糖化血红蛋白在糖尿病和空腹血糖受损及糖耐量异常中的诊断意义

Value of Glycosylated Hemoglobin in Diagnosis of Diabetes Mellitus,Impaired Fasting Glucose and Impaired Glucose Tolerance

目的探讨糖化血红蛋白（Hb A1c）在糖尿病和空腹血糖受损（IFG）及糖耐量异常（IGT）诊断中的意义。方法选取2012年9月至2013年8月来北京市西城区白纸坊社区卫生服务中心体检者中以往未确诊糖尿病患者和糖尿病前期者470例。所有研究对象行口服葡萄糖耐量试验和Hb A1c检测。分析Hb A1c诊断糖尿病、IFG及IGT的灵敏度、特异度、阳性似然比和阴性似然比。结果糖尿病组Hb A1c水平显著高于非糖尿病组,差异有统计学意义[（8.5±0.9）%比（6.3±0.8）%,P=0.006]。Hb A1c≥6.5%诊断糖尿病的灵敏度为97.9%,特异度为94.8%,阳性似然比为18.83,阴性似然比为0.02;Hb A1c≥5.7%~6.5%诊断IGT的灵敏度为41.7%,特异度为89.1%,阳性似然比为3.83,阴性似然比为0.65;Hb A1c≥5.7%~6.5%诊断IFG的灵敏度为70.0%,特异度为94.0%,阳性似然比为11.67,阴性似然比为0.32。结论对于糖尿病的诊断,Hb A1c具有较高的灵敏度和特异度,而对于IFG及IGT的诊断,Hb A1c特异度较高而灵敏度较低。

Objective To study the value of Glycosylated Hemoglobin （ HbA1c ） in the diagnosis of dia-betes mellitus （ DM ） , impaired fasting plasma glucose （ IFG ） and impaired glucose tolerance （ IGT ） . Methods A total of 470 subjects without history of diabetes and pre-diabetes admitted to Baizhifang Com-munity Health Service Centers of Xicheng District of Beijing from Sep .2012 to Aug.2013 were enrolled.Oral glucose tolerance test（OGTT） and HbA1c were measured.The diagnostic sensitivity（S）,specificity（Sp）, positive likelihood ratio （ ＋LR）,and negative likelihood ratio （-LR） of HbA1c were analyzed.Results The HbA1c level of diabetes group was significantly higher than non-diabetic group,the difference was statisti-cally significant [（8.5 ±0.9）% vs （6.3 ±0.8）%,P=0.006].To diagnose DM with HbA1c≥6.5%：S was 97.9%,Sp was 94.8%,＋LR was 18.83,and -LR was 0.02;to diagnose IGT with HbA1c≥5.7%~6.5%：S was 41.7%,Sp was 89.1%,＋LR was 3.83,and -LR was 0.65;and to diagnose IFG with HbA1c≥5.7%~6.5%：S was 70.0%,Sp was 94.0%,＋LR was 11.67,and-LR was 0.32.Conclusion HbA1c has a high sensitivity and specificity in diagnosing DM ,a high specificity but low sensitivity in diagnosing IFG and IGT.