空腹血糖、餐后2h血糖及糖化血红蛋白对糖尿病的诊断价值

Diagnostic value of fasting plasma glucose,2h postprandial plasma glucose and glycosylated hemoglobin on diabetes mellitus

目的:探讨空腹血糖、餐后2h血糖及糖化血红蛋白(HbAlc)对糖尿病及糖调节受损的诊断价值。方法:收集2009年12月至2011年8月在郑州市第二人民医院和郑州市中心医院检测空腹血糖(FPG)、糖化血红蛋白(HbAlc)和餐后2h血糖(2h-PG)的738例临床资料完整的、HbAlc在5.4%～7.0%的就诊者入选该研究,采用ROC曲线确定HbAlc预测糖尿病及糖调节受损的诊断界点。结果:以FPG≥7.0mmol/L和(或)餐后2h-PG≥11.1mmol/L为诊断DM的金标准作ROC曲线,HbAlc=6.35%为诊断DM的最佳阈值,此切点敏感度0.698,特异度0.680,阳性似然比为2.18,阴性似然比为0.44。以FPG6.1～6.9mmol/L和(或)餐后2h-PG在7.8～11.1mmol/L作为诊断糖调节受损的金标准作ROC曲线,HbAlc=6.0%为诊断糖调节受损的最佳阈值,此切点敏感度0.646,特异度0.659,阳性似然比为1.89,阴性似然比为0.54。结论:用HbAlc诊断糖尿病敏感度中等,诊断糖调节受损敏感性不高,联合实验有助于提高糖尿病及糖调节受损的检出率。

Aim：To investigate the diagnostic value of the fasting plasma glucose（FPG）,2 h postprandial plasma glucose（2 h-PG） and glycosylated hemoglobin（HbAlc） towards diabetes mellitus（DM） and impaired glucose regulation（IGR）.Methods：A total of 738 patients with complete clinical data were collected from December2009 to August2011 in the Second People’s Hospital of Zhengzhou and Zhengzhou Central Hospital.All the subjects were detected for the FPG,HbAlc and 2 h-PG,while the levels of HbAlc ranging 5.4% to 7.0% were enrolled the study.Receiver operating characteristic curve（ROC curve） was used to examine the optimal cut-point of HbAlc for detecting DM and IGR.Results：Regarding FPG≥7.0 mmol/L and（or） 2 h-PG≥11.1 mmol/L as the gold standard for diagnosing DM and making ROC curve,and the optimal cut-point of HbAlc for diagnosing DM was 6.35%,with sensitivity of 0.698,specificity of 0.680,positive likelihood ratio of 2.18 and negative likelihood ratio of 0.44.Regarding FPG 6.1 - 6.9 mmol/L and（or） 2 h-PG 7.8 - 11.1 mmol/L as the gold standard for diagnosing IGR and making ROC curve,and the optimal cut-point of HbAlc was 6.0%,with sensitivity of 0.646,specificity of 0.659,positive likelihood ratio of 1.89 and negative likelihood ratio of0.54.Conclusion：There are a medium sensitivity to diagnose DM by HbAlc and a lower sensitivity to diagnose IGR by HbAlc.Combined test may contribute to improve the detection rate of DM and IGR.