行OGTT以明确有无DM,而HbA1c≥6．5％具有较好的特异性可用于诊断DM,与ADA的推荐一致。     

糖化血红蛋白检测对中国西藏藏族糖尿病及糖尿病前期诊断价值的研究

目的 探讨HbA-C检测在西藏高原藏族糖尿病及糖尿病前期的诊断价值。方法选取西藏拉萨地区无糖尿病史的藏族研究对象321名,检测HbA1c及75gOGTT,以1999年WH0标准为“金标准”,绘制受试者工作特征曲线（R0c）,评估HbA1C诊断的敏感性及特异性。结果诊断藏族糖尿病最佳切点为HbA1c≥6．5％,敏感性93．9％,特异性95％,阳性似然比（＋LR）18．7,阴性似然比（-LR）0．06,阳性预测值（＋PV）86．5％,阴性预测值（-PV）97．8％;诊断藏族糖尿病前期最佳切点为HbA,c≥5．7％,敏感性54．3％,特异性74．7％,-FLR2．15,-LR0．61,＋PV52．4％,-PV76．1％。结论HbA,c≥6．5％可作为藏族糖尿病诊断切点,但不能充分识别西藏藏族糖尿病前期患者。     

Hemoglobin A1c for the diagnosis of diabetes: To replace or to guide oral glucose tolerance tests?

Aims/Introduction: To evaluate if hemoglobin A1c (A1C) can replace the use of the oral glucose tolerance test (OGTT) to diagnose diabetes in Chinese patients. Materials and Methods: Subjects without pre‐existing diabetes were included in this community‐based study. Each participant received a 75‐g OGTT and A1C tests. Results: A total of 1362 subjects, 512 men and 850 women, aged 18–88 years, were enrolled. The prevalence of diabetes was 7.4 and 7.3% by OGTT and by A1C ≥ 6.5% criteria, respectively. The optimal A1C cut‐off for diabetes defined by OGTT was 6.1%. The performance of A1C ≥ 6.1% to find diabetes by OGTT was poor, with a kappa 0.50, sensitivity 80% and specificity 91%. Using current criteria of fasting plasma glucose (FPG) < 5.56 mmol/L to exclude and ≥7 mmol/L to diagnose diabetes (FPG criterion), the sensitivity, specificity and OGTT required were 77.2, 100 and 13.5%, respectively. Using A1C < 5.9% to exclude and ≥7.0% to diagnose diabetes (A1C criterion), the sensitivity, specificity and OGTT required were 89.1, 99.8 and 26.5%, respectively. However, using FPG < 5.56 mmol/L and A1C < 6.1% to exclude, and A1C ≥ 7.0% to diagnose diabetes (A1C plus FPG criterion), the sensitivity, specificity and OGTT required were 85.2, 100 and 18.9%, respectively. Conclusions: To screen for diabetes, the A1C criterion is more sensitive than the FPG criterion, with more OGTT needed. The A1C plus FPG criterion reduced the number of OGTT needed with acceptable sensitivity. A1C can guide, but cannot replace, OGTT to diagnose diabetes. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00181.x, 2011)     

HbA1C和空腹血糖在糖尿病筛查中的应用价值

目的探索HbA1c及FPG筛查糖尿病（DM）的应用价值。方法南京地区参加体检的未诊断糖尿病1330例,测定FPG和HbA1c,予标准化早餐后测定餐后2小时血糖（2hPG）,用受试者工作特征曲线（ROC）评价FPG和HbA1C筛查糖尿病的效果。结果按1999年WHO的糖尿病诊断标准,本研究人群DM患病率为6．8％。采用ROC曲线判断,与DM状态相关的FPG临界点为6．1mmol／L,敏感性和特异性分别为81．3％和96．3％;HbA1c临界点为6．1％,敏感性和特异性分别为83,5％和88．8％。当采用FPG≥6．1mmol／L或HhA1c≥6．1％作为标准时,敏感性达到92．3％,同时有较好的特异性81．2％。结论单独使用FPG较HbA1c在筛查DM中具有稍高的价值,为了最大限度的筛查DM患者,建议对6．1mmol／L≤FPG≤7．0mmol／L或HbA1c≥6．1％的患者行OGTT以明确有无糖尿病。     

