CAJ | 학술논문

目的评估糖化血红蛋白(HbAlc)、糖化血清白蛋白(GA)联合检测在筛查糖尿病(DM)中的应用价值.方法研究对象来自于2007年3月至2009年12月为明确DM诊断而就诊者和糖尿病高危人群接受DM筛查共1480例,男677名、女803名.平均年龄(52.7±15.2)岁,研究对象空腹10 h行口服葡萄糖耐量试验(OGTT),采用高压液相法测定HbAlc水平,采用液态酶法测定GA水平.结果 (1)按1999年WHO糖尿病诊断标准,本组研究人群糖耐量正常组(NGT)562名、糖调节受损组(IGR)411名、新诊断DM患者组507例.HbAlc、GA水平在NGT、IGR、DM 3组间两两比较差异均有统计学意义(均P<0.01).(2)Pearson相关分析显示HbAlc与GA呈正相关(r=0.75,P<0.01).HbAlc与OGTT中空腹血糖(FPG)、糖负荷后2 h血糖(2 hPG)均呈正相关(r分别为0.82、0.78,P<0.01).GA与OGTY、FIG、2 hPG均晕正相关(r分别为0.73、0.75,P<0.01).(3)以OGTT为诊断DM的金标准绘制ROC曲线,结果显示,HbAlc、GA对DM均有较高的预测价值,曲线下面积(AUC)分别为0.882、0.881,两者之间的差异无统计学意义(P>0.05).HbAlc识别DM的最佳切点为6.1%.(4)联合HbAlc 6.1%、GA 17.1%为切点筛查DM的敏感度显著高于单用HbAlc 6.1%或GA17.1%的标准(94.7%比81.1%、88.4%均P<0.01).结论 HbAlc和GA的联合检测能进一步提高DM的筛查效率.当HbAlc≥6.1%或GA≥17.1%时应进一步行OGTT以明确有无DM.
목적 평고당화혈홍단백(HbAlc)、당화혈청백단백(GA)연합검측재사사당뇨병(DM)중적응용개치.방법 연구대상래자우2007년3월지2009년12월위명학DM진단이취진자화당뇨병고위인군접수DM사사공1480례,남677명、녀803명.평균년령(52.7±15.2)세,연구대상공복10 h행구복포도당내량시험(OGTT),채용고압액상법측정HbAlc수평,채용액태매법측정GA수평.결과 (1)안1999년WHO당뇨병진단표준,본조연구인군당내량정상조(NGT)562명、당조절수손조(IGR)411명、신진단DM환자조507례.HbAlc、GA수평재NGT、IGR、DM 3조간량량비교차이균유통계학의의(균P<0.01).(2)Pearson상관분석현시HbAlc여GA정정상관(r=0.75,P<0.01).HbAlc여OGTT중공복혈당(FPG)、당부하후2 h혈당(2 hPG)균정정상관(r분별위0.82、0.78,P<0.01).GA여OGTY、FIG、2 hPG균훈정상관(r분별위0.73、0.75,P<0.01).(3)이OGTT위진단DM적금표준회제ROC곡선,결과현시,HbAlc、GA대DM균유교고적예측개치,곡선하면적(AUC)분별위0.882、0.881,량자지간적차이무통계학의의(P>0.05).HbAlc식별DM적최가절점위6.1%.(4)연합HbAlc 6.1%、GA 17.1%위절점사사DM적민감도현저고우단용HbAlc 6.1%혹GA17.1%적표준(94.7%비81.1%、88.4%균P<0.01).결론 HbAlc화GA적연합검측능진일보제고DM적사사효솔.당HbAlc≥6.1%혹GA≥17.1%시응진일보행OGTT이명학유무DM.
Objective To assess the validity of combined detection of hemoglobin Alc (HbAlc)and glycated albumin (GA) in diabetic screening. Methods A total of 1480 subjects at our out-patient department from March 2007 to December 2009. Those suspected of diabetes or at a high risk of diabetes were enrolled. The study population included 677 males and 803 females with a mean age of 52. 7 years. All subjects received an oral glucose tolerance test ( OGTT) after a 10-hour fasting. Glycated albumin ( GA)and hemoglobin Alc (HbAlc) were measured with liquid enzyme method and high pressure liquid chromatography respectively. Results ( 1 ) According to World Health Organization diabetes diagnosis criteria, there were 562 subjects with normal glucose tolerance (NGT), 411 subjects with impaired glucose regulation (IGR) and 507 subjects with newly diagnosed diabetes mellitus (DM). The level of HbAlc and GA had a rising tendency among NGT, IGR and DM groups (P<0. 01). (2) Pearson correlation analysis demonstrated that HbAlc had a positive association with GA ( r = 0. 75, P < 0. 01). (3) Using OGTT as golden standard of diabetic diagnosis, receiver operator characteristic (ROC) curve indicated that HbAlc and GA were strong predictors of diabetes. The area under curve ( AUC) was 0. 882 and 0. 881 respectively with no significant difference ( P >0. 05). (4) The sensitivity of combined use of HbA1 c and GA at optimal cut-off points of 6. 1% and 17. 1% was significantly higher than that of single use of HbAlc or GA in diabetic screening (94. 7% vs 81. 1% , 88. 4% , P <0. 01). Conclusion A combined detection of HbAlc and GA may improve the efficacy of diabetic screening. The subject with HbAlc≥6. 1% or GA≥17.1% is recommended to undergo OGTT for confirming a diagnosis of diabetes.