空腹血糖联合糖化血清白蛋白在2型糖尿病筛查中的应用价值研究

Study on the Application Value of Fasting Blood Glucose and Glycosylated Serum Albumin in Screening Test Investigation for Type 2 Diabetes Mellitus

目的：评估空腹血糖（FBG）和糖化血清白蛋白（GA）在筛查糖尿病（DM）中的应用价值。方法：选取2013年4月至2014年4月本院健康体检者869例,测定空腹血糖及糖化血清白蛋白。FBG≥6.1且〈7.0 mmol/L或GA〉18.5%行口服葡萄糖耐量试验（OGTT）进行确诊。结果：FBG与诊断为DM相关的截断点为6.2 mmol/L,敏感性为97.1%,特异性为96.0%,曲线下面积（AUC）0.988（95%CI 0.980-0.996）,阳性似然比24.55,阴性似然比0.03;GA与诊断为DM相关的截断点为14.55%,敏感性和特异性分别为82.8%和90.2%,曲线下面积为0.923（95%CI 0.870-0.975）,阳性似然比8.43,阴性似然比0.19。当筛查DM时,AUC的结果为FBG=6.2（0.988）〉GA=14.55（0.923）,提示FBG的筛查准确度较高。FBG≥6.2且GA大于14.55%同时符合为阳性,得出灵敏度为96.7%,比单纯采用FBG≥7.0 mmol/L筛查糖尿病提高筛查效率35.4%,而特异度无明显差异。结论：空腹血糖联合糖化血清白蛋白筛查糖尿病有较高的灵敏度、特异性。

Objective To investigate the validity of using fasting blood glucose（FBG）and glycosylated serum albumin（GA） for the screening of diabetes. Methods 869 subjects（633 men, 236 women） over the age of 20 in our hospital physical examination center line underwent health check-up for screening diabetes between April 2013 and April 2014. Their average age was（42.95 ± 12.3）years. FBG and GA were examined at the same time on an empty stomach for 10 h. When FBG〈 7.0 mmol/L and ≥ 6.1 mmol/L or GA ≥ 18.5 %, OGTT was necessary to verify the diagnosis of diabetes. Results According to 1999 WHO criteria, 834 patients were normal, while 35 patients had diabetes. Using a receiver operating characteristic curve（ROC）, the optim al cut-point of FBG related to diabetes diagnosed by OGTT was 6.2mmol/L that was associated with a sensitivity and specifi city of 97.1 % and 96.0 % respectively. Area under the curve（AUC） was 0.988（95 % CI 0.980 - 0.996）, a positive likelihood ratio（LR）was 24.55, and a negative LR was 0.03. The optimal cut-point of GA related to diabetes diagnosed by OGTT was 14.55 %, which was associated with a sensitivity and specifi city of 82.8 % and 90.2 % respectively. Area under the curve（AUC） was 0.923（95 % CI 0.870 - 0.975）, a positive LR was 8.43, and a negative LR was 0.19. When screening for DM, the result of the AUC for the FBG=6.2（0.988）〉 GA=0.988（0.923）, indicating higher FBG screening accuracy. Joint test can improve the effi ciency of screening, series of experiments that FBG ≥ 6.2 and GA was more than 14.55 % in accord with positive criteria at the same time, so it was concluded that the sensitivity was 96.7 %, than just used the FBG ≥ 7.0 mmol/L screening diabetes screening effi ciency by 35.4 %, and no obvious difference was found between specifi c degrees. Conclusion The joint test can improve the screening effi ciency. When FBG 7.0 mmol/L and ≥ 6.2 mmol/L and GA ≥ 14.55 %, OGTT is necessary adopted as a screening test to verify the diagnosis of diabetes.