HbA1c对中老年人糖尿病及糖调节受损诊断价值的探讨

目的 探讨HbA1c诊断中老年人糖尿病、糖调节受损的最佳切点.方法 采用整群随机抽样方法选取贵阳市云岩区40岁及以上,且居住5年以上的中老年人共8 803名.所有研究对象进行口服葡萄糖耐量试验(OG'TT)及检测HbA1c等指标.对HbA1c诊断糖尿病、糖调节受损的切点进行分析;按年龄分层分析HbA1c诊断糖尿病在不同年龄段的切点.结果 HbA1c诊断新发现糖尿病的切点为6.4％的特异性较高(86.8％),相应的敏感性为68.0％.HbA1c诊断糖调节受损的受试者工作曲线下面积偏低(0.558).40 ～49岁年龄组HbA1c诊断糖尿病的切点值最低,为6.1％;而70～岁年龄组HbA1c诊断糖尿病切点值最高,为6.6％.结论 中老年人群中HbA1c 6.4％为诊断糖尿病的最佳切点,HbA1 c不适合作为诊断糖调节受损的指标.     

糖化血红蛋白与糖调节受损血糖水平相关性的研究

目的 探讨研究糖化血红蛋白(HbAlc)与糖调节受损血糖水平的相关性.方法 2009年2-3月在兰州大学附属白银医院在岗职工中开展口服75 g葡萄糖耐量试验(OGTT)和HbAlc普查,测定空腹血糖、服糖后2 h血糖及HbAlc,采用葡萄糖氧化酶法测定静脉血浆血糖,采用高效液相色谱分析法测定HbAlc.研究资料纳入标准:空腹血糖<7.0 mmol/L且服糖后2 h血糖<11.1mmol/L者,无糖尿病、血红蛋白病、肝、肾疾患等.进入结果分析的对象共726例,男197例,女529例,平均年龄(39±10)岁.其中正常糖耐量636例(87.6%),糖调节受损90例(12.4%),糖调节受损诊断采用1999年世界卫生组织糖尿病诊断标准.率间比较采用χ~2检验,双变量分析采用Pearson相关分析.结果 (1)糖调节受损占HbAlc≤5.7%人群的2.3%,占HbAlc≥5.8%的人群中89.3%.HbAlc≥5.8%时预测OGTT诊断的糖调节受损状态的敏感度、特异度、阳性预测值、阴性预测值分别为83%、99%、0.89和0.98;(2)OGTT诊断的空腹血糖受损、糖耐量减低及糖调节受损状态的患病率,在HbAlc为5.8%组与5.7%组比较差异具有统计学意义(χ~2值分别为10.077、22.219和27.780,P<0.01或P<0.001);(3)HbAlc水平与空腹血糖受损、糖耐量减低、糖调节受损的患病率之间呈显著性正相关(r值分别为0.957、0.928和0.936,均P<0.01).结论 (1)HbAlc预测糖调节受损与OGTT具有一致性,与OGTT诊断的糖调节受损状态相关的HbAlc最佳临界值为5.8%;(2)HbAlc与OGTT诊断空腹血糖受损、糖耐量减低、糖调节受损状态的血糖水平呈显著性正相关,且HbAlc为5.8%与其相关性极其密切.建议当HbAlc≥5.8%时均应行OGTY检查,以明确有无糖调节受损.     

糖化血红蛋白用于筛查糖尿病的意义

目的比较并评价空腹血糖（FPG）和糖化血红蛋白（HbA1c）在筛查DM中的应用价值。方法上海地区研究对象2298名,为明确DM诊断而就诊者和DM高危人群接受DM筛查者,男956名,女1342名,年龄52±13岁,行OGTT并测定HbA1C;以其工作特征曲线（ROC）评价FPG和HbA。C在筛查DM中的敏感性和特异性。结果（1）按照1999年WHO的DM诊断标准,本研究人群糖耐量正常（NGT）、空腹血糖受损（IFG）、糖耐量受损（IGT）、IGT合并IFG和DM者分别为830、110、380、183、795例。其中DM患病率为34．6％。（2）依据ROC判断,与DM状态相关的FPG最佳临界点为6．1mmol／L,敏感性和特异性均为81．5％,曲线下面积为0．899（95％CI0．885～0．914）,阳性似然比4．18,阴性似然比0．23;与DM状态相关的HbA1c最佳临界点为6．1％,敏感性和特异性均为81．0％,曲线下面积为0．890（95％CI0．876-0．904）,阳性似然比4．26,阴性似然比0．23;如应用FPG≥6．1mmol／L或HbA1c≥6．1％筛查DM,敏感性和特异性分别为96．5％和65．2％,阳性似然比2．77,阴性似然比0．05。结论FPG和HbA1C在筛查DM中具有相似的价值,二者均有相似的特异性和敏感性以及阳性似然比和阴性似然比。为了最大限度的筛查出DM患者,建议对于6．1mmol／L≤FPG〈7．0mmol／L或HbA1c≥6．1％的患者行OGTT检查以明确有无DM。     

