CAJ | 학술논문

背景美国糖尿病学会（ADA）推荐以糖化血红蛋白（HbA1c ）≥6.5%作为糖尿病（DM）的诊断标准，但此标准是否适用于我国人群，尚有待证实。不同海拔高度人群血红蛋白的差异也会影响 HbA1c 的测定值，给制订诊断标准带来了难度。目的通过检测冀中平原中老年人群的 HbA1c水平，探讨平原地区 HbA1c诊断 DM 的最佳值。方法采用随机整群抽样的方法选取2011年6月-2012年10月冀中平原5个中心城市的3168例社区居民，对其进行横断面流行病学调查。检测空腹血糖（FPG）及指尖血糖，行口服葡萄糖耐量试验（OGTT），结合 HbA1c进行 DM 的诊断。结果 HbA1c诊断 DM 的截点为6.35%，敏感度和特异度分别为93.5%和87.2%。HbA1c诊断空腹血糖受损（IFG）的截点为5.75%，敏感度和特异度分别为79.5%和31.3%。HbA1c诊断糖耐量受损（IGT）的截点为5.75%，敏感度和特异度分别为85.4%和34.4%。结论 HbA1c对 DM 的诊断价值优于单一采用 FPG 或餐后2 h 血糖（2 hPG），在平原地区 HbA1c可作为客观反映一段时间内血糖水平的良好指标，但并不适合作为 IFG 及 IGT 的诊断指标，需要同时行OGTT，避免漏诊。
배경미국당뇨병학회（ADA）추천이당화혈홍단백（HbA1c ）≥6.5%작위당뇨병（DM）적진단표준，단차표준시부괄용우아국인군，상유대증실。불동해발고도인군혈홍단백적차이야회영향 HbA1c 적측정치，급제정진단표준대래료난도。목적통과검측기중평원중노년인군적 HbA1c수평，탐토평원지구 HbA1c진단 DM 적최가치。방법채용수궤정군추양적방법선취2011년6월-2012년10월기중평원5개중심성시적3168례사구거민，대기진행횡단면류행병학조사。검측공복혈당（FPG）급지첨혈당，행구복포도당내량시험（OGTT），결합 HbA1c진행 DM 적진단。결과 HbA1c진단 DM 적절점위6.35%，민감도화특이도분별위93.5%화87.2%。HbA1c진단공복혈당수손（IFG）적절점위5.75%，민감도화특이도분별위79.5%화31.3%。HbA1c진단당내량수손（IGT）적절점위5.75%，민감도화특이도분별위85.4%화34.4%。결론 HbA1c대 DM 적진단개치우우단일채용 FPG 혹찬후2 h 혈당（2 hPG），재평원지구 HbA1c가작위객관반영일단시간내혈당수평적량호지표，단병불괄합작위 IFG 급 IGT 적진단지표，수요동시행OGTT，피면루진。
Backgrounds American Diabetes Association( ADA) recommends glycosylated hemoglobin( HbA1c )≥ 6. 5% as a diagnostic criteria for diabetes mellitus(DM),but it remains to be confirmed whether this standard is applicable to the population in our country. In addition,the hemoglobin concentration differences between people living at different altitudes influence estimated values of HbA1c ,which makes it difficult to formulate diagnostic criteria. Objectives To detect the HbA1c levels of elderly population in Jizhong Plain to explore the optimum value of HbA1c diagnosing DM. Methods A randomized cluster sampling method was used to select 3,168 community residents in 5 central cities in Jizhong plain from June 2011 to Octo-ber 2012 to perform a cross - sectional epidemiological survey. We determined fasting plasma glucose(FPG)and fingertip glu-cose,did oral glucose tolerance test(OGTT)and combined with HbA1c detection. Results The cut - off point of HbA1c diag-nosing DM was 6. 35% ,its sensitivity and specificity were 93. 5% ,87. 2% ,respectively. The cut - off point of HbA1c diagno-sing impaired fasting glucose(IFG)was 5. 75% ,its sensitivity and specificity were 79. 5% ,31. 3% ,respectively. The cut -off point of HbA1c diagnosing impaired glucose tolerance( IGT)was 5. 75% ,its sensitivity and specificity were 85. 4% , 34. 4% ,respectively. Conclusion In plain areas,the DM diagnostic value of HbA1c ,superior to that of single - used FPG or 2 hPG,can be a good indicator for blood sugar level but not for IFG,IGT. OGTT is needed to avoid misdiagnosis.