HbA1c和空腹血糖在糖尿病筛查中的应用价值

摘要

Objective To explore the optimal cut-off point of the glycosylated hemoglobin (HbA1c) versus fasting plasma glucose (FPG) for screening diabetes (DM), and to validate the current HbA1c diagnostic criteria from large-scale epidemiological survey. Methods A total of 1330 non-diabetic subjects who participated in health examination in Nanjing were included. All subjects underwent standardized breakfast and HbA1c measurement. Receiver operating characteristic (ROC) curve analysis was used to-examine the sensitivity and specificity of FPG and HbA]C for diagosing diabetes, which was defined by the standard from WHO in 1999. Results DM prevalence was 6. 8%. Based on the ROC curve, the optimal cut-point of FPG related to the OGTT-diagnostic criteria for diabetes was 6. 1 mmol/L which was associated with a sensitivity and specificity of 81. 30% and 96. 3% respectively. The optimal cut-point of HbAlc related to diabetes diagnosis by OGTT was 6. 1 %, which was associated with a sensitivity and specificity of 83. 5% and 88. 8% respectively. If the proposed use of HbA1c≥6. 5% of ADA as a diagnostic criteria for DM was adopted, the sensitivity and specificity were 59. 3% and 97. 4%. If the newly proposed HbA1c≥6. 3% as a diagnostic criteria of DM for the Chinese population was adopted, the sensitivity and specificity were 71. 4% and 94.7%. The screening model using FPG≥ 6. Lmmol/L or HbAlc ≥6. 1% had sensitivities of 92.3% for detecting undiagnosed diabetes. Conclusions ' Compared with HbA1c in screening DM, FPG has a slightly higher diagnostic value. Thesimultaneous measurement of FPG and HbAlc might be a more sensitive and specific screening tool for identifying high-risk individuals for diabetes at an early stage.%目的 探索HbA1c及FPG筛查糖尿病(DM)的应用价值.方法 南京地区参加体检的未诊断糖尿病1330例,测定FPG和HbA1c,予标准化早餐后测定餐后2小时血糖(2hPG),用受试者工作特征曲线(ROC)评价FPG和HbA1 c筛查糖尿病的效果.结果 按1999年WHO的糖尿病诊断标准,本研究人群DM患病率为6.8％.采用ROC曲线判断,与DM状态相关的FPG临界点为6.1mmol/L,敏感性和特异性分别为81.3％和96.3％;HbA1c临界点为6.1％,敏感性和特异性分别为83.5％和88.8％.当采用FPG≥6.1mmol/L或HbAc≥6.1％作为标准时,敏感性达到92.3％,同时有较好的特异性81.2％.结论 单独使用FPG较HbA1c在筛查DM中具有稍高的价值,为了最大限度的筛查DM患者,建议对6.1mmol/L≤FPG≤7.0mmol/L或HbA1c≥6.1％的患者行OGTT以明确有无糖尿病.