广西地区老年人群糖化血红蛋白参考范围及筛查糖尿病最佳截断值的研究

Study on the reference range of glycosylated hemoglobin and the best cut-off value for screening diabetes of elderly people in Guangxi

目的探讨广西地区老年人群HbA_(1)c参考范围及筛查DM的最佳截断值。方法选取2019~2020年于我院体检的≥60岁老年人群,行75 g OGTT并检测HbA_(1)c,分为IGR组157例、T2DM组304例及健康对照组(NGT)306名。以95%参考范围制定HbA_(1)c医学参考区间,采用受试者工作特征曲线(ROC)确定HbA_(1)c筛查DM的最佳截断值。结果NGT组HbA_(1)c为(5.60±0.41)%,HbA_(1)c参考范围4.82%~6.38%。以OGTT诊断的DM患者HbA_(1)c的ROC曲线最佳截断值为6.55%,曲线下面积为0.852(95%CI 0.821~0.883),灵敏度67.1%,特异度93.1%。结论广西地区老年人群HbA_(1)c参考范围4.82%~6.38%;HbA_(1)c≥6.55%是诊断广西地区老年人群DM的最佳截断值。

Objective To explore the reference range of glycosylated hemoglobin(HbA_(1)c)and the best cut-off value for diagnosing diabetes in the elderly in Guangxi.Methods Randomly select the elderly≥60 years old who will undergo a physical examination in our hospital from 2019 to 2020,perform 75 g OGTT and detect HbA_(1)c.Taking OGTT as the gold diagnosis standard of diabetes,306 healthy elderly with normal glucose tolerance(NGT group),157 prediabetes(IGR group)and 304 diabetes(T2DM group)were enrolled.The medical reference interval of HbA_(1)c was established based on the 95%reference range.ROC curve analysis was used to determine the best cut-off value of HbA_(1)c in the diagnosis of diabetes.ResultsThe average HbA_(1)c in NGT group was(5.60±0.41)%,with reference range 4.82%~6.38%.Taking OGTT as the gold standard,the best cut-off value of HbA_(1)c for DM diagnosis is 6.55%and the area under the ROC curve is 0.852(95%CI 0.821~0.883),with sensitivity 67.1%and specificity93.1%.Conclusion The reference range of HbA_(1)c for the elderly in Guangxi is 4.82%~6.38%.HbA_(1)c≥6.55%is the best cut-off value for diagnosing diabetes in the elderly in Guangxi.