2型糖尿病高危人群的早期筛查分析

Analysis of early screening in high-risk population for type 2 diabetes mellitus

[目的]探讨正常糖耐量(NGT)伴胰岛素抵抗(IR)人群中2型糖尿病高危人群的判别方法.[方法]对204例NGT受试者进行(6.01±0.35)年的随访研究,以随访时是否发展为前驱糖尿病和或2型糖尿病为标准,分析基线时受试者空腹胰岛素(Fins)、胰岛素曲线下面积(AUCins)、稳态模型胰岛素抵抗指数(HOMA-IR)、稳态模型胰岛β细胞分泌(HOMA-β)及胰岛素早期分泌指数(ΔI30/ΔG30)等指标的受试者工作特征(ROC)曲线下面积,选择最大ROC曲线下面积为指标,以该指标约登指数最大分值为最佳诊断临界值,根据其将基线时204例NGT受试者分为高危组和低危组,比较两组基线时IR情况及随访时前驱糖尿病和或2型糖尿病的发病率.[结果]Fins,AUCins,HOMA-IR,HOMA-β和ΔI30/ΔG30等指标的ROC曲线下面积分别为0.805,0.848,0.825,0.632和0.753,以AUCins的ROC曲线下面积为最大,其最佳诊断临界值为108.43 mU/L.与低危组比较,高危组前驱糖尿病或2型糖尿病发病率显著增高(29.41%,2.21%,P<0.001),Fins,AUCins,HOMA-IR等指标亦均显著增高(P<0.001).[结论]2型糖尿病高危人群也存在于NGT受试者中.以AUCins≥108.43 mU/L为诊断临界值可初步筛查2型糖尿病的高危人群.

OBJECTIVE To study the discriminate method in high-risk population with normal glucose tolerance（NGT）and insulin resistance（IR）for type 2diabetes mellitus（T2DM）.METHODS204 subjects with NGT were followed up for 6.01±0.35 years.The subjects were followed up whether development of prediabetes and/or T2 DM as standard,it was analyzed at baseline that the area under receiver operating characteristic（ROC）curve of indexes of fasting insulin（Fins）,area under the curve of insulin（AUCins）,homeostasis model assessment of insulin resistance（HOMA-IR）,homeostasis model assessment ofβ-cell function（HOMA-β）andΔI30/ΔG30 and so on,and the biggest area under the ROC curve was choosed as an index,and the highest score of Yauden＇s index was as the optimal diagnostic critical value.According to the diagnostic threshold baseline,the 204 subjects with NGT were divided into high-risk and low-risk groups,and the status of IR at baseline and the incidence of prediabetes and/or T2 DM at following up were compared between two groups.RESULTS The areas under the ROC curve of indexes of Fins,AUCins,HOMA IR,HOMA-βandΔI30/ΔG30were 0.805,0.848,0.825,0.848 and 0.825,respectively,and the area under ROC curve of AUCins was as the biggest,and its optimal diagnostic critical value was 108.43 mU/L.The incidence of prediabetes and/or T2DM（29.41%,2.21%,）and the indexes of Fins,AUCins,HOMA-IR increased significantly in high risk group than in low risk group（P〈0.001）.CONCLUSION The high-risk population for T2 DM also exist in NGT subjects,and is preliminarily screened with the AUCins≥108.43mU/L as diagnosis threshold.