糖化血红蛋白对中国人群糖尿病诊断价值的Meta分析

摘要

Objective To assess the diagnostic value of glycosylated hemoglobin A1c (HbA1c) ≥6.5％ for diabetes in Chinese adults with oral glucose tolerance test(OGTT) as the reference standard.Methods Major databases were searched to get all diagnostic tests with HbA1c ≥ 6.5％ for diabetes in Chinese adults.QUADAS items were used to evaluate the quality of the eligible studies.Meta-disc software was used to perform comprehensive quantitative assessment for all included studies and summary ROC (SROC) curve were drawn.Results A total of 11 studies were included.The outcomes of the diagnostic value with HbA1c ≥6.5％ were as the following:pooled sensitivity 0.62 (95％ CI:0.60-0.64),pooled specificity 0.96 (95％ CI:0.95-0.96),diagnostic odds ratio (DOR) 40.25 (95％ CI:20.79-77.95) and AUCSROC 0.7702 (sx =0.0636).Conclusions The diagnostic specificity is pretty high for the diagnostic test with HbA1c ≥6.5％,while sensitivity is low.Combination of HbA1c and glucose tests is needed to reduce the missed diagnosis rate.%目的 系统评价糖化血红蛋白(HbA1c)≥6.5％在中国成人糖尿病诊断中的价值.方法 计算机检索国内外重要数据库,搜索有关HbA1c≥6.5％在中国成人中糖尿病诊断价值的文献.采用诊断性试验准确性质量评价工具(QUADAS)评价纳入文献质量,应用Meta-Disc1.4软件对纳入研究进行综合定量评价,并绘制综合ROC (SROC)曲线.结果 共纳入11篇文献.对于HbA1c≥6.5％在中国成人中的诊断价值为:合并敏感度为0.62(95％CI:0.60 ～0.64),合并特异度为0.96(95％ CI:0.95～0.96),诊断性比值比(DOR)为40.25(95％CI:20.79～ 77.95),AUCSROC为0.7702(Sx=0.0636),Q=0.7103(Sx=0.0537).结论 HbA1c≥6.5％在中国成人糖尿病中的诊断特异度非常高,但敏感度相对较低,存在一定的漏诊率,需结合血糖检测以降低漏诊率.