HbA1c与FPG联合筛查诊断糖尿病的应用价值

目的 探索糖化血红蛋白（HbA1c）与空腹血糖（FPG）联合筛查糖尿病（DM）及DM高危人群的应用价值.方法 测定沧州行政和企事业单位6 533例健康体检者的HbA1c和FPG,筛查DM患者及DM高危人群,对DM诊断有疑问者进一步作糖耐量实验（OGTT）.结果 采用ADA推荐的HbA1c≥6.5％或FPG≥7.0mmol/L为筛查DM标准,本研究人群DM筛查率为10.51％,DM高危人群为18.69％.如果用HbA1c≥6.5％单项筛查DM,漏诊率占联合检出DM人数的20.23％;用FPG≥7.0 mmol/L单项筛查DM,漏诊率为21.83％.依据联合筛查提出了适于本地筛查DM的切点：HbA1c≥6.5％与FPG≥6.0 mmol/L,HbA1c≥6.0％与FPG≥7.0mmol/L可直接诊断DM;5.5％≤HbA1c＜6.0％与FPG≥7.0 mmol/L,HbA1c＜5.5％与FPG≥7.0 mmol/L,这部分人群应重新验证或作OGTT明确诊断,高者诊断DM,低者降为高危人群,对DM高危人群也提出了筛查切点.结论 HbA1c与FPG联合检测在筛查DM中可以达到较高的灵敏度和保持较高的特异性,最大限度地提高了体检人群筛查诊断DM效率.

Utility of Combined Glycated Hemoglobin Alc and Fasting Plasma Glucose in Screening of Diabetes Mellitus

Objective To explore the value of glycated hemoglobin Alc （HbAlc） combined with fasting plasma glucose （FPG） in screening of diabetes Mellitus （DM） and DM related high-risk population. Methods The 6 533 subjects from the administration and enterprises system of Cangzhou received HbAlc and FPG tests. Additional oral glucose tolerance test （OGTT） was performed in suspect subjects in the screening. Results According to the ADA standard of screening for DM,whieh was HbAle ≥6.5% or FPG ≥7.0 mmol/L,the detection rates was 10.51% for DM and 18.69% for high risk population. With HbAle≥6.5% for the screen of DM , the rate of missed diagnosis was 20.23%. With FPG≥7.0 mmol/L,the missed diagnosis rate was 21.83%. Results of combined screening test suggested critical points for diagnosis of DM were： HbAle≥6.5% and FPG≥6.0 mmol/L, HbAlc≥6.0% and FPG ≥7, 0 mmol/L for direct diagnosis of DM. For those people with 5.5≤HbAlc≥6.0% and FPG ≥7.0 mmol/L, HbAlc〈5. 5% and FPG≥7. 0 mmoI/L,extra OGTT were given to support the diagnosis of MD or high risk population. Specific screening point was proposed for the high risk population. Conclusion Combined detection of HbAle and FPD in the screening of DM may yield a higher sensitivity and higher specificity,which has potential to increase the efficiency of DM diagnosis in the general population.