探讨糖化血红蛋白对糖尿病的诊断价值
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摘要
目的探讨糖化血红蛋白(Hb Alc)对糖尿病的诊断价值。方法检测455例体检者的空腹血糖、糖化血红蛋白和餐后2 h血糖(2h-PG),采用ROC曲线确定Hb Alc诊断糖尿病的诊断界点。结果以FPG≥7.0 mmol/L或2 hPG≥11.1 mmol/L为诊断DM的金标准作ROC曲线,Hb A1c 6.1%为最佳切点,灵敏度为92.7%,特异度为83.4%;以FPG<7.0 mmol/L且2 h-PG(7.8~11.1)mmol/L为诊断IGT的金标准作ROC曲线,Hb A1c 5.8%为最合适的切点,灵敏度为83.3%,特异度为55.8%;以FPG(6.1~7.0)mmol/L且2 h-PG<7.8 mmol/L为诊断IFG的金标准作ROC曲线,Hb A1c的5.6%为最合适的切点,灵敏度为84.4%,特异度为44.2%。结论 Hb A1c作为诊断糖尿病的指标具有可行性,其灵敏度较高,诊断糖调节受损特异度不高,联合实验有助于提高糖调节受损的检出率。
Objective To investigate the diagnostic value of glycosylated hemoglobin( Hb Alc) towards diabetes mellitus( DM).Methods FPG,Hb Alc and 2 h- PG of 455 health check- out people were detected. Receiver operating characteristic curve( ROC curve) was used to examine the optimal cut- point of Hb Alc for detecting DM. Results Regarding FPG≥7. 0 mmol/L or 2 h- PG≥11. 1 mmol / L as the gold standard for diagnosing DM and making ROC curve. The optimal cut point of Hb Alc for diagnosing DM was 6. 1%,with sensitivity of 92. 7%,specificity of 83. 4%. Regarding FPG < 7. 0 mmol / L and 2 h- PG7. 8 mmol / L- 11. 1 mmol / L as the gold standard for diagnosing IGT and making ROC curve,and the optimal cut point of Hb Alc was 5. 8%,with sensitivity of 83. 3%,specificity of 55. 8%. Regarding FPG 6. 1 mmol / L- 7. 0 mmol / L and 2 h- PG< 7. 8 mmol / L as the gold standard for diagnosing IFG and making ROC curve,and the optimal cut point of Hb Alc was 5. 6%,with sensitivity of 84. 4%,specificity of 44. 2%. Conclusion There are a high sensitivity to diagnose DM by Hb Alc and a lower specificity to diagnose IGT and IFG by Hb Alc. Combined test may contribute to improve the detection rate of IGR.
Objective To investigate the diagnostic value of glycosylated hemoglobin( Hb Alc) towards diabetes mellitus( DM).Methods FPG,Hb Alc and 2 h- PG of 455 health check- out people were detected. Receiver operating characteristic curve( ROC curve) was used to examine the optimal cut- point of Hb Alc for detecting DM. Results Regarding FPG≥7. 0 mmol/L or 2 h- PG≥11. 1 mmol / L as the gold standard for diagnosing DM and making ROC curve. The optimal cut point of Hb Alc for diagnosing DM was 6. 1%,with sensitivity of 92. 7%,specificity of 83. 4%. Regarding FPG < 7. 0 mmol / L and 2 h- PG7. 8 mmol / L- 11. 1 mmol / L as the gold standard for diagnosing IGT and making ROC curve,and the optimal cut point of Hb Alc was 5. 8%,with sensitivity of 83. 3%,specificity of 55. 8%. Regarding FPG 6. 1 mmol / L- 7. 0 mmol / L and 2 h- PG< 7. 8 mmol / L as the gold standard for diagnosing IFG and making ROC curve,and the optimal cut point of Hb Alc was 5. 6%,with sensitivity of 84. 4%,specificity of 44. 2%. Conclusion There are a high sensitivity to diagnose DM by Hb Alc and a lower specificity to diagnose IGT and IFG by Hb Alc. Combined test may contribute to improve the detection rate of IGR.
引文
[1]American Diabetes Association.Standards of medical care for patients with diabetes mellitus[J].Diabetes Care,2003,26(1):S33-S50.
[2]Barr RG,Nathan DM,Meigs JB,et al.Tests of glycemia for the diagnosis of type 2 diabetes mellitus[J].Ann Intern Med,2002,137(4):263-272.
[3]Sandek CD,Herman WH,Sacks DB,et al.A new look at screening and diagnosing diabetes mellitus[J].J Clin Endocrinol Metab,2008,93(7):2447-2453.
[4]王梅华,卢娉霞,王福安,等.3 269例糖化血红蛋白检测的临床效果分析[J].福建医科大学学报,2008,42(6):551-553.
[5]American Diabetes Association.Diagnosis and classification of diabetes mellitus[J].Diabetes Care,2011,34(Suppl 1):S62-S69.
[6]王连升,庄兴,张琦,等.糖化血红蛋白对糖尿病的诊断价值[J].临床检验杂志,2011,29(3):193-194.
[7]储小宏,丛安丽,吴邦庆,等.Hb Alc与OGTT在糖尿病诊断中的应用比较[J].安徽医科大学学报,2011,57(9):982-983.
[8]Zhou XH,Ji LN,Luo YY,et al.Performance of Hb A(1c)for detecting newly diagnosed diabetes and pre-diabetes in Chinese communities living in Beijing[J].Diabetes Med,2009,26(12):1262-1268.
[9]Hu Y,Liu W,Chen Y,et al.Combined use of fasting plasma glncose and glycated hemoglobin A1c in the screening of diabetes and impaired glucose tolerance[J].Acta Diabetol,2010,47(3):231-236.
[10]American Diabetes Association.Standards of medical care in diabetes-2010[J].Diabetes Care,2010,33(3):692.
[2]Barr RG,Nathan DM,Meigs JB,et al.Tests of glycemia for the diagnosis of type 2 diabetes mellitus[J].Ann Intern Med,2002,137(4):263-272.
[3]Sandek CD,Herman WH,Sacks DB,et al.A new look at screening and diagnosing diabetes mellitus[J].J Clin Endocrinol Metab,2008,93(7):2447-2453.
[4]王梅华,卢娉霞,王福安,等.3 269例糖化血红蛋白检测的临床效果分析[J].福建医科大学学报,2008,42(6):551-553.
[5]American Diabetes Association.Diagnosis and classification of diabetes mellitus[J].Diabetes Care,2011,34(Suppl 1):S62-S69.
[6]王连升,庄兴,张琦,等.糖化血红蛋白对糖尿病的诊断价值[J].临床检验杂志,2011,29(3):193-194.
[7]储小宏,丛安丽,吴邦庆,等.Hb Alc与OGTT在糖尿病诊断中的应用比较[J].安徽医科大学学报,2011,57(9):982-983.
[8]Zhou XH,Ji LN,Luo YY,et al.Performance of Hb A(1c)for detecting newly diagnosed diabetes and pre-diabetes in Chinese communities living in Beijing[J].Diabetes Med,2009,26(12):1262-1268.
[9]Hu Y,Liu W,Chen Y,et al.Combined use of fasting plasma glncose and glycated hemoglobin A1c in the screening of diabetes and impaired glucose tolerance[J].Acta Diabetol,2010,47(3):231-236.
[10]American Diabetes Association.Standards of medical care in diabetes-2010[J].Diabetes Care,2010,33(3):692.