2型糖尿病血糖控制水平临床常用指标评估价值研究

The value of clinical commonly-used biomarkers in glycaemic control of type 2 diabetes:an evaluation research

目的评估临床常用指标对口服药(单纯口服降糖药)治疗的2型糖尿病患者血糖控制水平的影响价值及其意义。方法对西北地区3家3级(甲等)医院2010年7—12月门诊或住院的1488例2型糖尿病患者采取问卷式调查和现场测量。监测临床指标为年龄、收缩压、舒张压、体重指数、病程、糖化血红蛋白(HbA1c)、空腹血糖(FBG)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)。HbA1c≥6.5 mmol/L为血糖控制不良。结果应用ROC曲线分析出对男性及女性均具有影响价值的指标:病程、FBG、TG、TC、LDL。其中FBG、病程、TG、LDL截断点、特异性、灵敏度在男女间存在差异。TG在两组间的影响意义无明显差别。多因素Lo-gistic逐步回归分析得出:男性组最佳联合评估指标:病程、FBG、TG;女性组最佳联合评估指标:病程、FBG、LDL。联合评估指标ROC曲线下面积分别为为0.855,0.856,与0.5的差异有统计学意义。结论临床常用指标病程、FBG、TG、TC、LDL评估糖尿病患者血糖控制不良具有影响价值。病程、FBG、TG、LDL截断点在男女间存在差异。利用联合评估指标筛查血糖控制不良,具有较高的临床应用价值。

Objective To evaluate the value of commonly-used biomarkers in glycaemic control in T2D patients treated with oral medicine （single oral medicine） and their significance. Methods From July,2010 to December,2010,questionnaire survey and field measurement were performed in 1488 T2D patients admitted or hospitalized in 3 three level of first-class hospitals of northwestern area. The clinical index were age, SBP, DBP, BMI, disease duration, HbA1 c, FBG, TG, TC, HDL, LDL. It could be diagnosed as adverse glucose control when the measured HbAl e was no less than 6. 5 mmol/L. Results ROC curve was used to analyze all the markers that affect both males and females including disease duration, FBG, TG, TC and LDL. Notably, there were differences in FBG, disease duration, TG, LDL cutoff points, specificity and sensitivity between males and females. Nevertheless, no significant difference was found in TG. The Multi-factor Logistic stepwise regression a- nalysis demonstrated the best combined evaluation markers of disease duration, FBG and TG in male group and of disease duration, FBG and LDL in female group. The joint evaluation index of the area under the ROC curves were respectively 0. 855,0. 856, with significant difference based on the standard of 0. 5. Conclusion Commonly-used clinical biomarkers of the disease duration FBG,TG,TC and LDL had influential value in evaluation of glucose control in T2D patients. There was difference in disease duration, FBG, TG and LDL cutoff points between males and females. The combined evaluation markers were used to screen adverse glucose control,with favorably high clinical application value.