皮肤晚期糖基化终产物无创检测技术在社区糖尿病早期筛查中的应用价值

Application of skin advanced glycosylation end products:a non-invasive detection technology in early screening of community diabetes mellitus

目的评估皮肤晚期糖基化终产物(AGEs)无创检测技术在社区糖尿病早期筛查中的应用价值。方法于2018年1月至2019年1月选取社区健康体检、既往无糖尿病病史者701例,根据口服葡萄糖耐量试验(OGTT)结果分为正常糖耐量组443例、糖调节受损组198例和初诊糖尿病组60例。采用糖尿病无创检测技术对各组患者上臂皮肤AGEs进行检测,同时测定空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、胰岛素、C肽、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、肌酐、尿素等指标。另将研究对象分为<45岁、45~59岁、≥60岁三个年龄段,比较不同糖调节状态人群在不同年龄段AGEs水平的变化。采用单因素方差分析比较各组间一般资料、生化指标及皮肤AGEs水平差异,并进行Pearson相关性分析和logistic回归分析。结果<45岁、45~59岁、≥60岁糖尿病前期和糖尿病患者AGEs值均高于正常糖耐量者(P<0.05)。皮肤AGEs水平与FPG和HbA1c相关(r=0.215、0.233,P<0.01)。AGEs是糖尿病前期和糖尿病风险的独立危险因素[优势比(95%可信区间):1.054(1.025~1.084)、1.116(1.071~1.163)]。糖尿病无创检测技术识别糖尿病的受试者工作特征(ROC)曲线下面积为0.721(95%可信区间:0.658~0.783),灵敏度为73.3%,特异度为61.3%;糖尿病无创检测技术识别糖尿病前期的ROC曲线下面积为0.601(95%可信区间:0.551~0.652),灵敏度为35.4%,特异度为87.1%。结论皮肤AGEs无创检测对评估糖尿病风险有一定应用价值,但可能不完全适用于糖尿病早期筛查。

Objective To evaluate the application value of skin advanced glycosylation end products(AGEs),a non-invasive detection technology for the early screening in community diabetes mellitus.Methods A total of 701 people without history of diabetes mellitus were recruited from community health check-up center between Jan.2018 and Jan.2019 and divided into normal glucose tolerance group(n=443),impaired glucose regulation group(n=198)and newly diagnosed diabetes group(n=60)according to the results of oral glucose tolerance test(OGTT).Upper arm skin AGEs were detected by diabetes mellitus scan(DM Scan).Parameters of fasting plasma glucose(FPG),2-hour postprandial blood glucose(2 h PG),glycosylated hemoglobin(HbA1c),insulin(INS),C-peptide(C-P),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),creatinine(Cr),urea(UREA)were tested.Additionally,AGEs levels were compared in<45 years old,45 to 59 years old and≥60 years old age groups.One-way analysis of variance was used to compare the differences of parameters and skin AGEs levels among 3 groups,and Pearson correlation analysis and logistic regression analysis were performed.Results The levels of AGEs in prediabetes and diabetic patients in different ages were higher than those in healthy controls respectively(P<0.05).Pearson correlation analysis showed that skin AGEs were correlated with FPG and HbA1c(r=0.215 and 0.233,P<0.01).Multivariate logistic regression analysis showed that AGEs were independent risk factors for prediabetes and diabetes risk[OR(95%CI):1.054(1.025-1.084),1.116(1.071-1.163)].The area under the receiver operator characteristic curve of DM Scan for identifying diabetes was 0.721[95%CI(0.658-0.783)],with a sensitivity of 73.3%and specificity of 61.3%.The area under receiver operator characteristic curve of DM Scan for pre-diabetes was 0.601[95%CI(0.551-0.652)],with a sensitivity of 35.4%and specificity of 87.1%.Conclusion Non-invasive detection of skin AGEs may be useful for assessing the risk of diabetes,but it may not be suitable for screening early diabetes mellitus.