血清糖化白蛋白水平升高对糖尿病视网膜病变的诊断价值

Diagnosis Value of Increased Serum Ghycated Albumin Levels in Diabetic Retinopathy

目的:分析血清糖化白蛋白(GA)水平升高对2型糖尿病(T2DM)视网膜病变(DR)患者的诊断效能。方法:T2DM患者120例,依据是否合并DR将其分为DR组(50例)和非DR组,即T2DM组(70例)。液态酶法测定血清GA,液相色谱法测定全血HbA1c,比较两组GA和HbA1c水平差异及其对DR诊断的敏感度、特异度、阳性似然比和阴阳性预测值,分析GA和HbA1c与DR危险性的关系。结果:DR组GA、HbA1c水平(25.11±6.50%和9.38±1.77%)较T2DM组(21.21±4.50%和8.71±1.31%)明显升高(P<0.05)。GA和HbA1cROC曲线下面积最大值分别为0.68和0.61,对应的诊断DR的cut off值分别为24.00%和9.35%,GA诊断DR灵敏度为62.00%,高于HbA1c的38.00%(P<0.05),GA诊断DR的特异度、阴阳性预测值略优于HbA1c,但差异无统计学意义(P>0.05)。GA诊断DR的阳性似然比为2.71,优于HbA1c的1.48。Logistic回归分析,GA回归系数的Waldχ2值为7.488(P<0.05),其致DR的危险因子(OR)为1.16;HbA1c的Waldχ2为0.226(P>0.05)。结论:DR患者GA水平明显高于非DR患者,是DR的危险因素;GA>24.00%可作为DR的诊断指征。

Objective：To analyze the diagnosis effect of glycated albumin（GA）elevation in type 2 diabetic mellitus （T2DM）retinopathy （DR）.Method：There were 120 cases of type 2 diabetes mellitus.DR group were 50 cases and non-DR group （T2DM）were 70 cases.Serum GA was detected by liquid enzymatic method.Whole blood glycated hemoglobin （HbA1c）was detected by HPLC.Comparing the difference of GA and HbA1c level and the sensitivity,specificity,positive likelihood ratio and predictive value in DR diagnosis.The relationship of HbA1c and DR danger risk were analyzed.Results：GA and HbA1c in DR group was 25.11±6.50% and 9.38±1.77%.GA and HbA1c in T2DM group was 21.21±4.50% and 8.71±1.31%.There was significant different between DR group and T2DM group （P〈0.05）.The ROC curve area of GA was 0.68 and the GA cut off value was 24.00%. The ROC curve area of HbA1c was 0.61 and the HbA1c cut off value was 9.35%.The sensitivity of GA in DR was 62.00%.It was higher than that of HbA1c 38.00%（P〈0.05）.Specificity,positive and negative predictive value of GA in DR were all a little bit higher than these of HbA1c in DR.But there is no statistically significant difference（P〉0.05）.The positive likelihood ratio of GA in DR diagnosis was 2.71.It was better than 1.48 of HbA1c.Waldχ2 value of GA regression coefficients was 7.488（P〈0.05）,OR was 1.16.Waldχ2 value of HbA1c was 0.226 （P〉0.05）.Conclusion：The GA level in DR patients of T2DM is obviously higher than that in non-DR patients.It is a related risk factor of DR.GA〉24.00% can be used as diagnostic indicators of critical value of DR.