糖化血红蛋白筛查青春期前儿童血糖异常的效果研究

  目的  探讨糖化血红蛋白(HbA1c)筛查青春期前儿童血糖异常的效果，为儿童血糖异常筛查指标的选择提供科学依据。  方法  2017年整群抽取厦门市未进入Tanner Ⅱ期的1 208名7~10岁学生为研究对象，抽取空腹静脉血检测HbA1c和空腹血糖(FPG)。采用美国糖尿病协会标准将研究对象分为正常组、HbA1c异常组、FPG异常组和联合指标异常组(HbA1c或FPG异常)，使用偏相关分析HbA1c与FPG的相关性，使用约登系数法计算FPG为5.6 mmol/L时HbA1c的界值点，使用受试者工作特征曲线(ROC)判断HbA1c的筛查效果。  结果  以HbA1c，FPG及联合指标为筛查指标，儿童血糖异常检出率分别为2.2%, 4.0%和5.8%。HbA1c和FPG的偏相关系数为0.15(P < 0.01)，女生组、非超重组偏相关系数较高(r值分别为0.22，0.16)。FPG为5.6 mmol/L时，对应的HbA1c界值点为5.15%。以联合指标为参照标准，FPG和HbA1c的ROC曲线下面积(95%CI)分别为0.84(0.79~0.90)和0.69(0.63~0.74)。  结论  青春期前儿童HbA1c和FPG的相关性较低，HbA1c筛查血糖异常的效果与FPG相比存在差异。建议同时使用HbA1c和FPG筛查青春期前儿童血糖异常。

Effectiveness effects of screening elevated blood glucose of pre-pubertal children with HbA1c

  Objective  To explore the performances of HbA1c when identifying elevated blood glucose among pre-pubertal children, and to provide scientific basis for early screening biomarkers of abnormal blood glucose in children.  Methods  A total of 1 208 prepubertal children aged 7 to 10 years old in Xiamen were sampled with the cluster sampling method. Fasting venous blood was drawn to measure the level of HbA1c and FPG. According to American Diabetes Association (ADA) criteria, participants were divided into normal group, HbA1c abnormal group, FPG abnormal group and combined abnormal group. Partial correlation analysis was used to analyze the correlation between HbA1c and FPG. The cutoffs of HbA1c were calculated when FPG was 5.6 mmol/L. Receiver operating curve (ROC) was used to judge the performances of HbA1c while screening abnormal blood glucose.  Results  With HbA1c, FPG and the combined indicators as the screening criteria, the prevalence of high blood glucose were 2.2%, 4.0%, and 5.8%, respectively. The partial correlation coefficient of FPG and HbA1c was 0.15(P < 0.01), and the correlation coefficient in girls(r=0.22) and non-overweight group(r=0.16) were higher. The cutoff of HbA1c was 5.15% if FPG was 5.6 mmol/L. Taking the combined indicator as the reference standard, the AUC of FPG was 0.84 (95%CI=0.79-0.90) and the AUC of HbA1c was 0.69(95%CI=0.63-0.74).  Conclusion  There is a low correlation between HbA1c and FPG in pre-pubertal children. The performance of HbA1c is different from FPG when used as the indicator to screen children with abnormal blood glucose. It is recommended to use the combined indicator of HbA1c and FPG to screen abnormal blood glucose in prepubertal children.