空腹血糖、糖负荷后2h血糖和HbA1c对糖尿病的诊断价值

The diagnostic value of fasting plasma glucose, 2 h plasma glucose after glucose loading, and HbA1c to diabetes mellitus

采用整群抽样的方法，对东莞市横沥镇35岁以上的6656名户籍居民进行问卷调查和身高、体重、腰围、臀围、血压测量，同时检测血脂、空腹血糖（FPG）、HbA1c及糖负荷后2h血糖（2hPG），仅单项血糖指标增高而无糖尿病症状者1周以后再次检测，分析采用FPG、2hPG、HbA1c对糖尿病的诊断价值。结果显示，第1周检测中，FPG、HbA1c、2hPG三者中一项以上增高的初诊糖尿病共有800例，其中FPG、HbA1c、2hPG增高的初诊糖尿病分别为42．0％、55．3％、67．1％；两两组合时FPG＋HbAmFPG＋2hPG、HbA1c＋2hPG增高的初诊糖尿病分别为68．8％、79．8％、91.0％。第2周对仅单项指标增高而未能确诊的糖尿病人群进行复查，FPG、HbA。2hPG增高的重复率各为27．6％、74．3％、31．4％；最终共确诊糖尿病患者503例，其中FPG、HbA1c、2hPG确诊糖尿病各占55．7％、76．9％、69．8％，两两组合时，FPG＋HbA1c、FPG＋2hPG、HbA1c＋2hPG确诊糖尿病各占87．3％、78．7％、96．8％。结果提示，单纯FPG、HbA1c、2hPG诊断糖尿病均存在不同程度的漏诊，两两组合可减少漏诊率。HbA1c较FPG、2hPG更适合作为诊断糖尿病的指标；HbA1c＋2hPG明显优于其他两种组合。

A total of 6 656 residents aged above 35 years in Hengli, Dongguan, were included in this epidemiologic investigation. A questionnaire survey was performed. Body height, weight, waist circumference, hip circumference, and blood pressure were measured. The plasma lipid, fasting plasma glucose （ FPG）, HbA1c, and 2 h plasma glucose （2hPG） levels were detected. The test was repeated one week later if only one index was increased without any symptoms of diabetes mellitus. The diagnostic values of FPG, HbA1c, and 2hPG in diabetes mellitus were explored. The results showed that at the first week, 800 subjects were initially diagnosed as cases of diabetes mellitus by only one of the elevated FPG, HbAic or 2hPG values. The rates of single elevations of FPG, HbA1c, and 2hPG were 42.0%, 55.3% , and 67.1% respectively. The rates of elevation of FPG＋HbA1c, FPG＋2h PG value, and HbA1c ＋ 2hPG value were 68.8%, 79.8%, and 91.0% respectively. Among 800 patients, who had only one elevation of those three indices without symptoms of diabetes mellitus, FPG, HbA1c, and 2hPG were repeated by the second week. The recurrence rate of elevation of FPG, HbA1c, and 2hPG was 27.6% , 74.3%, and 31.4% respectively. 503 individuals had got the final diagnosis of diabetes mellitus, among whom the rates of single elevation in FPG, HbA1c and 2hPG were 55.7%, 76.9%, and 69.8% respectively ; and the rates of elevation of FPG＋HbA1c, FPG＋ 2hPG, and HbA1c＋2hPG were 87.3% , 78.7% , and 96.8% respectively. These results suggest that using one index of FPG, HbA1cor 2hPG may lead to miss diagnosis of diabetes mellitus. The combination of those three indices may reduce miss diagnosis. HbA1c alone is better than the other two indices, and HbA1c ＋2hPG combination was better than the other combinations for diagnosing diabetes mellitus.