糖化血红蛋白在新疆喀什维吾尔族2型糖尿病诊断与筛查中的价值

The value of glycosylated hemoglobin A_1c in screening and diagnosing of type 2 diabetes in Uygur population in Kashi,Xinjiang

目的探讨HbA1c在新疆喀什地区维吾尔族T2DM诊断和筛查中的价值。方法选取待确诊糖尿病者457名,均行75g OGTT并测定HbA_1c,绘制受试者特征工作（ROC）曲线,分析FPG及HbA1c诊断与筛查T2DM的敏感性和特异性。结果以OGTT结果为＂金标准＂,FPG的ROC曲线的最佳切点为6.995 mmol/L,特异性99.5%,敏感性96.2%,曲线下面积（AUC）0.994（95%CI：0.910~0.970）,阴性似然比（-LR）0.039,阳性似然比（＋LR）213.43。HbA_1c的ROC曲线的最佳切点6.95%,特异性97.7%（95%CI：0.850~0.978）,敏感性98.3%（95%CI：0.858~0.952）,AUC 0.997（95%CI：0.945~0.990）,-LR 0.017,＋LR 43.64。结论 HbA_1c≥6.95%可作为新疆喀什地区维吾尔族T2DM诊断及筛查的一种有效方法,诊断的敏感性较FPG高,特异性较FPG低。

Objective To explore the value of glycosylated hemoglobin（HbA_1 c） in screening and diagnosing T2 DM in Uygur population in Kashi,Xinjiang.Methods 457 subjects from the outpatient and inpatient accepted 75 g OGTT test and HbA1c measurement.ROC curve analysis was used to evaluate the best HbA1c and FPG cut-off points for screening and diagnosing T2 DM.Results Taking OGTT as the gold standard,the optimal FPG cut-off point was 6.995 mmol/L,with specificity 99.5%,sensitivity96.2%,area under the curve（AUC） 0.994（95%CI：0.910 ~ 0.970）,negative likelihood ratio（-LR）0.039,and positive likelihood ratio（＋ LR） 213.43.The optimal HbA1ccut-off point was 6.95%,with specificity 97.7%（95%CI：0.850 ~ 0.978）,sensitivity 98.3%（95%CI：0.858~0.952）,AUC 0.997（95%CI：0.945~0.990）,— LR 0.017,and ＋LR 43.64.Conclusion HbA1c≥6.95%can be set as the threshold to diagnose and screen T2 DM in Uygur population in Kashi,Xinjiang.Compared with FPG,HbA1c has higher sensitivity but lower specificity.