糖化血红蛋白与糖化白蛋白在诊断2型糖尿病中的价值比较

Value of HbA1c and glucoprotein for diagnosis of type 2 diabetes mellitus: A comparative study

目的探讨诊断2型糖尿病时糖化血红蛋白(HbA1c)的参考值,并对比分析糖化白蛋白(GA-L)和HbA1c对于诊断2型糖尿病的灵敏度和可靠性。方法 509例疑似2型糖尿病患者(男268例,女241例),以2003年美国糖尿病学会(ADA)标准为诊断标准。通过绘制受试者工作特征曲线(ROC曲线),分析比较GA-L及HbA1c诊断糖尿病的灵敏度和特异性。结果 HbA1c的ROC曲线的最佳切点为6.75%,灵敏度75.5%,特异度93.2%,曲线下面积0.886,阳性似然比5.45,阴性似然比0.23,阳性预测值92%,阴性预测值70%。GA-L的ROC曲线的最佳切点为17.45%,灵敏度70.1%,特异度91.6%,曲线下面积0.844。当HbA1c≥6.75%时诊断的准确性为94.9%,而GA-L≥17.45%时诊断的准确性为93.3%。结论 HbA1c≥6.75%和GA-L≥17.45%可作为诊断2型糖尿病的一种参考方法,且HbA1c的灵敏度和特异度优于GA-L。

Objective To study the reference value of HbAlc for diagnosis of type 2 diabetes mellitus（DM）and compare the sensitivity and reliability of glycosylated albumin（GA-L） and HbAlc in diagnosis of type 2 DM. Methods Five hundred and nine patients with type 2 DM（268 males and 241 females） were diagnosed according to the diagnostic criteria of American Diabetes Association （ADA）. The sensitivity and reliability of GA-L and HbAlc in diagnosis of type 2 DM were analyzed and compared by plotting the receiver operating characteristic（ROC） curve for DM. Results The optimal cut point of HbAlc for diagnosis of type 2 DM was 6.75% with a sensitivity of 75.5% and a specificity of 93.2%. The area under the ROC curve was 0.886 with a positive likelihood ratio of 5.45 and a negative likelihood ratio of 0.23, a positive predictive value of 92% and a negative predicative value of 70%. The optimal cut point of GA-L was 17.45% with a sensitivity of 70.1% and a specificity of 91.6%. The area under the ROC curve was 0.844. When the optimal cut point of HbAlc and GA-L was I〉 6.75% and ~〉 17.45%, its diagnosis accuracy was 94.9% and 93.3% respectively. Conclusion The HbAlc /〉 6.75% and GA-L I〉 17.45% can be used the reference values for the diagnosis of type 2 DM. The sensitivity and specificity of HbAlc are higher than those of GA-L in diagnosis of type 2 DM.