糖化白蛋白、糖化血红蛋白在2型糖尿病及并发症预测中的作用

The Role of Glycosylated Blbumin and Glycosylated Hemoglobin in the Prediction of Type 2 Diabetes and Its Complications

目的探讨糖化白蛋白(GA)、糖化血红蛋白(HbA1c)在2型糖尿病及并发症中的临床应用价值。方法选取2016年3月1日至2017年3月15日四川省自贡市第一人民医院内分泌科收治的2型糖尿病患者(T2DM)302例为病例组,选取同期体检正常人群50例为对照组,检测上述人群GA、HbA1c水平,将检测结果按2型糖尿病及伴不同并发症分组进行统计学分析,应用受试者工作特征(ROC)曲线评估GA、HbA1c的诊断效能。结果 1)单纯2型糖尿病、2型糖尿病周围神经病变、2型糖尿病高血压、2型糖尿病周围血管病变、2型糖尿病肾病组GA和HbA1c水平皆明显高于对照组,差异有统计学意义(P<0.05)。2)通过Pearson相关分析显示,各组GA与HbA1c均呈正相关(P<0.01)。3)2型糖尿病肾病组的GA水平为(28.3±10.4)%,明显高于单纯2型糖尿病组(22.3±10.4)%,差异有统计学意义(P<0.05)。4)ROC曲线结果显示,GA、HbA1c诊断糖尿病最佳切点为15.4%和6.0%,曲线下面积(AUC)分别为0.989、0.918。结论 GA在2型糖尿病及其并发症患者中明显升高,与HbA1c有较好相关性,二者对2型糖尿病均有较高的预测价值。GA较HbA1c对2型糖尿病肾病的发生更具相关性,适于临床推广。

Objective To investigate the clinical application value of glycated albumin(GA)and glycated hemoglobin(HbA1c)in patients with type 2 diabetes mellitus and its complications.Methods A total of 302 patients with type 2 diabetes mellitus(T2DM)treated in Zigong First People's Hospital from March 1st,2016 to March 15th,2017 were selected and classified into the case group,and the other 50 healthy cases over the corresponding period were selected and classified into the control group.The levels of GA and HbA1c were assayed and the results were statistically analyzed and compared among the subgroups with T2DM and different complications.The diagnostic efficiency of GA and HbA1c were evaluated by the receiver operating characteristic(ROC)curve.Results Firstly,the levels of GA and HbA1c in the subgroup of T2DM with no complications,subgroup of type 2 diabetic peripheral neuropathy,subgroup of type 2 diabetic hypertension,subgroup of type 2 diabetic peripheral vascular disease and subgroup with type 2 diabetic nephropathy were significantly higher than those in the control group(P<0.05).Secondly,the Pearson correlation analysis showed that there was a positive correlation between GA and HbA1c in all the groups(P<0.01).Thirdly,the GA level in the subgroup of type 2 diabetic nephropathy was(28.3±10.4)%and it was significantly higher than that in the subgroup of T2DM with no complications,which was(22.3±10.4)%(P<0.05).Fourthly,the ROC curve showed that the best points for the diagnosis of diabetes by GA and HbA1c were 15.4%and 6%respectively and the area under the curve(AUC)was 0.989 and 0.918 respectively.Conclusion GA is significantly increased in the patients with T2DM and its complications and it is closely correlated with HbA1c.GA and HbA1c have high predicative values in the diagnosis of T2DM.GA is more valuable than HbA1c in predicting type 2 diabetic nephropathy,which is worthy of being generalized clinically.