CAJ | 학술논문

目的比较HbA1C在两组不同年龄人群中糖代谢异常的诊断切点和临床意义.方法与口服葡萄糖耐量试验(OGTT)比较,在两个经糖尿病筛查(横断面资料)、不同年龄分布的人群中对HbA1C诊断2型糖尿病和糖调节受损(IGR)的切点进行分析,探讨其临床意义.结果中青年为主的院校组(1 064人)和老年社区组(1 671人)的HbA1C均值分别为5.31%±0.41%和5.79%±0.71%.对应OGTT诊断的结果计算HbA1C诊断的尤登指数,两组HbA1C诊断糖尿病的切点分别为5.7%(特异性86.7%,敏感性66.7%)和5.9%(特异性73.8%,敏感性80.1%),诊断IGR的切点分别为5.6%(特异性82.8%,敏感性55.8%)和5.7%(特异性60.9%,敏感性64.3%).在总人群中以HbA1C 5.7%、5.9%和6.5%为切点,诊断为糖尿病的患者分别为87.8%、78.7%和38.5%,IGR为61.6%、39.6%和4.1%,正常糖耐量者24.4%、10.0%和0.4%.结论 HbA1C诊断糖尿病和IGR的切点受评估人群年龄和HbA1C水平的影响.HbA1C6.5%虽敏感性差但特异性高,需结合空腹血糖、随机血糖和OGTF作为临床诊断糖尿病标准之一.
목적 비교HbA1C재량조불동년령인군중당대사이상적진단절점화림상의의.방법 여구복포도당내량시험(OGTT)비교,재량개경당뇨병사사(횡단면자료)、불동년령분포적인군중대HbA1C진단2형당뇨병화당조절수손(IGR)적절점진행분석,탐토기림상의의.결과 중청년위주적원교조(1 064인)화노년사구조(1 671인)적HbA1C균치분별위5.31%±0.41%화5.79%±0.71%.대응OGTT진단적결과계산HbA1C진단적우등지수,량조HbA1C진단당뇨병적절점분별위5.7%(특이성86.7%,민감성66.7%)화5.9%(특이성73.8%,민감성80.1%),진단IGR적절점분별위5.6%(특이성82.8%,민감성55.8%)화5.7%(특이성60.9%,민감성64.3%).재총인군중이HbA1C 5.7%、5.9%화6.5%위절점,진단위당뇨병적환자분별위87.8%、78.7%화38.5%,IGR위61.6%、39.6%화4.1%,정상당내량자24.4%、10.0%화0.4%.결론 HbA1C진단당뇨병화IGR적절점수평고인군년령화HbA1C수평적영향.HbA1C6.5%수민감성차단특이성고,수결합공복혈당、수궤혈당화OGTF작위림상진단당뇨병표준지일.
Objective To compare the difference of cutpoint and clinical significance of HbA1C for the diagnosis of abnormal glucose metabolism in two population groups with different ages.Methods According to oral glucose tolerance test(OGTT),the cutpoint and clinical significance of HbA1C for the diagnosis of type 2 diabetes and impaired glucose regulation(IGR)were investigated in the two population groups.Results The mean HbA1C of 1 064 young subjects in an academy and 1 671 aged subjects in a community were 5.31% ±0.41% and 5.79% ±0.71%,respectively.The cutpoints of HbA1C for diagnosis of diabetes were 5.7%(specificity 86.7%,sensitivity 66.7%)and 5.9%(specificity 73.8%,sensitivity 80.1%)in the two population groups,and 5.6% for diagnosis of IGR (specificity 82.8%,sensitivity 55.8%)and 5.7%(specificity 60.9%,sensitivity 64.3%),respectively.87.8%,78.7%,and 38.5% were diagnosed diabetes by current OGTT criteria at HbA1C levels of ≥5.7%,≥5.9%,and≥6.5%,IGR being 61.6%,39.6%,and 4.1%,and normal glucose tolerance being 24.4%,10.0%,and 0.4%.Conclusion The cutpoints of HbA1C for diagnosis of diabetes and IGR are different in populations with different ages and HbA1C levels.As one of diagnostic criteria for diabetes,HbA1C 6.5% with relatively higher specificity and lower sensitivity must be combined with fasting blood glucose,random blood glucose,and OGTT.