皮肤糖基化终产物无创检查筛查糖尿病及糖耐量减低的临床应用价值

Clinical value of non-invasive advanced glycation end product measurement in screening for diabetes mellitus and impaired glucose tolerance

目的探讨皮肤糖基化终产物(AGE)无创检测筛查糖尿病及糖耐量减低(IGT)的临床应用价值。方法选取2016年12月至2017年8月在武汉大学人民医院进行健康体检且有意愿参加本研究的389人为研究对象,排除不符合标准者,最终纳入293人,对纳入研究的受检者采用AGE无创检测技术检测受检者皮肤组织中的AGE值,并对其进行口服葡萄糖耐量试验,测定糖负荷后2h血糖。同时检测其空腹血糖及糖化血红蛋白水平。结果293名受检者中,糖代谢正常209人,IGT50人,糖尿病34例,3组AGE分值分别为(69.44±7.28)AU、(79.67±5.65)AU、(81.17±9.28)AU,依次递增(P均<0.05)。Pearson相关性分析表明AGE值与空腹血糖、糖化血红蛋白及糖负荷后2h血糖具有正相关的关系(r=0.472、0.433、0.546,P均<0.001)。AGE无创检测筛查IGT的灵敏度为84.00%,特异度为84.87%,筛查糖尿病的灵敏度为79.41%,特异度为84.87%,灵敏度和特异度较高。结论AGE无创检测对糖尿病及IGT的早期诊断具有重要的临床应用价值。

Objective To evaluate the clinical value of non-invasive skin autofluorescence measurement of advanced glycation end products (AGE) to screen for both diabetes mellitus and impaired glucose tolerance (IGT). Methods A total of 389 individuals who underwent physical examination at Renmin Hospital of Wuhan University from December 2016 to August 2017, and were willing to participate were enrolled in our study. 293 people meeting the criteria were included finally. AGE value in the skin tissue was measured non-invasively via autofluorescence with the DM Scanner. Two-hour oral glucose tolerance testing, and measurements of fasting blood glucose and glycosylated hemoglobin were also performed for each patient. Results Among 293 subjects, 209 had normal glucose metabolism, 50 had IGT, and 34 had diabetes mellitus. The measured Advanced glycation end product values in these groups were (69.44 ± 7.28) AU, (79.67 ± 5.65) AU, and (81.17 ± 9.28) AU, respectively. The differences between groups were statistically significant (P<0.05). Pearson correlation analysis showed a significant positive correlation between autofluorescence measurements and fasting blood glucose, glycosylated hemoglobin and glucose level 2 hours after oral glucose loading (r=0.472, 0.433, and 0.546, respectively;P<0.001). The sensitivity of DM Scan screening for IGT was 84.00%, with a specificity of 84.87%. For diabetes mellitus, the sensitivity was 79.41%, and the specificity 84.87%. Conclusion DM Scan has high sensitivity in screening for diabetes mellitus and IGT. It has important clinical value in the early diagnosis of IGT.