空腹血糖诊断糖尿病截点的探讨与评价

Fasting Plasma Glucose Cut-off Point for Diagnosis Diabetes

背景目前广泛应用的以空腹血糖≥7.0 mmol/L作为糖尿病的诊断标准,并不是一个灵敏的诊断早期糖尿病的指标。目的探讨不同空腹血糖水平诊断糖尿病的敏感度和特异度,寻找空腹血糖诊断糖尿病的合理截点。方法选择2007—2013年河北省唐山市河北联合大学附属开滦总医院25～75周岁的门诊、住院患者以及体检健康者,均在检测空腹血糖后行口服75 g葡萄糖耐量试验（OGTT）。检查OGTT后0.5、1.0、2.0、3.0 h血糖,以OGTT后2 h静脉血糖（2 hPG）≥11.1 mmol/L者为新诊断糖尿病组（3 915例）,2 hPG〈11.1 mmol/L者为非糖尿病组（1 844例）。分析空腹血糖与2 hPG的相关性,绘制空腹血糖诊断糖尿病的受试者工作特征曲线（ROC曲线）。结果新诊断糖尿病组中34.4%的受试者空腹血糖〈7.0 mmol/L。空腹血糖与年龄、性别无直线相关关系（r值分别为-0.025和-0.020,P〉0.05）,与2 hPG呈正相关（r=0.853,P〈0.05）。直线回归分析显示,当2 hPG≥11.1 mmol/L时空腹血糖≥6.13 mmol/L。ROC曲线显示,空腹血糖诊断糖尿病的最佳截点也为6.13 mmol/L。空腹血糖≥6.13 mmol/L诊断糖尿病的敏感度优于空腹血糖≥7.0 mmol/L（敏感度分别为81.97%和65.62%）。结论空腹血糖≥6.13 mmol/L诊断糖尿病的敏感度优于空腹血糖≥7.0 mmol/L,且能降低漏诊率,适于作为筛查早期糖尿病的空腹血糖截点。

Background The widely-used diabetic criteria（FPG≥7.0 mmol/L） is not a so sensitive indicator for early diabetes diagnosis.Objective To explore the sensitivity and specificity of different FPG levels for diabetes diagnosis,to find a reasonable cut-off point diagnosing diabetes.Methods A 75 g oral glucose tolerance test（OGTT） was performed in patients or healthy subjects from 2007 to 2013 in Kailuan General Hospital Affiliated to Hebei United University.Blood glucose（BG） at hours 0.5,1.0,2.0,3.0 after OGTT.Subjects with 2 hPG≥11.1 mmol/L were enrolled in diabetes group（3 915）,those with 2 hPG 11.1 mmol/L in non-diabetes group（1 844）.The correlation of FPG with 2 h FPG was analyzed,ROC curve of FPG diagnosing diabetes drawn.Results In diabetes group,34.4% had FPG〈7.0 mmol /L.FPG was not correlated linearly with age,gender（r =-0.025,-0.020,P〈0.05）,positively with 2 hPG（r=0.853,P〈0.05）.Linear regression analysis showed that FPG was 6.13 mmol /L or higher when 2 hPG≥11.1 mmol /L.ROC curve showed that the best cut-off point was 6.13 mmol /L.The sensitivity of FPG ≥ 6.13 mmol /L was superior to that of FPG ≥ 7.0 mmol /L（81.97%,65.62%,respectively）.Conclusion The sensitivity of FPG≥6.13 mmol/L is superior to that of FPG≥7.0mmol /L,and can reduce rate of missed diagnosis,which is good as the cut-off point of FPG diagnosis early diabetes.