糖化血红蛋白诊断糖尿病标准的初步探讨

A preliminary study on criteria of glycosylated hemoglobin(HbA1c) for diagnosing diabetes mellitus

目的初步评估使用糖化血红蛋白(HbA1c)诊断糖尿病(DM)的最佳切点,探讨美国糖尿病协会(ADA)推荐的HbA1c≥6.5%作为糖尿病诊断标准是否适用于中国人群。方法 2010年6月至2011年10月在南京明基医院门诊进行75 g口服葡萄糖耐量试验的未被诊断为糖尿病的患者393例,同时测定其HbA1c。以世界卫生组织(WHO)的标准诊断DM,用受试者工作特征曲线(ROC)分析HbA1c诊断DM的能力。结果以非DM组为对照组,用HbA1c来诊断DM时,ROC曲线下面积(AUCROC)为0.926,最佳切点为6.3%,敏感度为91.1%,特异度为88.0%。当切点为6.5%时,敏感度下降为81.8%,特异度为93.7%。结论 HbA1c诊断DM的最佳切点为6.3%,ADA推荐HbA1c≥6.5%的诊断标准也许更适合欧美人群,中国人群的诊断标准仍有待大范围调查后确定。

Objective To evaluate the diagnostic cut - off point of glycosylated hemoglobin （ HbAI c） in diagnosing diabetes mellitus. A- merican Diabetes Association （ADA） recommended HbAlc ≥ 6.5% as the diagnostic criteria for diabetes mellitus whether these criteria are a- dapted to Chinese. Methods Three hundred and ninety - three out - patients accepted 75 g oral glucose tolerance test （OGTT） and HbA1 c was determined at the same time by HPLC method. The diagnosis was based on WHO standard for diagnosing diabetes mellitus. The cut - off points for diabetes were established based on receiver operating characteristic curve （ROC）. Results The AUCROC was O. 926 for diagnosis of diabetes in comparison with non- DM group. The optimal cut- off point of HbAlc was 6.3%, with the sensitivity of 91.1% and specificity of 88.0%. When the cut - off point was 6.5%, the sensitivity was 81.8% and specificity was 93.7%. Conclusion The optimal cut - off point was 6.3% for HbA1 c in this study for diagnosis of diabetes mellitus, and it is inconsistent with the criterium of 6.5 % recommended by ADA. The diagnostic point adapted to Chinese remains to be further studied.