年龄对糖化血红蛋白和糖化血清白蛋白筛查糖尿病的影响

摘要

Objective To evaluate the effect of age on the performance of hemoglobin A 1c(HbA1 c) and glycated albumin(GA)for detecting undiagnosed diabetes in Chinese populations. Methods Two study populations came from communities and hospitals ,respectively. A total of 876 volunteers aged ≥20 years without known diabetes living in two communities in Beijing were recruited. Data of 9592 individuals without known diabetes from 37 hospitals in China were collected. 75 g glucose tolerance tests (OGTT) were performed ,and HbA1 c and GA were measured. Individuals were divided into groups based on age tertiles. Receiver operating characteristic curves (ROCs ) were plotted and the areas under the curves (AUCs) for HbA1c and GA values were compared among three age groups. Results The AUCHbA1c of HbA1 c for detecting diabetes in the 21 ~ 50 ,51 ~ 57 and 58 ~ 79 years age group in the community population was 0.977 ,0.934 and 0.865 ( P< 0.005 ) ,respectively. The AUCGA of GA for detecting diabetes was 0.903 ,0.854 and 0.845 (P=0.591) ,respectively. The AUCHbA1c of for detecting diabetes in the 18~47 ,48~59 and 60~75 years age group in the hospital population was 0.936 ,0.889 and 0.849 (P<0.05) ,respectively. Conclusion The accuracy of HbA1c for detecting undiagnosed diabetes decreases with increasing age. The impact of age on GA for detecting diabetes needs further investigation.%目的：探讨年龄对 HbA1 c和糖化血清白蛋白（GA ）筛查糖尿病准确性的影响。方法选取北京2个社区年龄≥20岁的志愿者876名，以及全国37家医院的糖尿病就诊者9592例。行75 g OGTT并测定 HbA1c。按年龄三分位数分组，绘制2个人群中 HbA1c ，以及社区人群中GA筛查糖尿病的受试者工作特征（ROC）曲线，比较各年龄组曲线下面积（AUC），计算 HbA1 c和GA在最佳切点上筛查糖尿病的敏感性和特异性。结果在社区人群中，HbA1c筛查糖尿病的AUCHbA1c在21～50、51～57及58～79岁组分别为0.977、0.934及0.865（P＜0.005）；GA筛查糖尿病的AUCGA在上述年龄组分别为0.903、0.854及0.845（P＝0.591）。在医院人群中，HbA1c筛查糖尿病的 AUCGA在18～47、48～59及60～75岁组分别为0.936、0.889及0.849（P＜0.05）。结论 HbA1 c筛查糖尿病的准确性随年龄增加而降低，年龄对GA筛查糖尿病准确性的影响尚需进一步研究。