糖化血红蛋白和糖化血清白蛋白联合检测在糖尿病筛查中的应用

目的 评估糖化血红蛋白(HbAlc)、糖化血清白蛋白(GA)联合检测在筛查糖尿病(DM)中的应用价值.方法 研究对象来自于2007年3月至2009年12月为明确DM诊断而就诊者和糖尿病高危人群接受DM筛查共1480例,男677名、女803名.平均年龄(52.7±15.2)岁,研究对象空腹10 h行口服葡萄糖耐量试验(OGTT),采用高压液相法测定HbAlc水平,采用液态酶法测定GA水平.结果 (1)按1999年WHO糖尿病诊断标准,本组研究人群糖耐量正常组(NGT)562名、糖调节受损组(IGR)411名、新诊断DM患者组507例.HbAlc、GA水平在NGT、IGR、DM 3组间两两比较差异均有统计学意义(均P<0.01).(2)Pearson相关分析显示HbAlc与GA呈正相关(r=0.75,P<0.01).HbAlc与OGTT中空腹血糖(FPG)、糖负荷后2 h血糖(2 hPG)均呈正相关(r分别为0.82、0.78,P<0.01).GA与OGTY、FIG、2 hPG均晕正相关(r分别为0.73、0.75,P<0.01).(3)以OGTT为诊断DM的金标准绘制ROC曲线,结果显示,HbAlc、GA对DM均有较高的预测价值,曲线下面积(AUC)分别为0.882、0.881,两者之间的差异无统计学意义(P>0.05).HbAlc识别DM的最佳切点为6.1%.(4)联合HbAlc 6.1%、GA 17.1%为切点筛查DM的敏感度显著高于单用HbAlc 6.1%或GA17.1%的标准(94.7%比81.1%、88.4%均P<0.01).结论 HbAlc和GA的联合检测能进一步提高DM的筛查效率.当HbAlc≥6.1%或GA≥17.1%时应进一步行OGTT以明确有无DM.

Abstract：

Objective To assess the validity of combined detection of hemoglobin Alc (HbAlc)and glycated albumin (GA) in diabetic screening. Methods A total of 1480 subjects at our out-patient department from March 2007 to December 2009. Those suspected of diabetes or at a high risk of diabetes were enrolled. The study population included 677 males and 803 females with a mean age of 52. 7 years. All subjects received an oral glucose tolerance test ( OGTT) after a 10-hour fasting. Glycated albumin ( GA)and hemoglobin Alc (HbAlc) were measured with liquid enzyme method and high pressure liquid chromatography respectively. Results ( 1 ) According to World Health Organization diabetes diagnosis criteria, there were 562 subjects with normal glucose tolerance (NGT), 411 subjects with impaired glucose regulation (IGR) and 507 subjects with newly diagnosed diabetes mellitus (DM). The level of HbAlc and GA had a rising tendency among NGT, IGR and DM groups (P<0. 01). (2) Pearson correlation analysis demonstrated that HbAlc had a positive association with GA ( r = 0. 75, P < 0. 01). (3) Using OGTT as golden standard of diabetic diagnosis, receiver operator characteristic (ROC) curve indicated that HbAlc and GA were strong predictors of diabetes. The area under curve ( AUC) was 0. 882 and 0. 881 respectively with no significant difference ( P >0. 05). (4) The sensitivity of combined use of HbA1 c and GA at optimal cut-off points of 6. 1% and 17. 1% was significantly higher than that of single use of HbAlc or GA in diabetic screening (94. 7% vs 81. 1% , 88. 4% , P <0. 01). Conclusion A combined detection of HbAlc and GA may improve the efficacy of diabetic screening. The subject with HbAlc≥6. 1% or GA≥17.1% is recommended to undergo OGTT for confirming a diagnosis of diabetes.

Combined utility of hemoglobin A1c and glycated albumin in diabetic screening

Objective To assess the validity of combined detection of hemoglobin Alc (HbAlc)and glycated albumin (GA) in diabetic screening. Methods A total of 1480 subjects at our out-patient department from March 2007 to December 2009. Those suspected of diabetes or at a high risk of diabetes were enrolled. The study population included 677 males and 803 females with a mean age of 52. 7 years. All subjects received an oral glucose tolerance test ( OGTT) after a 10-hour fasting. Glycated albumin ( GA)and hemoglobin Alc (HbAlc) were measured with liquid enzyme method and high pressure liquid chromatography respectively. Results ( 1 ) According to World Health Organization diabetes diagnosis criteria, there were 562 subjects with normal glucose tolerance (NGT), 411 subjects with impaired glucose regulation (IGR) and 507 subjects with newly diagnosed diabetes mellitus (DM). The level of HbAlc and GA had a rising tendency among NGT, IGR and DM groups (P<0. 01). (2) Pearson correlation analysis demonstrated that HbAlc had a positive association with GA ( r = 0. 75, P < 0. 01). (3) Using OGTT as golden standard of diabetic diagnosis, receiver operator characteristic (ROC) curve indicated that HbAlc and GA were strong predictors of diabetes. The area under curve ( AUC) was 0. 882 and 0. 881 respectively with no significant difference ( P >0. 05). (4) The sensitivity of combined use of HbA1 c and GA at optimal cut-off points of 6. 1% and 17. 1% was significantly higher than that of single use of HbAlc or GA in diabetic screening (94. 7% vs 81. 1% , 88. 4% , P <0. 01). Conclusion A combined detection of HbAlc and GA may improve the efficacy of diabetic screening. The subject with HbAlc≥6. 1% or GA≥17.1% is recommended to undergo OGTT for confirming a diagnosis of diabetes.