糖化血红蛋白在合并贫血2型糖尿病诊断中的价值

THE VALUE OF GLYCOSYLATED HEMOGLOBIN IN THE DIAGNOSIS OF TYPE 2 DIABETES COMPLICATED WITH ANEMIA

目的探讨糖化血红蛋白(HbA1c)检测在合并贫血2型糖尿病诊断中的价值。方法对159例合并贫血2型糖尿病病人(贫血组)、100例非贫血2型糖尿病病人(非贫血组)及100例健康体检者,分别检测HbA1c、空腹血糖(FPG)和血红蛋白(Hb)水平,分析HbA1c与FPG的相关性,并分组比较不同Hb含量病人间HbA1c水平及诊断灵敏度。结果贫血、非贫血组病人HbA1c与FPG均存在正相关关系(r=0.724、0.615,P<0.05),贫血组病人HbA1c水平及诊断灵敏度显著低于非贫血组(t=2.908,χ2=4.075,P<0.05)。与非贫血组比较,中度及重度贫血组病人HbA1c水平和诊断糖尿病的灵敏度显著降低(t=3.483、5.268,χ2=3.894、15.122,P<0.05),而轻度贫血组差异无统计学意义(P>0.05)。将HbA1c<7.95%作为判断2型糖尿病是否合并中、重度贫血的指标,其诊断灵敏度和特异度分别达到了0.850和0.805,Youden指数高达0.665。结论 HbA1c高于参考值上限可作为糖尿病诊断的一个敏感指标,但在糖尿病合并贫血时其诊断灵敏度明显降低,HbA1c<7.95%是诊断糖尿病病人是否合并中、重度贫血的有效指标。

Objective To assess the value of glycosylated hemoglobin A1c（HbA1c）in the diagnosis of type 2diabetes mellitus（T2DM）complicated with anemia. Methods This study consisted of 159 patients with T2 DM complicated with anemia（anemia group）,100 diabetic patients without anemia（non-anemia group）and 100 healthy individuals（healthy control）.Levels of HbA1 c,fasting plasma glucose（FPG）and hemoglobin（Hb）were detected in the patients and healthy controls.The correlation between HbA1 cand FPG was analyzed.The levels of HbA1 cin patients with different levels of Hb were analyzed and the diagnostic sensitivity of HbA1 ccompared among each group. Results Positive correlation was found between HbA1 cand FPG in anemia group and non-anemia group（r=0.724,0.615;P〈0.05）,and the level of HbA1 cin anemia group and its diagnostic sensitivity were lower than that in non-anemia group（t=2.908,χ2=4.075,P〈0.05）.Compared with the non-anemia group,the level of HbA1 cin both moderate and severe anemia groups and its sensitivity in diabetes diagnosis were much lower（t=3.483,5.268;χ2=3.894,15.122;P〈0.05）.Taking HbA1c 〈7.95% as a parameter for determining whether or not T2 DM complicated with moderate or severe anemia,its diagnostic sensitivity and specificity reached 0.850 and 0.805,respectively,and Youden index up to 0.665.Conclusion HbA1 cthat higher than upper limit of reference value can be used as a sensitive index for diagnosis of type 2diabetes mellitus,but when the disease is complicated with anemia,its diagnostic sensitivity is significantly reduced.HbA1c7.95%is an effective indicator in the diagnosis if diabetes is complicated with moderate or severe anemia.