基于皮肤自体荧光的糖尿病快速无创筛查方法的临床研究

Investigation on noninvasive and rapid diabetes screening using skin autofluorescence

目的基于皮肤自体荧光光谱，反映受试者皮肤晚期糖基化终末产物（AGEs）累积水平，并比较皮肤荧光法与空腹血糖（FPG）在糖尿病筛查中的应用价值。方法选取2009年6月至2011年6月于中国科学院合肥物质科学研究院医院健康体检及安徽省立医院内分泌科门诊进行皮肤荧光、FPG及口服葡萄糖耐量试验（OGTT）糖负荷后2h血糖测量（2hPG）的受试者201名，其中正常糖调节组111名、糖调节受损组27例和2型糖尿病患者组63例。糖尿病、糖调节受损的诊断采用2010年《中国2型糖尿病防治指南》中的糖尿病诊断标准。测量比较各组FPG，并行OGTT，测定2hPG，且同时检测受试者右前臂内侧皮肤的荧光，记录皮肤荧光强度值。统计学采用单因素ANOVA方差分析、X^2检验和Spearman相关性分析。结果正常糖调节组、糖调节受损组和2型糖尿病患者组的平均FPG分别为（4．99±0．45）、（6．57±0．27）和（9．45±3．98）mmol／L，组间差异具有统计学意义（F=280．88，P〈0．05）。皮肤荧光平均值分别为（1．88±0．12）、（1．92±0．14）和（2．15±0．22）AU，组间差异有统计学意义（F=10．88，P〈0．05）。ROC曲线分析表明，在FPG=6．1mmol／L这一工作点，空腹血糖法用于糖尿病筛查的特异性和敏感性分别为86．2％和65．1％。在相同特异性水平下，皮肤荧光法的敏感性达到77．8％，皮肤荧光法的筛查敏感性明显高于空腹血糖法。结论与空腹血糖相比，皮肤荧光法筛查糖尿病具有无创、快速的优点，且具有更高的敏感性。

Objective To evaluate the accumulation of advanced glycation end products （AGE） in human skin using the method of skin autofluorescence and compare its sensitivity in diabetes screening with fasting plasma glucose （FPG）. Methods From June 2009 to June 2011, 201 subjects who accepted skin autofluorescence test, FPG test and oral glucose tolerance test （OGTr） in out-patient department of Hefei Institutes of Physical Science＇s hospital and Anhui Provincial hospital were enrolled, including 111 with normal glucose regulation, 27 with impaired glucose regulation and 63 with type 2 diabetes. The diagnosis of diabetes mellitus and impaired glucose regulation was based on the diagnostic criteria specified in Chinese Type 2 Diabetes Prevention and Treatment Guidelines （2010）. FPG was investigated in each group. Oral glucose tolerance test was performed and 2 h post-challenge glycemia （2 h PG） was also measured in the three groups. Skin autofluorescence of right forearm was tested and the intensity was recorded. Statistical analysis was performed by using one way ANOVA, Chi-square test and Spearman correlation analysis. Results The levels of FPG in the group with normal glucose regulation, impaired glucose regulation and type 2 diabetes were （4. 99 ± 0. 45 ）, （ 6. 57 ± 0. 27 ） and （ 9. 45 ± 3.98 ） mmol/L respectively, there was significant difference among the groups （ F = 280. 88, P 〈 0. 05 ）. The levels of skin autofluorescence were （1.88 ±0. 12）, （1.92 ± 0. 14） and （2. 15 ± 0. 22） AU respectively in the three groups, and there was significant difference among the groups （F = 10. 88, P 〈 0.05 ） . According to the receiver-operatorcharacteristics （ROC） for the noninvasive testing and FPG, the sensitivity of the noninvasive testing method and FPG method were 77.8% and 65. 1% respectively under the same spec, ificity of 86.2% （ FPG= 6. 1 mmol/L）. Conclusions The preliminary findings show that skin autofluoreseence method has the advantages of non-invasive and rapid testing and also a higher sensitivity.