摘要
目的探讨甲状腺功能亢进(下称"甲亢")患者采用HbA_1c联合FPG筛查糖尿病及糖尿病前期的敏感性和特异性并确定相应的最佳切点。方法选取2013~2016年于我院内分泌科住院的甲亢患者508例,行OGTT,检测HbA_1c、FPG及2hPG,测定身高和体重,计算BMI,采用受试者工作特征曲线(ROC)获得HbA_1c诊断和筛查糖尿病及糖尿病前期的相关切点及阳性似然比(+LR)、阴性似然比(-LR)。结果糖耐量正常组(NGT)、糖尿病前期组(IGR)、糖尿病(DM)组HbA_1c水平依次升高[(5.3±0.2)%vs(5.5±0.3)%vs(6.0±0.4)%,P<0.001]。依据ROC曲线判定,本组人群中HbA_1c筛查糖尿病前期的最佳临界点为5.4%,敏感性为55.9%,特异性为64.39%。HbA_1c诊断糖尿病的最佳临界点为5.5%,敏感性为79.71%,特异性为73.16%。结论 HbA_1c可准确反映甲亢患者不同阶段的糖代谢异常状态,在甲亢患者中诊断和筛查糖尿病前期及糖尿病的ROC切点分别为5.4%与5.5%。HbA_1c联合FPG筛查糖尿病与OGTT诊断结果的吻合度有统计学意义(P<0.001),较单独HbA_1c诊断糖尿病吻合度高。
Objective To evaluate the value of hemoglobin Alc (HbA1 c) and fasting blood glucose (FPG)in screening diabetes and impaired glucose regulation in patients with hyperthyroidism,and identify the optimal HbA1 c cut-off point. Methods A total of 508 hospitalized patients with hyperthyroidism in Endocrinology and Metabolism Department in our hospital were recruited in this study. All the patients underwent OGTT. HbAlc,FPG and 2 hPG were tested. Height and weight were measured,and BMI was calculated. ROC curve was made to identify the optimal HhAlc cut-off and positive likelihood ratio (+LR) and negative likelihood ratio (--LR). Results The levels of HbA1 c increased gradually with statistical difference in NGT group, IGR group and DM group [ (5.3±0. 2)% vs (5.5 ± 0. 3)% vs (6.0 ± 0. 4)%,P〈0. 001]. According to ROC curve, the optimal cut-off point of HbA1 e in the diagnosis of IGR was 5.4%,while the sensitivity was 55.9% and the specificity was 64. 39%. The optimal cut-off point of HbA1 c for the diagnosis of diabetes(DM) in patients with hyperthyroidism was 5.5 %, while the sensitivity was 79.71% and the specificity was 73.16%. Conclusion HbAlc can correctly reflect the different glucose metabolism in patients with hyperthyroidism. The optimal cut-off point of HbA1 c for screening IGR and DM is 5.4% and 5.5%, respectively. The coincidence degree between HbAlc combined with FPG and OGTT is statistically significant in the diagnosis of DM(P〈0. 001). The coincidence degree was higher in HbA1 c combined with FPG than HbA1 c alone.
出处
《中国糖尿病杂志》
CAS
CSCD
北大核心
2018年第2期107-111,共5页
Chinese Journal of Diabetes
基金
安徽省年度重点科研项目(11070403035)