糖化血红蛋白诊断糖尿病及糖调节受损截点的研究

HbA_(1c) Diagnosing Diabetes and Its Cut-off Point for Impaired Glucose Regulation

背景美国糖尿病学会(ADA)推荐以糖化血红蛋白(HbA1c)≥6.5%作为糖尿病(DM)的诊断标准,但此标准是否适用于我国人群,尚有待证实。不同海拔高度人群血红蛋白的差异也会影响HbA1c的测定值,给制订诊断标准带来了难度。目的通过检测冀中平原中老年人群的HbA1c水平,探讨平原地区HbA1c诊断DM的最佳值。方法采用随机整群抽样的方法选取2011年6月—2012年10月冀中平原5个中心城市的3 168例社区居民,对其进行横断面流行病学调查。检测空腹血糖(FPG)及指尖血糖,行口服葡萄糖耐量试验(OGTT),结合HbA1c进行DM的诊断。结果 HbA1c诊断DM的截点为6.35%,敏感度和特异度分别为93.5%和87.2%。HbA1c诊断空腹血糖受损(IFG)的截点为5.75%,敏感度和特异度分别为79.5%和31.3%。HbA1c诊断糖耐量受损(IGT)的截点为5.75%,敏感度和特异度分别为85.4%和34.4%。结论 HbA1c对DM的诊断价值优于单一采用FPG或餐后2 h血糖(2 hPG),在平原地区HbA1c可作为客观反映一段时间内血糖水平的良好指标,但并不适合作为IFG及IGT的诊断指标,需要同时行OGTT,避免漏诊。

Backgrounds American Diabetes Association（ADA） recommends glycosylated hemoglobin（HbA1c）≥ 6.5% as a diagnostic criteria for diabetes mellitus（DM）,but it remains to be confirmed whether this standard is applicable to the population in our country.In addition,the hemoglobin concentration differences between people living at different altitudes influence estimated values of HbA1c,which makes it difficult to formulate diagnostic criteria.Objectives To detect the HbA1c levels of elderly population in Jizhong Plain to explore the optimum value of HbA1cdiagnosing DM.Methods A randomized cluster sampling method was used to select 3,168 community residents in 5 central cities in Jizhong plain from June 2011 to October 2012 to perform a cross-sectional epidemiological survey.We determined fasting plasma glucose（FPG） and fingertip glucose,did oral glucose tolerance test（OGTT） and combined with HbA1cdetection.Results The cut-off point of HbA1cdiagnosing DM was 6.35%,its sensitivity and specificity were 93.5%,87.2%,respectively.The cut-off point of HbA1cdiagnosing impaired fasting glucose（IFG） was 5.75%,its sensitivity and specificity were 79.5%,31.3%,respectively.The cut-off point of HbA1cdiagnosing impaired glucose tolerance（IGT） was 5.75%,its sensitivity and specificity were 85.4%,34.4%,respectively.Conclusion In plain areas,the DM diagnostic value of HbA1c,superior to that of single-used FPG or2 hPG,can be a good indicator for blood sugar level but not for IFG,IGT.OGTT is needed to avoid misdiagnosis.