糖化血红蛋白、糖化白蛋白及空腹血糖在糖尿病诊断中的价值

The diagnostic value of glycated hemoglobin,glycated albumin and fasting plasma glucose in diagnosis of diabetes

目的：评估糖化血红蛋白（HbA1c）、血清糖化白蛋白（Glycated Albumin，GA）及空腹血糖（Fasting Plasma Glucose， FPG）在糖尿病（ Diabetes Mellitus，DM）患者早期诊断中的价值。方法收集2010～2013年浙江省台州医院同时检测HbA1c、GA及FPG的人群的相关数据，分为糖尿病组和非糖尿病组，进行受试者工作特征曲线（ Receiver Operator Character-istic curve，ROC曲线）分析以得出3种指标诊断DM的cut-off值、曲线下面积（ Area Under the Curve，AUC）其灵敏度、特异性，再进一步计算3种指标联合诊断DM的灵敏度及特异性。结果①DM组的HbA1c、GA及FPG均高于非DM 组（ HbA1c：9．14％vs．5．84％， P ＝0．000；GA：24．8mmol/Lvs．13．8mmol/L， P ＝0．000；FPG：9．65mmol/L vs．5．77mmol/L， P ＝0．000）。②HbA1c诊断DM的cut-off值为6．85％，AUC为0．911，灵敏度为84．2％，特异性为96．2％；GA诊断DM的cut-off值为17．5，AUC为0．881，灵敏度为71．6％，特异性为93．6％；FPG诊断DM的cut-off值为7．52mmol/L，AUC为0．836，灵敏度为70．2％，特异性为82．1％。③HbA1c、GA及FPG联合诊断DM的灵敏度及特异性分别为91．1％，76．3％。结论HbA1c、GA及FPG对DM皆有诊断价值，其中HbA1c的诊断DM效能最大。 HbA1c、GA及FPG联合诊断可提高DM诊断的灵敏度，在DM筛查中具有重要价值。

Objectives To assess the diagnostic value of glycated hemoglobin （ HbA1c） ,serum glycated albumin （ Glycated Al-bumin,GA） and fasting plasma glucose （ Fasting Plasma Glucose,FPG） to early diabetes （ Diabetes Mellitus ,DM） patients.Methods Patients who came to Taizhou Hospital of Zhejiang Provinceduring 2010~2013 and detected HbA1c,GA and FPG simultaneously were collected.The crowd were divided into diabetic group and non-diabetic group for the receiver operating characteristic curve （ Re-ceiver Operator Characteristic curve,ROC curves ） analysis.The cut-off value ,area under the curve（ AUC） ,sensitivity and specifici-ty were calculated,the combined diagnostic sensitivity and specificity of HbA1c,GA and FPG were further analyzed.Results ①HbA1c,GA and FPG were higher in DM group than the non-DM group （HbA1c：9.14%vs.5.84%,P=0.000;GA：24.8mmol/L vs.13.8mmol/L,P=0.000;FPG：9.65mmol/L vs .5.77mmol/L,P=0.000）.②The cut-off value ,AUC,sensitivity and speci-ficity of HbA1c in diagnosis of DM were 6.85%,0.911,84.2%,96.2%,respectively;The cut-off value ,AUC,sensitivity and spe-cificity of GA in diagnosis of DM were 17.5mmol/L,0.881,71.6%,93.6%,respectively;The cut-off value ,AUC,sensitivity and specificity of FPG in diagnosis of DM were 7.52mmol/L,0.836,70.2%,82.1%,respectively.③The combined sensitivity and spe-cificity of HbA1c,GA and FPG in diagnosing DM was 91.1%and 76.3%.Conclusions HbA1c,GA and FPG had diagnostic val-ue for DM individually,among the three,HbA1c had the maximum diagnostic performance.HbA1c,GA and FPG could be combined to improve the sensitivity in DM diagnosis,with important value in screening DM.