糖尿病危险积分筛查新发糖尿病的评价

The evaluation of diabetes risk score for screening an undetected diabetes mellitus by ROC analysis

目的评价糖尿病危险积分(DRS)对糖尿病(DM)一线筛查的价值。方法 259例既往未诊断DM的受试人群进行问卷调查和查体,分别计算芬兰DRS(F-DRS)和中国DRS(C-DRS),间隔2～3周重复进行两次OGTT。结果两次OGTT结果显示为正常、IFG或IGT、IFG合并IGT、DM组的F-DRS和C-DRS分别为5.6521±4.53和13.97±9.84、7.60±3.85和20.59±8.87、8.90±3.77和23.07±8.56、11.67±5.05和26.31±7.87(P<0.05).ROC曲线显示F-DRS切点为9时,以单次OGTT结果和两次OGTT结果评价的敏感性分别为63.8%和67.3%,特异性为60.8%和62.7%,若敏感性达到85%时的切点分别为6.0和6.5;C-DRS切点为18时,以单次OGTT结果和两次OGTT结果评价的敏感性分别为83.0%和85.5%,特异性为49.1%和51.0%,敏感性达到85%时的切点均为19.5。对F-DRS≥9的人群再进行OGTT检测DM的诊断率为67%,33%患者漏诊,而49%的非DM患者可以免做OGTT。对C-DRS≥18的人群再进行OGTT检测DM的诊断率达85%,15%患者漏诊,而39%的非DM患者免做OGTT。结论DRS与IGT程度具有很好的一致性;C-DRS比F-DRS敏感性更高,更适合于中国人群DM的一线筛查。

Objective To evaluate the role of Diabetes Risk Score （DRS） as the initial instrument for screening diabetes mellitus （DM）. Methods The Finnish DRS （F-DRS） and Chinese DRS （C-DRS） were calculated based on a simple self-administered questionnaire completed by Chinese individuals without a history of diabetes （male 152, female 107） who underwent two oral glucose tolerance tests （OGTT） over a period of 2-3 weeks. Results The two tests of OGTT showed significant prevalence（%） differences between F-DRS and CDRS （all P〈0. 05）in NGT [（5. 65±4. 53） vs （13. 97±9.84）],in IFG or IGT[（7. 60±3. 85） vs （20. 59± 8. 87）%,in IFG plus IGT [（8. 90±3. 77） vs （23. 07±8. 56）],and in DM [（11.67±5.05） vs （26. 31±7. 87）1. The ROC showed that, with a cutoff of 9, the sensitivities of F-DRS in detecting DM by one and two OGTTs were 63. 8% and 67. 3% respectively, the specificity 60. 8% and 62. 7% ; at sensitivity o[ 85% with the cutoffs of 6. 0 and 6. 5. With a cutoff of 18, the sensitivity of C-DRS in detecting DM by one and two OGTTs was 83. 0% and 85.5%, the specificity 49.1% and 51.0% respectively; at sensitivity of 85% with the cutoffs of 19. 5 and 19. 5. The use of the F-DRS and C-DRS followed by the OGTT may lead to the identification of 67% and 85% of DM, with undetection rate of 33 % and 15% respectively. Conclusions The DRS is in concordance with OGTT-diagnosed glucose metabolism categories. Compared with F-DRS, C-DRS represents a more sensitive and suitable method for screening DM in China.