广西医学
廣西醫學
엄서의학
GUANGXI MEDICAL JOURNAL
2013年
12期
1642-1645
,共4页
糖尿病%糖化血红蛋白%血糖%诊断阈值%ROC曲线
糖尿病%糖化血紅蛋白%血糖%診斷閾值%ROC麯線
당뇨병%당화혈홍단백%혈당%진단역치%ROC곡선
Diabetes mellitus%Glycosylated hemoglobin%Blood glucose%Cut-off point%Receiver operating characteristic curve
目的：比较不同浓度的糖化血红蛋白（HbA1 c）与空腹血糖（FPG）、餐后2 h血糖（2hPG）在糖尿病诊断中的相关性，探讨HbA1 c对糖尿病的诊断效率及最佳阈值，对人群进行糖尿病筛查的效益。方法2型糖尿病患者1294例，采用高效液相色谱法（HPLC法）测定HbA1 c，根据HbA1 c水平分为HbA1 c≥6．5％和HbA1 c≥6．2％两组，探讨HbA1 c水平与血糖浓度的相关性；用受试者工作特征曲线（ ROC）判断不同浓度的HbA1 c诊断糖尿病的效率。结果 FPG≥7．0 mmol/L和2hPG≥11．1 mmol/L分别检出糖尿病748例（57．89％）和828例（64．18％）。用美国糖尿病学会（ADA）推荐的HbA1c≥6．5％作为糖尿病诊断阈值，则该组患者糖尿病的检出699例（54．01％），其敏感度和特异度分别为54．0％、100．0％，该阈值与FPG、2 hPG相比诊断相关度差异均有统计学意义（ P＜0．01）。而用HbA1c≥6．2％作为诊断阈值则该组患者糖尿病的检出953例（73．65％），与FPG相比检出率差异有统计学意义（P＜0．01）；与2hPG检出率相比差异无统计学意义（P＞0．05）。 HbA1c≥6．2％时ROC曲线下面积为0．922，最大诊断指数1．73，其敏感度和特异度分别是73．64％、99．0％。结论以HbA1 c≥6．2％作为诊断阈值时糖尿病诊断符合率较高，优于单纯检测FPG≥7．0 mmol/L及HbA1 c≥6．5％作为糖尿病诊断阈值，而与2hPG ≥11．1 mmol/L诊断符合率相近似。以HbA1 c≥6．2％作为诊断阈值对糖尿病高危人群的诊断效率高，可用于人群的糖尿病筛查。
目的：比較不同濃度的糖化血紅蛋白（HbA1 c）與空腹血糖（FPG）、餐後2 h血糖（2hPG）在糖尿病診斷中的相關性，探討HbA1 c對糖尿病的診斷效率及最佳閾值，對人群進行糖尿病篩查的效益。方法2型糖尿病患者1294例，採用高效液相色譜法（HPLC法）測定HbA1 c，根據HbA1 c水平分為HbA1 c≥6．5％和HbA1 c≥6．2％兩組，探討HbA1 c水平與血糖濃度的相關性；用受試者工作特徵麯線（ ROC）判斷不同濃度的HbA1 c診斷糖尿病的效率。結果 FPG≥7．0 mmol/L和2hPG≥11．1 mmol/L分彆檢齣糖尿病748例（57．89％）和828例（64．18％）。用美國糖尿病學會（ADA）推薦的HbA1c≥6．5％作為糖尿病診斷閾值，則該組患者糖尿病的檢齣699例（54．01％），其敏感度和特異度分彆為54．0％、100．0％，該閾值與FPG、2 hPG相比診斷相關度差異均有統計學意義（ P＜0．01）。而用HbA1c≥6．2％作為診斷閾值則該組患者糖尿病的檢齣953例（73．65％），與FPG相比檢齣率差異有統計學意義（P＜0．01）；與2hPG檢齣率相比差異無統計學意義（P＞0．05）。 HbA1c≥6．2％時ROC麯線下麵積為0．922，最大診斷指數1．73，其敏感度和特異度分彆是73．64％、99．0％。結論以HbA1 c≥6．2％作為診斷閾值時糖尿病診斷符閤率較高，優于單純檢測FPG≥7．0 mmol/L及HbA1 c≥6．5％作為糖尿病診斷閾值，而與2hPG ≥11．1 mmol/L診斷符閤率相近似。以HbA1 c≥6．2％作為診斷閾值對糖尿病高危人群的診斷效率高，可用于人群的糖尿病篩查。
목적：비교불동농도적당화혈홍단백（HbA1 c）여공복혈당（FPG）、찬후2 h혈당（2hPG）재당뇨병진단중적상관성，탐토HbA1 c대당뇨병적진단효솔급최가역치，대인군진행당뇨병사사적효익。방법2형당뇨병환자1294례，채용고효액상색보법（HPLC법）측정HbA1 c，근거HbA1 c수평분위HbA1 c≥6．5％화HbA1 c≥6．2％량조，탐토HbA1 c수평여혈당농도적상관성；용수시자공작특정곡선（ ROC）판단불동농도적HbA1 c진단당뇨병적효솔。결과 FPG≥7．0 mmol/L화2hPG≥11．1 mmol/L분별검출당뇨병748례（57．89％）화828례（64．18％）。용미국당뇨병학회（ADA）추천적HbA1c≥6．5％작위당뇨병진단역치，칙해조환자당뇨병적검출699례（54．01％），기민감도화특이도분별위54．0％、100．0％，해역치여FPG、2 hPG상비진단상관도차이균유통계학의의（ P＜0．01）。이용HbA1c≥6．2％작위진단역치칙해조환자당뇨병적검출953례（73．65％），여FPG상비검출솔차이유통계학의의（P＜0．01）；여2hPG검출솔상비차이무통계학의의（P＞0．05）。 HbA1c≥6．2％시ROC곡선하면적위0．922，최대진단지수1．73，기민감도화특이도분별시73．64％、99．0％。결론이HbA1 c≥6．2％작위진단역치시당뇨병진단부합솔교고，우우단순검측FPG≥7．0 mmol/L급HbA1 c≥6．5％작위당뇨병진단역치，이여2hPG ≥11．1 mmol/L진단부합솔상근사。이HbA1 c≥6．2％작위진단역치대당뇨병고위인군적진단효솔고，가용우인군적당뇨병사사。
