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目的比较糖化血红蛋白(HbA1c)与口服糖耐量试验(OGTT)在一般人群中筛检糖尿病和糖尿病前期的效果。方法测定2010年中国居民营养与健康调查中江西省南昌市和湖北省武汉市的1416名调查对象的HbA1c,比较两种方法诊断的患者分布及血糖水平。用受试者工作特征曲线分析HbA1c诊断糖尿病的灵敏度和特异度。结果根据1999年WHO标准,研究对象中糖尿病、糖调节受损(IGR)患者分别为86例和262例。与OGTT相比,HbA1c≥6.5%的灵敏度为41.9%,特异度为98.9%。HbA1c标准与OGTT标准检出的糖尿病患者例数不同,两部分人群的HbA1c水平不同。HbA1c 5.7%6.4%筛检IGR的灵敏度为78.6%,特异度为55.1%。HbA1c 5.7%6.4%与IGR检出的患者不同,HbA1c 5.7%6.4%患者的空腹血糖及餐后2 h血糖水平均低于IGR患者。结论 HbA1c≥6.5%诊断糖尿病特异度较高但灵敏度较低。HbA1c 5.7%6.4%筛查糖尿病前期的价值较低。
Abstract：Objective To compare the performance of glycated hemoglobin(HbA1c)and oral glucose tolerance test(OGTT) in diagnosing diabetes and pre-diabetes in the general population. Methods A total of 1416 subjects from Nanchang,Jiangxi Province and Wuhan,Hubei Province who have participated the 2010 Chinese Nutrition and Health Survey were studied and their HbA1c were measured. The glycemic levels and distribution of the subjects diagnosed with diabetes and pre-diabetes by OGTT and HbA1c were compared. Receiver operating characteristic curves were constructed to determine the sensitivity and specificity of HbA1c in detecting diabetes as defined by OGTT. Results According to the 1999 WHO criteria,86 subjects were diagnosed with diabetes and 262were with pre-diabetes. Comparing with OGTT,the sensitivity and specificity of HbA1c≥6. 5% was 41. 9% and 98. 9%. Subjects with diabetes diagnosed by HbA1c and OGTT were not consistent,and they have different HbA1c level. The HbA1c level of 5. 7%-6. 4% was associated with a sensitivity of 78. 6% and a specificity of 55. 1% in detecting impaired glucose regulation(IGR). Cases with pre-diabetes identified by HbA1c 5. 7%- 6. 4% were different from those with IGR. They had lower fasting glucose and 2-hour plasma glucose after glucose load than those with IGR. Conclusion Among this studied population,HbA1c ≥ 6. 5% showed high specificity but low sensitivity for detecting glucose-defined diabetes. The performance of HbA1c of 5. 7%- 6. 4% in screening prediabetes is poor.
[1]VAN DEN DONK M,SANDBAEK A,BORCHJOHNSEN K,et al.Screening for type 2 diabetes:lessons from the ADDITION-Europe study[J].Diabet Med,2011,28(11):1416-1424.
[2]American Diabetes Association.Standards of medical care in diabetes-2010[J].Diabetes Care,2010,33(Suppl 1):S11-S61.
[3]WONG T Y,LIEW G,TAPP R J,et al.Relation between fasting glucose and retinopathy for diagnosis of diabetes:three population-based cross-sectional studies[J].Lancet,2008,371(9614):736-743.
[4]VISTISEN D,COLAGIURI S,BORCH-JOHNSEN K.Bimodal distribution of glucose is not universally useful for diagnosing diabetes[J].Diabetes Care,2009,32(3):397-403.
[5]JORGENSEN M E,BJERREGAARD P,BORCHJOHNSEN K,et al.New diagnostic criteria for diabetes:is the change from glucose to HbA1c possible in all populations[J].J Clin Endocrinol Metab,2010,95(11):E333-E336.
[6]肖海英,田慧,李春霖,等.老年人群糖化血红蛋白用于诊断糖调节异常的可行性研究[J].军医进修学院学报,2011,32(6):542-544,547.
[7]CHRISTENSEN D L,WITTE D R,KADUKA L,et al.Moving to an A1C-based diagnosis of diabetes has a different impact on prevalence in different ethnic groups[J].Diabetes Care,2010,33(3):580-582.
[8]BAO Y,MA X,LI H,et al.Glycated haemoglobin A1c for diagnosing diabetes in Chinese population:cross sectional epidemiological survey[J].BMJ,2010(340):c2249.
[9]HERMAN W H,MA Y,UWAIFO G,et al.Differences in Alc by race and ethnicity among patients with impaired glucose tolerance in the Diabetes Prevention Program[J].Diabetes Care,2007,30(10):2453-2457
[10]BENNETT C M,GUO M,DHARMAGE S C.HbA(1c)as a screening tool for detection of type 2diabetes:a systematic review[J].Diabet Med,2007,24(4):333-343.
[11]MOHAN V,VIJAYACHANDRIKA V,GOKULAKRISHNAN K,et al.A1C cut points to define various glucose intolerance groups in Asian Indians[J].Diabetes Care,2010,33(3):515-519.
[12]ZHOU X H,JI L N,LUO Y Y,et al.Performance of HbA(1c)for detecting newly diagnosed diabetes and pre-diabetes in Chinese communities living in Beijing[J].Diabet Med,2009,26(12):1262-1268.
[13]OLSON D E,RHEE M K,HERRICK K,et al.Screening for diabetes and pre-diabetes with proposed A1C-based diagnostic criteria[J].Diabetes Care,2010,33(10):2184-2189.
基本信息:
DOI：10.19813/j.cnki.weishengyanjiu.2014.03.018
中图分类号:R587.1
引用信息:
[1]黄淑娥,张坚,孟丽苹,等.糖化血红蛋白与口服糖耐量试验诊断糖尿病的比较研究[J].卫生研究,2014,43(03):439-443.DOI:10.19813/j.cnki.weishengyanjiu.2014.03.018.
2014-05-30
2014-05-30