餐后血糖对2型糖尿病诊断的意义

Significance of Postprandial Glucose Test for the Diagnosis of Type 2 Diabetes

目的通过口服葡萄糖耐量(OGTT)和胰岛素释放(IRT)试验,解析空腹和餐后血糖对糖尿病诊断的意义。方法收集2005年1月—2007年6月,内分泌和代谢科门诊及住院患者共3 588例进行OGTT和IRT检测。以血浆葡萄糖5.6、6.1、7.0mmol/L为空腹血糖切点,7.8、11.1mmol/L为餐后血糖切点,分析患者分布情况以及空腹血糖(FPG)、餐后1h血糖(1 h PG)和餐后2 h血糖(2 h PG)等不同切点对糖尿病诊断的价值。结果依据1999年WHO糖尿病诊断标准,诊断糖尿病患者3097例。其中FPG≥7.0mmol/L者2654例,单独检测2hPG漏诊62例,占2.33%;单独检测1hPG仅漏诊18例,占0.68%,差别有统计学意义(P<0.001)。2 h PG≥11.1 mmol/L者中FPG<7.0 mmol/L的占14.60%(443/3 035);1 h PG≥11.1mmol/L者中FPG<7.0mmol/L的占14.00%(429/3065),差别无有统计学意义(P=0.503)。FPG和餐后2hPG均正常202例〔但其中113例存在高胰岛素血症和(或)胰岛素分泌延迟,占55.94%〕,其余289例为糖耐量受损和(或)空腹血糖受损。在1 hPG≥11.1 mmol/L且2 h PG<11.1 mmol/L的291例中,54例FPG≥7.0mmol/L经复查诊断为糖尿病,另有125例餐后30 min血糖≥11.1 mmol/L者的HOMA指数及胰岛素曲线下面积与FPG5.6～6.1mmol/L而2 h PG≥11.1mmol/L的糖尿病患者接近。结论1 h PG与FPG的一致性不比2 h PG差,且更敏感,提示1 h PG同2 h PG一样,可以作为糖尿病的餐后血糖诊断切点。

Objective To examined the relationship between the Fast Plasma Glucose（FPG） and the Postprandial Plasma Glucose（PPG） by analyzing 3 588 OGTT and IRT,and assessed the role of PPG in the diagnosis of type 2 diabetes.Methods Data of OGTT and IRT in 3 588 patients from 2000-Jan to 2007-June were collected and the distribution of the patients evaluated with cut-points of fasting plasma glucose by 5.6 mmol/L,6.1 mmol/L ＆ 7.0 mmol/L and postprandial plasma glucose by 7.8 mmol/L and 11.1mmol/L were analyzed.T-test and corrected t-test of two independent samples have been done with SPSS 11.5.Results By WHO standard,3 097 T2DM were diagnosed.Of 2654 T2DM patients diagnosed by FPG≥7.0 mmol/L,54 patients showed 2 h PG〈11.1 mmol/L（2.03%）,and 10 showed 1 h PG〈11.1mmol/L（0.38%）（P〈0.001）.Of 3 035 T2DM patients diagnosed by 2 h PG≥11.1 mmol/L,443 patients showed FPG〈7.0 mmol/L（14.60%）,and of 3 065 subjects diagnozed by 1 h PG≥11.1mmol/L,429 showed FPG〈7.0 mmol/L（14.00%）（P〉0.05）.202 cases were NGT（but hyperinsulinemia and/or delayed insulin secretion were found in 113 of them,55.94%）.Other 289 cases were IFG and/or IGT.In the 291 cases diagnozed with 1 h PG≥11.1 mmol/L and 2 h PG〈11.1 mmol/L,there were 54 cases diagnosed T2DM by FPG≥7.0 mmol/L.And 125 subjects diagnozed with 30′PG≥11.1mmol/L had similar insulin AUC of T2DM with FPG less than 6.1mmol/L.Conclusion As a cutpoint of postprandial plasma glucose for the diagnosis of diabetes,the results showed that 1 h PG was more sensitive than 2 h PG,and more coincident with FPG,it suggests that 1 h PG may be a new postprandial plasma glucose cutpoint for the diagnosis of diabetes.