Objective To study the diagnostic validity and find out the optimum diagnostic cut-off point of glycosylated hemoglobin ( HbA1 c) for the purpose of large population screening for diabetes by comparing the correlations between the blood levels of HbA1c and fasting plasma glucose(FPG),plasma glucose 2 hours after meal(2hPG) in the diagnosis of diabetes mellitus .Methods The blood levels of HbA 1 c of 1294 patients with type 2 diabetes mellitus were determined by high pressure liquid chromatography (HPLC).Then the patients were divided into two groups of HbA1 c>or=6.5%and HbA1 c>or=6.2%,and the correlation between HbA 1 c and blood glucose was studied .The validities of HbA 1 c of different levels as the tool for the diagnosis of diabetes were analyzed by receiver-operating characteristic (ROC) curve.Results FPG>or=7.0 mmol/L was found in 748(57.89%) diabetic patients,and 2hPG>or=11.1 mmol/L in 828(64.18%) diabetic patients.For HbA1 c at a diagnostic cut-off point of>or=6.5%which was recommended by ADA,699 (54.01%) diabetes patients were detected ,and the sensitivity and specificity were 54.0%and 100.0%,respectively . There was significant difference among HbA 1c>or=6.5%,FPG and 2hPG in the diagnosis of correlation (P<0.01). For HbA1 c at a diagnostic cut-off point of>or=6.2%,953(73.65%) diabetic patients were detected,which was significantly different from FPG(P<0.01),but wasn′t significantly different from 2hPG(P>0.05),in the detection rate .For HbA1 c at a diagnostic cut-off point of>or=6.2%,the maximal area under ROC curve was 0.992 while the maximal diagnostic index was 1.73,and the sensitivity and specificity were 73.64%and 99.0%,respectively.Conclusion For HbA1 c at a diagnostic cut-off point of>or=6.2%,its validity for the diagnosis of diabetes is superior to that of HbA 1 c at a diagnostic cut-off point of>or=6.5%or FPG at a cut-off point of>or=7.0 mmol/L,and is similar to that of 2hPG at a cut-off point of>or=11.1 mmol/L.HbA1 c>or=6.2%used as the diagnostic cut-off point is more accurate in the diagnosis of diabetes and is suitable for a large population screening for diabetes .
