空腹血糖及OGTT1h血糖对糖尿病诊断意义的比较

The comparison of fasting plasma glucose and 1-hour plasma glucose to diagnose diabetes mellitus

目的:比较空腹血糖(FPG)及口服糖耐量试验(OGTT)1h血糖(PG)诊断糖尿病灵敏度和特异度的差异及其与胰岛B细胞功能及胰岛素抵抗的关系。方法:选取需行OGTT的4 430名受试者。用接受者工作特征(ROC)曲线计算出OGTT1hPG诊断糖尿病的最佳切点,后将其与FPG进行比较分析。结果:以糖尿病为参考标准,ROC曲线得出OGTT1hPG诊断糖尿病的最佳切点为12.94 mmol/L。以OGTT2hPG≥11.1 mmol/L为诊断糖尿病的金标准,FPG≥7.0mmol/L诊断糖尿病的灵敏度为62.91%,特异度为96.46%;OGTT1hPG≥12.94 mmol/L诊断糖尿病的灵敏度为83.62%,特异度为88.42%。FPG和1hPG与胰岛素抵抗指数(HOMA-IR)呈正相关(P<0.01);与HOMA-B呈负相关(P<0.01);与胰岛素生成指数呈负相关(P<0.01)。结论:单纯用FPG诊断糖尿病漏诊率高,1hPG更有诊断价值,且FPG和1hPG可一定程度反映胰岛B细胞功能及胰岛素抵抗情况。

Objective： To compare the sensitivity and specificity of fasting plasma glucose（FPG） and 1- hour plasma glucose （ lhPG）to diagnose diabetes mellitus （DM）, and the relation of them with islet B cell function and insulin resistance. Methods： 4 430 objects who need an OGTI＇ were recruited. The optimal cutoff value of I hPG was calculated by ROC curve , and compared with FPG. Results： According to ROC results, to diagnose type 2 DM, the optimal cutoff value of lh PG was 12.94 mmol/L. Classifying OGqT 2hPG ≥11.1 mmol/L as gold standard of diagnosing diabetes mellitus, the sensitivity of FPG ≥7.0mmol/L to diagnose DM was 62.91%,the specificity was 94,46%; the sensitivity of lhPG I〉 12.94 mmol/L to diagnose DM was 83.62% ,the specificity was 88.42%. There was a negative correlation between FPG, lhPG and insulingenie index, HOMA-B （P〈0.01） and a positive correlation between lhPG and HOMA-IR （P〈0.01）. Conclusion： By FPG alone, there is high rate of missed diagnosis of DM, lhPG have more diagnostic value, and they all can reflect islet B cell function and insulin resistance in some extent.