标准馒头餐试验诊断糖尿病的临床应用

Standard bread meal test in clinical diagnosis of Diabetes mellitus application

目的探讨标准馒头餐试验(SBMT)及其空腹血糖(FPG)、餐后2h血糖(2hPG)诊断糖尿病(DM)的临床意义,比较世界卫生组织(WHO)糖尿病诊断标准(1999/1985)的临床价值。方法标准馒头以100g富强面粉制成,约含葡萄糖75g,代替无水葡萄糖口服进行标准馒头餐试验(SBM了);血浆葡萄糖检测采用葡萄糖氧化酶终点比色法。依据WHO(1999)DM诊断标准FPG≥7.00 mmol/L的155例患者(其中分成FPG≥7.00 mmol/L≤7.80 mmol/L患者35例;FPG≥7.80 mmol/L患者120例;)设为实验组。依据WHO(1999)DM诊断标准FPG≤7.00 m mol/L的健康体检者45例(其中FPG<6.10 mmol/L 25例;FPG≥6.10mmol/L≤7.00 mmol/L 20例)设为实验对照组。根据SBMT检测结果计算实验组SBMT曲线下面积,分析FPG及2hpG的临床意义;应用实验诊断学的评价指标(敏感性、特异性、准确度、假阴性率等)评价SBMT,并WHO(1999/1985)糖尿病诊断标准进行比较。结果以2hpG11.10mmol/L为"金标准",SBMT诊断DM的阳性率为84%(168/200),诊断指数为155.05%;诊断试验的敏感度86.3%,特异度68.5%,准确度83.50%,假阴性率为13.70%,阳性预测值为93.55%,阴性预测值为49.0%;试验组SBMT曲线下面积均值其统计学差异均有显著性意义(P<0.001)。将空腹血浆葡萄糖(FPG)≥7.0 mmol/L(WHO1999诊断标准)和FPG≥7.8 m mol/L(WHO1985诊断标准)2个血糖临界值比较;FPG≥7.0 mmol/L诊断标准的敏感度、准确度分别提高了16.7%和10.5%(P<0.01、P<0.05);假阴性率下降了16.6%(P<0.01)。WHO(1999/1985)空腹血糖诊断标准分別有23例(23/168)及5 1例(51/168)需要作SBMT或者OGTT以核实DM诊断。结论标准馒头餐试验(SBMT)可以替代口服葡萄糖耐量试验(OGTT)检验诊断DM;FPG检出率较高,操作简便,但有假阴性,确诊率差;临界值2hPG≥11.10 mmol/L是珍断DM合适的截点,是诊断DM的"金标准"。

Objective To investigate the standard bread meal test(SBMT) and fasting plasma glucose(FPG),2-hour postprandial blood glucose(2hpG) the clinical significance of the diagnosis of diabetes mellitus(DM),Comparison of the World Health Organization(WHO) diagnostic criteria for diabetes(1999/1985)the clinical value of diagnosis of diabetes.Methods Standard bread made of rich and strong flour of 100 g containing glucose 75 g,about,instead of anhydrous glucose oral administration of standard bread meal test(SBMT);endpoint colorimetric plasma glucose detection using glucose oxidase.According to WHO(1999) DM diagnostic criteria of FPG≥7.00 mmol/L,155 patients;(which is divided into of FPG≥7.00mmol/L ≤7.80 mmol/L in 35 patients;of FPG≥7.80 mmol/L in patients with 120 cases;) Make experimental group.In accordance with the WHO(1999) DM diagnostic criteria of FPG≤7.00 mmol/L,45 cases of healthy persons;(one of FPG<6.10mmol/L,25 cases;of FPG≥6.10 mmol/L≤7.00 mmol/L,20 cases) is set to the experimental control group.Area under the onSBMT test results experimental group SBMT curve analysis of FPG and 2hpG clinical significance;Application of Laboratory Diagnosis evaluation(sensitivity,specificity,accuracy,false negative rate,etc.) evaluation SBMT,and WHO(1999 / 1985)diagnostic criteria for diabetes were compared.Results the 'gold standard' to 2hpG11.10mmol / L,SBMT diagnosis of DM positive rate was 84%(168/200),the diagnostic index of 155.05 percent;diagnostic test sensitivity 86.3%,specificity 68.5%,accuracy83.50%,false negative rate was 13.70%,93.55%positive predictive value,negative predictive value was 49.0%;experimental group SBMT curve area of the mean statistical differences were significant(P<0.001).Fasting plasma glucose(FPG)≥7.0 mmol/L(WHO 1999 diagnostic criteria) and of FPG≥7.8 mmol/L(WHO 1985 diagnostic criteria) 2 blood glucose threshold:of FPG≥7.0 mmol/L,the sensitivity of the diagnostic criteria accuracy were 16.7%and 10.5%(P<0.01,P<0.05);false negative rate has dropped by 16.6%(P <0.01).WHO(1999/1985) fasting plasma glucose diagnostic criteria,23 cases(23/168) and 51 cases(51/168) for SBMT or OGTT to verify DM diagnosis.Conclusion The standard bread meal test(SBMT) can replace the oral glucose tolerance test(OGTT) test diagnosis of the DM;of FPG higher detection rates,easy to operate,but false-negative diagnosis rate is poor;critical value of 2 h,the PG≥11.10 mmol/L is the diagnosis of DM the appropriate cut-off point is the 'gold standard' diagnosis of DM.