1,5-脱水葡萄糖醇、糖化白蛋白及糖化白蛋白/糖化血红蛋白比值应用于暴发性1型糖尿病早期诊断的价值

Serum 1,5-anhydroglucitol,glycated albumin and glycated albumin to glycated hemoglobin A_(1c) ratio in early identification of fulminant type 1 diabetes mellitus

目的探讨血1,5-脱水葡萄糖醇(1,5-AG)、糖化白蛋白(GA)和GA/糖化血红蛋白(HbA1c)比值用于暴发性1型糖尿病(FT1DM)和经典1型糖尿病(T1ADM)早期鉴别诊断的价值。方法收集2007年1月至2018年7月上海交通大学附属第六人民医院20例FT1DM患者及47例HbA1c<8.7%且年龄和性别匹配的新诊断T1ADM患者。测定其1,5-AG、GA、HbA1c等相关指标。采用t检验、Mann-Whitney U检验比较FT1DM和T1ADM患者的1,5-AG、GA及GA/HbA1c比值,采用受试者工作特性(ROC)曲线评价不同血糖监测指标鉴别FT1DM和HbA1c<8.7%的T1ADM的效能。结果FT1DM患者的血清1,5-AG水平低于T1ADM,FT1DM患者的血清GA水平较T1ADM稍有增加,但差异均无统计学意义(均P>0.05)。FT1DM患者的GA/HbA1c水平较T1ADM患者升高,差异有统计学意义(P=0.001)。1,5-AG和GA鉴别两者的最佳切点分别为6.2μg/ml和17.9%,其灵敏度分别为95.0%和90.0%,但特异度仅为31.9%和34.0%,曲线下面积(AUC)为0.597和0.601,两者筛查效力差异无统计学意义(P=0.972)。而对于GA/HbA1c比值,其最佳切点为>3.187,灵敏度为70.0%,特异度为76.6%,AUC为0.769,优于单用1,5-AG或GA。结论GA/HbA1c比值在早期识别FT1DM方面,优于单用1,5-AG或GA。

Objective The aim of the current study is to investigate whether 1,5-anhydroglucitol(1,5-AG),glycated albumin(GA)and GA to glycated hemoglobin A1c(HbA1c)ratio can be used for early identify fulminant type 1 diabetes mellitus(FT1DM)and type 1A diabetes mellitus(T1ADM).Methods From January 2007 to July 2018,20 FT1DM patients and 47 newly diagnosed T1ADM patients(age and sex matched,HbA1c<8.7%)admitted to the Department of Endocrinology and Metabolism,Shanghai Jiao Tong University Affiliated Sixth People′s Hospital were included in this study.Then,the serum 1,5-AG,GA,and HbA1c of these patients were measured for analysis.The 1,5-AG,GA and GA/HbA1c ratio between FT1DM and T1ADM patients were compared by the t test and Mann-Whitney U test.The receiver operating characteristic(ROC)curve was used to evaluate the efficacy of those indicators in identifying FT1DM and T1ADM with HbA1c<8.7%.Results The FT1DM patients had a decrease trend of 1,5-AG,although the GA increased slightly comparing with T1ADM patients,the differences was not statistically significant(both P>0.05).However,the GA/HbA1c ratio in FT1DM patients increased significantly than those in T1ADM patients(P=0.001).The optimal cut-off points for 1,5-AG and GA identifing FT1DM and T1ADM were 6.2μg/ml and 17.9%,with their sensitivity up to 95.0%and 90.0%respectively,while the specificity was only 31.9%and 34.0%,and the area under the curve(AUC)was 0.597 and 0.601,respectively.No difference was found in screening efficacy(P=0.972).As for GA/HbA1c ratio,the optimal cut-off point was 3.187,with its sensitivity,specificity and AUC of 70.0%,76.6%,and 0.769,respectively.Therefore,GA/HbA1c was clearly superior to 1,5-AG or GA alone.Conclusion GA/HbA1c ratio is a better indicator for early identification of FT1DM than 1,5-AG or GA.