两种标准诊断的糖尿病前期血糖血脂异常特点的比较研究

Comparative Analysis on Characteristics of Abnormal Blood Glucose and Dyslipidemia in Patients with Prediabetes Diagnosed by Tow Different Criteria

目的比较美国糖尿病学会（ADA）新建议的糖化血红蛋白（HbAlc）标准和经典的口服糖耐量试验（0GTT）标准诊断的糖尿病前期（PDM）人群血糖、血脂参数异常的特点，从糖尿病危险因子的角度验证HbAlc标准在中国人群中的适用性。方法对2011年1月～12月参加健康体检的497名广州籍汉族人进行口服葡萄糖耐量试验（0GTT）和HbAlC、血脂参数检测，分别对HbAlC标准与OGTT标准所定义的PDM组和正常糖耐量（NGT）组的空腹血糖（FPG）、0GTT2h血糖（2hPG）、HbAlC，总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL—C）、载脂蛋白Ap0A1和ApoB水平进行统计分析。结果HbAlC标准诊断时，PDM组FPG（5．41±0．48vs5．20±0．39mmol／L），2hPG（7．06±1．49vs6．67±1．23mmol／L），HbAlCI中位数（四分位数）：5．9％（5．8％，6．1％）vs5．5％（5．3％，5．6％）l，TC（5．83±1．07vs5．54±1．02retool／L），LDL—C（3．30±0．67vs3．11±0．64mmol／L），A．poB（0．93±0．24vs0．87±0．25g／L）水平明显高于NGT组，差异有统计学意义（t或Z=2．269～16．687，P〈0．05）。0GTT标准诊断时，PDM组FPG（5．68±0．42vs5．08±0．31retool／L），2hPG（7．86±1．44vs6．19±0．88retool／L），HbAlCl5．9％（5．7％，6．1％）vs5．8％（5．6％，6．0％）]，TG（1．84±1．41vs1．55±1．22retool／L）水平明显高于NGT组，而HDL—C（1．50±0．36vs1．61±0．42mmol／L）水平明显低于NGT组，以上差异均有统计学意义（t或Z=3．395～17．50，P〈0．05）。相同诊断两种标准间比较，HbAlC标准定义的PDM者的FPG和2hPG水平明显低于0GTT标准者，差异有统计学意义（t=6．443～7．020，P=0．000），而HbAlC水平与0GTT标准者差异无统计学意义（Z=1．724，P=0．085）；HbAlc标准定义的NGT者的FPG和2hPG水平明显高于0GTT标准者，而HbAlC水平却明显低于OGTT标准者，差异有统计学意义（t或Z=3．060～10．932，P=0．000）。结论相比0GTT标准，ADA建议的HbAlc标准诊断的PDM人群存在糖代谢异常，但程度可能相对较轻，具有不同的发生糖尿病及其血管并发症风险增加的血脂危险因子，在中国人群中应用有其合理性。

Objective To validate the applicability of the newly proposed HbAlc-based criteria on diagnosing prediabetes （PDM） by American Diabetes Association （ADA） to Chinese people in terms of risk factors for diabetes by obtaining the characteristics of abnormal blood glucose and dyslipidemia in patients with PDM diagnosed by the new HbAlc-based criteria and the classic criteria by oral glucose tolerance test （OGTT）. Methods 497 Han people in Guangzhou region taking in health examination undergone oral glucose tolerance tests （OGTT） as well as blood glycosylated hemoglobin （HbAlc） and serum lipid indexes （including TC,TG, HDL-C, LDL-C, ApoA1 and ApoB） detection during January to December in 2011. The levels of fasting plasma glucose（FPG）, postchallenge 2 hour plasma glucose （2hPG）, HbAlc and serum lipid indexes intwo groups which were defined with HbAlc-based criteria and OGTT-based criteria were statistically analyzed, respectively. Results Levels of FPG （5.41±0.48 vs 5.20±0.39 mmol/L）,2hPG （7.06±1.49 vs 6.67±1.23 mmol/L）,HhAlc[medi an （quartile） ：5.9% （5.8%,6.1%） vs 5.5% （5.3%,5.8%）],TC（5.83± 1.07 vs 5.54±1.02 mmol/L）,LDL-C（3.30± 0.67 vs 3. 114±0.64 mmol/L）,ApoB （0.93±0.24 vs 0.87±0.25 g/L） were statistically higher in PDM group than those in NGT group （t or Z=2. 269±16. 687,P〈0.05） ,which were defined with HbAlc-based criteria. When defined with OG- TT based criteria,PDM group had statistically higher levels of FPG （5.68±0.42 vs 5.08±0.31 mmol/L） ,2hPG （7.86± 1.44 vs 8. 19±0.88 mmol/L）,HbAlc [5.9%（5.7%,6.1%） vs 5.8% （5.6%,6.0%）] and TG （1.84±1.41 vs 1.55± 1.22 mmol/L） but statistically lower level of HDL-C （1.50±0.36 vs 1.61±0.42 mmol/L） than NGT group（t or Z= 3. 395 ~ 17.50, P〈0.05）. Levels of FPG and 2hPG were statistically lower in PDM group diagnosed by HbAlc-based crite- ria than those by OGTT-based criteria （t= 6. 443~7. 020,P= 0. 000） while level of HbAlc had no statistical difference be- tween the two criteria （Z= 1. 724,P=0. 085）. Levels of FPG and 2hPG were statistically higher,but the level of HbAlc was statistically lower,in NGT group defined with HbAlc-based criteria than those with OGTT-based criteria （t or Z= 3. 080~10. 932,P= 0. 000）. Conclusion In comparison with OGTT-based criteria, patients with prediabetes diagnosed by HbAlc-based criteria proposed by ADA had relatively less degree of impaired glucose regulation as well as different risk fac tots associated with serum lipid that might increase the risk for the occurrence of diabetes and diabetic vascular complica tions. As far as this is concerned,the HbAlc based criteria on diagnosing prediabetes by ADA seems applicable to Chinese people in some extent.