初诊2型糖尿病患者糖化血红蛋白与并发症的关系

目的 探讨初诊2型糖尿病(T2DM)患者糖化血红蛋白(HbA1c)与糖尿病并发血管病变和肾功能损害的关系.方法 对221例初诊T2DM患者行颈动脉彩色多普勒超声波检查[颈动脉内膜至中膜厚度(IMT)＞1.3 mm诊断为血管病变,纳入血管病变组,反之纳入血管正常组],并检测尿微量清蛋白(mAlb)>22.5 mg/L诊断为肾功能损害,为RI组;mAlb 0~2.25 mg/L为肾功能正常,纳入NR组.利用ROC曲线分析不同切点HbA1c值,判断糖尿病并发血管病变和肾功能损害的敏感性和特异性.结果 HbA1c在不同切点HbA1c≥6.75%、HbA1c≥6.85%、HbA1c≥7.35%,诊断初诊T2DM 患者并发血管或肾功能损害、血管病变、肾功能损害的敏感度和特异性分别是93.4%和77.4%(ROC=0.929),91.7%和76.8%(ROC=0.918),85.7%和91.4%(ROC=0.943).结论 HbA1c用于早期预测诊断DM并发血管病变和肾功能损害具有较高的敏感度和特异性,对防治糖尿病并发血管病变和肾功能损害有重要意义.

Relationship between hemoglobin A1c and complications of the new diagnose type 2 diabetes mellitus

Objective To investigate the relationship between HbA1c of the new diagnose T2DM patients and the complications of DM including renal impairment and vasculopathy.Methods There were 221 new diagnosed T2DM patients.All patients were checked up carotid artery with color Doppler ultrasound（carotid artery′s IMT value1.3 mm regard as vasculopathy）.Besides,the concentration of urine microalbumin（urine mAlb22.5 mg/L regard as renal impairment） and HbA1c in blood were detected by different methods.With the ROC curve there are different cut-off points of HbA1c,and they had different sensitivity and specificity to estimate the vasculopathy and renal impairment of DM.Results Using different HbA1c′pointcut to confirm the complication of the new diagnosed T2DM,The cut-off point of HbA1c≥6.75% had a sensitivity of 93.4%,a specificity of 77.4%（ROC=0.929）.The second pointcut of HbA1c≥6.85% had a sensitivity and specificity of 91.7% and 76.8%（ROC=0.918）,respectively.Similarly,in the case of HbA1c≥7.35% the sensitivity and specificity were 85.7% and 91.4%（ROC=0.943）,respectively.Conclusion HbA1c has a high sensitivity and specificity,when it is used to diagnose vasculopathy and renal impairment complications of DM in the early phase.It is significant to the prevention and treatment of the DM with the complication of vasculopathy or renal impairment.