糖化血红蛋白切点和糖调节异常的相关性研究

目的探讨HbAlc的可能切点和糖调节异常的相关性。方法江苏地区既往无糖尿病、具有糖尿病高危因素而接受筛查的受检者397名,男217名,女180名,行口服葡萄糖耐量试验（OGTT）,同时测定HbAlc。采用受试者工作特征曲线（ROC曲线）进行判断,以OGTT诊断糖尿病时HbAlc对应的可能切点。结果根据2004年美国糖尿病学会（ADA）的糖尿病诊断标准,本研究人群糖尿病233例,空腹血糖受损（IFG）24例,糖耐量受损（IGT）40例,糖调节异常（IGR）62例,糖耐量正常（NGT）38例。ROC曲线提示,以HbAlc作为诊断糖尿病的切点为6．1％（敏感性80．25％,特异性71．30％）;以FBG≥6．3mmol/L或HbAlc≥6．1％作为诊断糖尿病的敏感性和特异性分别为91．85％和59．76％;以FBG≥6．3mmol/L且HbAlc≥6．1％诊断糖尿病的敏感性和特异性分别为60．52％和89．63％。结论FBG≥6．3mmol/L或HbAlc≥6．1％者仍应行OGTF以明确是否患有糖尿病。     

糖化血红蛋白与胰岛β细胞功能关系的研究

目的 探讨不同糖代谢状态糖化血红蛋白（HbA1c）与胰岛β细胞功能的关系.方法 选取2010年6月至2013年2月为评价糖耐量水平而来南京大学医学院鼓楼医院内分泌科就诊者913例,所有受试者均行75 g口服葡萄糖耐量试验（OGTT）及胰岛素释放试验,测定HbA1c,根据HbA1c水平将受试者分为HbA1c ＜5.7％（277例）、5.7％≤HbA1c≤6.4％（391例）及HbA1c＞6.4％组（245例）;根据OGTT结果分为正常糖耐量组（NGT,205例）,糖调节受损组（IGR,328例）及2型糖尿病组（T2DM,380例）.以1/稳态模型胰岛素抵抗指数（1/HOMA-IR）、Matsuda胰岛素敏感指数（ISIM）评价胰岛素敏感性,以处置指数DI（早时相DI30、总时相DI120）评估校正胰岛素敏感性之后的胰岛β细胞功能.多组计量资料间比较采用方差分析,分类计数资料采用卡方检验,胰岛功能相关指数在校正性别、年龄、BMI之后采用一般线性模型进行比较.结果 与HbA1c ＜5.7％组相比,5.7％≤HbA1c≤6.4％组的DI30、DI120、ISIM、1/HOMA-IR分别下降了39％、33％、13％、14％;HbA1c＞6.4％组的DI30、DI120、ISIM、1/HOMA-IR分别下降了68％、66％、21％、32％（F=12.765 ～ 317.316,均P＜0.05）.在正常糖耐量阶段的人群中,5.7％≤HbA1c≤6.4％组的DI30、DI120明显低于HbA1c＜5.7％组（F=4.516、4.215,P＜0.05）;在HbA1c＜ 5.7％的人群中,DI30及DI120按照NGT→ IGR→T2DM的方向下降（F =87.604、108.369,P＜0.05）.结论 胰岛β细胞功能的进行性衰退及胰岛素抵抗共同促进了HbA1 c的升高;HbA1c与血糖结合能够更好地反映个体胰岛功能情况.