南京机关背景人群新旧IFG诊断标准与IGT诊断一致性分析

The agreement between the revised criteria of impaired fasting glucose and glucose tolerance

目的探讨ADA空腹血糖受损(IFG)诊断标准下调对IFG患病率的影响,比较诊断切点调整前后IFG与糖耐量异常(IGT)诊断的一致性。方法南京地区机关背景1163例无糖尿病史成人,均行75g口服葡萄糖耐量试验。计算IFG、IGT的患病率,采用κ检验评价不同诊断标准之间的一致性。以IGT为参照,对不同空腹血糖(FPG)值建立受试者工作特征曲线(ROC曲线),寻找FPB的理想临界值。结果下调诊断标准,IFG患病率由3.10%上升至8.94%,接近IGT患病率9.20%;诊断一致性检验量κ由0.230上升为0.296。ROC曲线分析提示以IGT为参照,最匹配的FPB切点为5.1mmol/L。结论①下调IFG诊断切点至5.6mmol/L,可增加IFG与IGT患病率的一致性;②IFG诊断切点下调适用于本研究人群;③IFG与IGT的重叠有限。仅以FPG不能替代餐后2-h血糖(2hPG)。

Objective To determine the effect of lowering the criterion for impaired fasting glucose （IFG） on the morbidity of IFG, as well to the agreement between IFG and impaired glucose tolerance （IGT） using the original and the revised definitions. Methods Seventy-five gram oral glucose tolerance tests were performed in 1163 individuals. The morbidity of IFG and IGT was calculated. The agreement between these categories was made using κ test. Results Lowering the criterion for IFG to 5. 6 mmol/L increased the morbidity of IFG from 3.10% to 8. 94%, closer to the morbidity of IGT （9. 20%）. However, a poor agreement was found between the new IFG definition and IGT for increasing to 0. 296 only. Conclusions Lowering the FPG criterion can improve the agreement between the morbidity of IFG and IGT. It is rational to revise the FPG criterion for diagnosing IFG to 5. 6 mmol/L. However, only using FPG can not detect all the IGT patients without additional 2-hour PG.