馒头餐后2小时血糖在糖尿病筛查中的意义

Significance of 2-hour blood glucose after standardized steamed bread meal in diabetic screening

目的研究馒头餐后2h血糖（SB-2hBG）在糖尿病筛查时的意义。方法回顾性分析解放军总医院1996年5月—2002年6月体检时行糖尿病（DM）筛查的数据资料。历年非糖尿病受检者采取空腹血后进食100g馒头，于餐后2h采指血测血糖，SB-2hBG≥7．2mmol／L者在2周内行75g口服葡萄糖耐量试验（OGTT）确定DM相关诊断（世界卫生组织1985和1999年糖尿病诊断标准）。提取连续7年数据资料比较SB-2hBG在诊断DM的意义和最佳切点，并观察不同糖代谢水平在不同糖负荷试验时血糖的变化情况。结果共有3343例完整资料纳入研究，其中男3101例，女242例，年龄40—94岁。根据OGTr结果诊断为DM429例（12．8％），糖调节受损（IGR）1405例（42．1％）；正常糖耐量（NGT）1509例（45．1％）。随着糖调节水平的恶化，SB-2hBG与对应OGTT-2hBG的差值分别为NGT组1．7（0．8～2．8）、IGR组-1．4（-1．2—0．6）和DM组-2．7（-3．8～1．1）mmol／L，3组间差异有统计学意义（P〈0．01）。诊断IGR和DM的相应最佳切点，FBG是5．3（敏感度46．2％，特异度68．5％）和5．6（敏感度57．4％，特异度76．4％）mmol／L；SB-2hBG是8．2（敏感度63．8％，特异度59．9％）和9．2（敏感度66．4％，特异度79．2％）mmol／L。SB-2hBG7．2mmol／L时的诊断特异度很低；11．1mmol／L时诊断19M的敏感度31．5％，特异度95．7％。F13G与S13-2h13G诊断IGR和DM相应切点的符合率一致（P〉0．05）。SB-2hBG7．8mmol／L时诊断IGR的敏感度77．4％，特异度41．8％，优于FBG5．6mmol／L（P〈0．01）。结论随着糖耐量的恶化，SB-2hBG与对应OGTT-2hBG的差值逐渐增大。与OGTT诊断比较，符合IGR和DM诊断的最佳切点FBG为5．3和5．6mmol／L，SB-2hBG为8．2和9．2mmol／L。建议在中老年人群采用FBG5．3或SB．2hBG7．8mmol／L作为糖尿病筛查时进一步行OGTT的指标。

Objective To explore the significance of 2-hour blood glucose after standardized steamed bread meal （SB-2 hBG） in diabetic screening. Methods A retrospective study was conducted for diabetic screening data of annual check-up at PLA General Hospital from May 1996 to June 2002. And 100 g standardized steamed bread meal test was performed for non-diabetic subjects. Those subjects with SB-2 h BG ≥ 7. 2 mmol/L underwent a 75 g oral glucose tolerance test （OGTT） within 2 weeks to determine whether the diagnosis of diabetes mellitus （DM） could be established （ WHO, 1985, 1999, Diagnostic Criteria for Diabetes）. By extracting the data for 7 consecutive years, we analyzed the significance and the cut-off point of SB-2 hBG in the diagnosis of DM and investigated the changes of blood glucose curves in different glucose tolerance status after different glucose loading tests. Results A total of 3 343 subjects with complete information were recruited. There were 3 101 males and 242 females with an age range of 40 -94 years. According to the results of OGTY, 429 （ 12.8% ） subjects were diagnosed as DM, 1 405 （42. 1% ） were diagnosed as impaired glucose regulation （IGR） and 1 509 （ 45.1% ） had normal glucose tolerance （NGT）. With a deterioration of glucose tolerance status, the difference between SB-2 hBG and OGTT-2 hBG increased gradually in 3 group（P 〈0. 01 ）, namely the NGT group 1.7 （0. 8 - 2. 8） mmoL/L, IGR group -0.4（ -1.2 -0. 6） retool/L, DM group -2. 7（ -3.8 - 1. 1） mmoL/L. The cut-off points of FBG for the diagnosis of IGR and DM were 5.3 （ sensitivity of 46.2% , specificity of 68.5% ） and 5.6 （ sensitivity of 57.4%, specificity of 76. 4% ） mmoL/L respectively. The cut-off points of SB-2 h BG were 8.2 mmol/L for the diagnosis of IGR （ sensitivity of 63.8%, specificity of 59.9% ） and 9.2 mmol/L for the diagnosis of DM （ sensitivity of 66. 4%, specificity of 76.4% ）. If the cut-off point of SB-2 h BG was set at 7.2 mmol/L, the diagnostic specificity became quite low. However, at 11.1 mmol/L, the sensitivity was 31.5% and the specificity 95.7% for the diagnosis of DM. The coincidences of cut-off points of FBG and SB-2 hBG for the diagnosis of IGR and DM were equal （P 〉0. 05）. When the cut-off point of SB-2 h BG was set at 7. 8 mmol/L, the sensitivity was 77. 4% and the specificity 41.8% for the diagnosis of IGR. And it was much better than FBG at 5.6 mmol/L （P 〈 0. 01 ）. Conclusions With a deterioration of glucose tolerance, the difference between SB-2 hBG and OGTT-2 hBG increases gradually. Compared to the diagnostic criteria of OGTr, the optimal cut-off points for the diagnosis of IGR and DM were 5.3 vs 5.6 mmol/L for FBG and 8.2 vs 9. 2 mmol/L for SB-2 hBG respectively. For diabetic screening in middle-aged and elders, the cut-off points of FBG at 5.3 mmol/L and SB-2 hBG at 7. 8 mmol/L are indicators for further OGTT.