2型糖尿病患者血浆1,5-AG测定的临床意义

目的评价血浆1,5-脱水山梨醇(1,5-AG)对糖尿病诊断和血糖监测的临床价值.方法对96例2型糖尿病、13例糖调节受损及55例正常对照进行研究,测定了血浆1,5-AG、空腹及餐后2h血糖、HbA1c等指标,糖尿病患者还检测了24h尿糖和尿白蛋白排泄率(AER).结果糖尿病组血浆1,5-AG水平显著低于正常对照和IGR组(P<0.01),IGR组血浆1,5-AG也低于正常对照(P<0.05).多元逐步回归分析提示FPG、24h尿糖与1,5-AG呈显著负相关,标准偏回归系数分别为-0.609(P< 0.01)和-0.235(P<0.05).在糖尿病患者,正常白蛋白尿组和微量白蛋白尿组1,5-AG水平与FPG、2hPG、HbA1c、24h尿糖均呈显著负相关(P<0.01),而与AER无相关性(P>0.05).糖尿病组和对照组在空腹、服糖后1h、2h的1,5-AG水平无明显波动.1,5-AG诊断糖尿病的ROC曲线下面积为0.956,最佳切点位于14mg/L,其诊断的敏感度和特异度分别为88.5%和 89.0%.结论 1,5-AG可作为糖尿病的诊断和短期血糖监测指标,且不受进餐的影响,还可用于微量白蛋白尿的糖尿病患者.

Cliniacal significance of 1,5-anhydro-D-glucitol assay in type 2 diabtes mellitus

Objective To evaluate the clinical significance of 1,5-anhydro-D-glucitol(1,5-AG) as a new marker for diagnosis and monitoring glucose metabolism in type 2 diabetes mellitus. Methods Plasma 1,5-AG, fasting plasma glucose(FPG),2h postprandial plasma glucose(2hPG) and HbA1c were determined in 96 type 2 diabetes mellitus,13 patients with impaired glucose regulation(IGR) and 55 control subjects. Albumin excretion rate (AER) and 24h urinary glucose(24h UG)were also studied in diabetic patients. Results Plasma 1,5-AG was obviously lower in the diabetes than that in IGR and controls(P<0.01).Compared with controls, IGR patients had lower plasma 1,5-AG(P<0.05).Stepwise multiple regression analysis showed 1,5-AG had significantly inverse correlation with FPG and 24h UG,and standardized coefficients were -0.609(P<0.01) and -0.235(P<0.05) respectively. Among diabetes, either in normal urinary albumin or in microalbuminuria subsection, plasma 1,5-AG had negative correlation with FPG,2hPG,HbA1c and 24h UG(P<0.01), but had no correlation with AER(P>0.05). Both in diabetic patients and controls,no significant fluctuation of 1,5-AG was found as fasting,1h and 2h after taking 75g glucose. The area under the ROC curve was 0.956 for 1,5-AG in the diagnosis of diabetes, 1,5-AG 14mg/L had the best equilibrium between sensitivity and specificity for diagnosing diabetes,and the sensitivity and specificity were 88.5% and 89.0% respectively. Conclusion Plasma 1,5 -AG can be used as a marker of diagnosis and monitoring glucose control in diabetes.No significant influence of diet is observed, and 1,5-AG can be used in diabetic patients with microalbuminuria.