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糖化血红蛋白水平的不同切点在诊断糖尿病中的应用研究
Utility of hemoglobin A1c at different cut-off points for diabetes diagnosis

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DOI:
作者:
李青,包玉倩 ,潘洁敏 ,马晓静, 唐峻岭, 袁巧英, 陆惠娟, 贾伟平
LI Qing, BAO Yu-qian, PAN Jie-ming, et al
作者单位:
上海市糖尿病临床医学中心 上海市糖尿病研究所 上海交通大学附属第六人民医院内分泌代谢科
Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Department of Endocrinology and Metabolism, Shanghai Jiaotong University affiliated Sixth People’s Hospital
关键词:
口服葡萄糖耐量试验；糖化血红蛋白；空腹血糖
Oral glucose tolerance test; Hemoglobin A1c;Fasting plasma glucose
摘要:
目的 评估不同糖化血红蛋白（HbA1c）切点在诊断糖尿病（DM）中的应用价值。 方法 研究对象来自于 2007年1月-2009年10月为明确DM诊断而就诊者和DM高危人群接受DM筛查者，共1427名，男645名，女782名，年龄（53±15）岁。研究对象空腹10小时行口服葡萄糖耐量试验（OGTT）并同时测定糖化血红蛋白（HbA1c）、糖化血清白蛋白（GA）。 结果（1）按1999年WHO糖尿病诊断标准,本研究人群中糖耐量正常 (NGT)、糖调节受损 (IGR)和糖尿病(DM)分别为582例、378例、467例。HbA1c水平在NGT、IGR、DM3组呈递增趋势（P＜0.05）。（2）Pearson相关分析结果显示；HbA1c与GA呈正相关（r=0.74，P <0.01），HbA1c与OGTT中空腹血糖（FPG）、糖负荷后2小时血糖（2h PG）呈正相关（相关系数r分别为0.82、0.80， P<0.01）。（3）以OGTT为诊断DM的金标准绘制ROC曲线，结果显示：用HbA1c来诊断DM的曲线下面积（AUC）(0.943 95%CI为0.931-0.955) 与用FPG来诊断DM的AUC (0.955 95%CI为0.944-0.965)差异无统计学意义（P＞0.05)。以HbA1c 6.3%为切点诊断DM敏感性显著高于FPG 7.0mmol/L(79.7% vs 51.4% P<0.01)及HbA1c 6.5%（79.7% vs 67.2% P<0.01）。 结论 在无法进行 OGTT的情况下，HbA1c可用于糖尿病的诊断，6.3%确是比较适合我国人群的诊断DM的HbA1c切点。
Objective To assess the validity of hemoglobin A1c (HbA1c) at different cut-off points for diabetes mellitus (DM) diagnosis. Methods We identified all patients who were suspected of having diabetes or at high risk of diabetes and underwent 75g-OGTT as diagnostic tool for diabetes from January 2007 to October 2009 in the outpatient department. Totally 1427 subjects, including 645 males and 782 females, at mean age of 53 years were enrolled. All the subjects underwent oral glucose tolerance test (OGTT), hemoglobin A1c (HbA1c) and glycated albumin (GA) level measurement after 10 hour fasting.Results (1) Based on the diabetes diagnosis criteria of WHO (1999), all the subjects were divided into normal glucose tolerance (NGT) group (n=582), impaired glucose regulation (IGR) group (n=378), and diabetes mellitus (DM) group (n=467). HbA1c level had increasing trend among the three groups (P<0.05).(2) Pearson correlation analysis demonstrated that HbA1c was positively correlated with GA, fasting plasma glucose (FPG) and 2h post-load plasma glucose(2h PG) level determined by OGTT (r=0.74, 0.82, 0.80, P<0.01). (3) Receiver operator characteristic (ROC) curve was plotted to detect undiagnosed diabetes. The analysis revealed that the area under the curve (AUC) was 0.943 of HbA1c (95% confidence interval: 0.931-0.955), had no difference with that of FPG (AUC 0.955, 0.944-0.965, P>0.05). The sensitivity of using HbA1c≥6.3% as the diabetes diagnosis criterion was significantly higher than using FPG ≥7.0mmol/L (79.7% vs 51.4% P<0.01) or HbA1c ≥6.5% (79.7% vs 67.2% P<0.01). Conclusions HbA1c measurement is valid in diabetes diagnosis when OGTT is not available. A HbA1c value of 6.3% is an optimal cut-off point for diabetes diagnosis in Chinese population.

 

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