HbA1C检测在肥胖儿童中诊断筛查糖代谢紊乱的效果

The validity of HbA1c detection in diagnosing and screening dysglycemia in children with obesity

评估应用美国糖尿病协会（ADA）近日推荐的HbA1c标准对早期探查肥胖儿童糖代谢紊乱的作用。293名肥胖儿童均行口服葡萄糖耐量试验（OGTT），以其工作特征曲线（ROC）评价空腹血糖（FPG）和HbA1c探查糖耐量异常的敏感性和特异性。结果显示，基于传统的血糖标准，本组研究对象2型糖尿病的患病率为3．8％、糖尿病前期的患病率为16．0％。加入HbA1c标准后有4．1％的患者符合2型糖尿病诊断、25．6％的患者可列人糖尿病高风险人群。以OGTT为金标准，HbA1c识别糖耐量异常的能力明显强于FPG，ROC曲线下面积分别为0．875和0．713（P〈0．01）。采用ADA推荐的HbA1c≥5．7％、FPG≥5．6mmol／L的切点识别糖耐量异常的敏感性和特异性分别为60．5％和86．8％、30．5％和94．0％。

The validity of the recently recommended HbA1c criterion by the American Diabetes Association （ADA） in identification of dysglycemia in children with obesity was evaluated. 293 obese children underwent oral glucose tolerance test. Receiver operating characteristic （ROC） curve analysis was used to examine the sensitivity and specificity of fasting plasma glucose （FPG） and HbA1c in identifying dysglycemia. The results showed that the prevalence of type 2 diabetes mellitus （ T2DM ） was 3.8% and prediabetes 16. 0% based on plasma glucose standard. 4. 1% and 25.6% were categorized as T2DM and ＂at high risk of diabetes mellitus＂ based on both HbA1c and plasma glucose criteria. HbA1c was more efficacious than FPG in detecting abnormal glucose tolerance as shown by the areas under the curve in ROC of 0. 875 and 0. 713 respectively（P〈0.01 ）. The sensitivity and specificity were 60. 5% and 86. 8% at HbAlc ≥5.7%, and 30. 5% and 94.0% at FPG ≥ 5.6 mmol/L.