CAJ | 학술논문

目的探讨糖化血红蛋白(HbA1c)在健康体检人群中对糖耐量异常(IGT)的筛查价值.方法对参加健康体检的489名广州户籍汉族人进行口服葡萄糖耐量试验(OGTT)和HbA1c检测,以OGTT结果为诊断标准,通过受试者工作特征(ROC)曲线分析分别获得HbA1c和空腹血糖(FPG)单独诊断IGT的ROC曲线下面积(AUC)、最佳临界值、灵敏度约95％的临界值和特异度约95％时的临界值,并计算和比较在上述临界值单独以及HbA1c和FPG不同临界值间两两联合诊断IGT时的各诊断试验评价指标Youden指数(YI)、灵敏度(Sn)、特异度(Sp)、阳性预测值(+PV)、阴性预测值(-PV)、阳性似然比(+LR)和阴性似然比(-LR).结果 HbA1c、FPG诊断IGT的AUC分别是0.605和0.679,最佳临界值分别是6.05％和5.465 mmol/L,此时YI分别是0.186和0.265、Sn分别是40.3％和56.9％、Sp分别是78.3％和69.6％、+PV分别是43.6％和43.9％、-PV分别是75.8％和79.5％、+LR分别是1.853和1.871,-LR分别是0.763和0.619;联合试验最佳组合的YI是0.282,Sn是61.8％,Sp是66.4％,+PV分别是43.4％,-PV是80.6,+LR是1.838,-LR是0.575.结论糖化血红蛋白单独、以及联合空腹血糖均不适合在体检人群中筛查糖耐量受损.
목적 탐토당화혈홍단백(HbA1c)재건강체검인군중대당내량이상(IGT)적사사개치.방법 대삼가건강체검적489명엄주호적한족인진행구복포도당내량시험(OGTT)화HbA1c검측,이OGTT결과위진단표준,통과수시자공작특정(ROC)곡선분석분별획득HbA1c화공복혈당(FPG)단독진단IGT적ROC곡선하면적(AUC)、최가림계치、령민도약95％적림계치화특이도약95％시적림계치,병계산화비교재상술림계치단독이급HbA1c화FPG불동림계치간량량연합진단IGT시적각진단시험평개지표Youden지수(YI)、령민도(Sn)、특이도(Sp)、양성예측치(+PV)、음성예측치(-PV)、양성사연비(+LR)화음성사연비(-LR).결과 HbA1c、FPG진단IGT적AUC분별시0.605화0.679,최가림계치분별시6.05％화5.465 mmol/L,차시YI분별시0.186화0.265、Sn분별시40.3％화56.9％、Sp분별시78.3％화69.6％、+PV분별시43.6％화43.9％、-PV분별시75.8％화79.5％、+LR분별시1.853화1.871,-LR분별시0.763화0.619;연합시험최가조합적YI시0.282,Sn시61.8％,Sp시66.4％,+PV분별시43.4％,-PV시80.6,+LR시1.838,-LR시0.575.결론 당화혈홍단백단독、이급연합공복혈당균불괄합재체검인군중사사당내량수손.
Objective To explore the value of blood glycosylated hemoglobin detection in identifying patients with impaired glucose tolerance (IGT) from those undergoing health examination.Methods 489 residents in Guangzhou region undergoing health examination suffered an oral glucose tolerance test (OGTT)as well as blood glycosylated hemoglobin (HbA1c) detection.Based on the results of OGTT as diagnostic standards,receiver operating characteristic (ROC) analysis were performed to obtain the Area under the ROC curve (AUC),the optimal thresholds,the thresholds of having about 95％ sensibility and the thresholds of having about 95％ specificity when using HbA1c and fasting plasma glucose (FPG) alone as a diagnostic test,respectively.Some indexes,such as youden index (YI),sensitivity (Sn),specificity (Sp),positive predictive value (+PV),negative predictive value (-PV),positive likelihood ratio (+LR) and negative likelihood ratio (-LR),were computed when IGT was diagnosed with HbA1c alone,FPG alone and combination tests that one of the three thresholds metioned above from HbA1c was matched with that from FPG each other,respectively.Results The AUC for HbA1c and FPG to diagnose IGT was 0.605 and 0.679,respectively.At the optimal threshold of 6.05％ for HbAlc and 5.465 mmol/L for FPG,YI was 0.186 and 0.265,Sn was 40.3％ and 56.9％,Sp was 78.3％ and 69.6％,+PV was 43.6％ and 43.9％,-PV was 75.8％ and 79.5％,+LR was 1.853 and 1.871,-LR was 0.763 and 0.619,for HbA1c and FPG,respectively.Of the combination tests the best one had a YI of 0.282,a Sn of 61.8％,a Sp of 66.4％,a +PV of 43.4％,a-PV of 80.6,a +LR of 1.838 and a-LR of 0.575.Conclusion Neither HbA1c alone nor HbAIc combined with FPG is available in screening patients with impaired glucose tolerance among subjects undergoing health examination.