高原地区不同人群糖化血红蛋白切点探讨

摘要

目的 探讨高原地区不同糖耐量人群对应HbA1c最佳诊断切点.方法 本研究属于横断面调查.(1)收集2012年1-3月昆明医学院第一附属医院就诊糖尿病(DM)患者以及糖尿病高危人群接受筛查者,共472例(男217例,女255例,年龄≥20岁,中位年龄54岁),行口服葡糖糖耐量试验(0GTT)和乳胶增强免疫比浊法测定HbA1c.(2)研究对象分为正常糖调节组(NGT)、空腹血糖调节受损(IFG)和(或)糖耐量减低(IGT)组及糖尿病(DM)组.依据受试者工作特征曲线(ROC)分别计算与IFG、IGT、DM状态对应HbA1c最佳切点.结果 NGT、IFG和(或)IGT、DM组HbA1c均值分别为(6.06±0.11)％、(6.63±0.11)％、(8.70±2.08)％,IFG和IGT状态时,对应HbA1c最佳切点分别为6.7％和6.6％；若仅以FBG或仅以2hPG诊断DM,对应HbA1c最佳切点均为7.1％;以FBG或2 hPG任一均可诊断DM,对应HbA1c最佳切点为7.0％；以FBG并且2hPG诊断DM,则对应HbA1c最佳切点为7.1％.结论 初步探明高原昆明地区不同糖耐量人群对应HbA1c最佳诊断切点,为HbA1c进一步临床应用提供依据.%Objective To explore the optimal HbAlc diagnostic cutpoint in different glucose tolerance populations in the plateau region.Methods (1) 472 diabetes mellitus (DM) patients and highrisk groups accepting diabetes screening in the First Affiliated Hospital of Kunming Medical College (217 males and 255 females,≥20 years old,median age 54 years old) were collected,oral glucose tolerance test (OGTT) and HbAlc were tested.(2) the research subjects were divided into normal glucose adjustment group (NGT),Impaired fasting glucose group (IFG) and (or) Impaired glucose tolerance IGT group and diabetes mellitus (DM) group.The receiver-operating characteristic curve (ROC) was explored to determine the optimal HbA1c diagnostic cut point for IFG,IGT and DM status respectively.Results The average HbA1 c values of NGT,IFG and (or) IGT,DM groups were (6.06 ± 0.11) ％,(6.63 ± 0.11) ％,(8.70 ± 2.08)％ respectively,for IFG and IGT groups,the optimal HbA1c diagnostic cut points were 6.7％ and 6.6％,respectively; If use either FBG or 2 h PG to diagnose DM,the corresponding optimal HbA1 c diagnostic cut point was 7.1％ ; If use anyone of FBG or 2hPG to diagnose DM,the corresponding optimal HbA1c diagnostic cut point was 7.0％ ; If both FBG and 2hPG were used to diagnose DM,the corresponding optimal HbA1 c diagnostic cut point was 7.1％.Conclusion Preliminarily confirm the optimal HbA1c diagnostic cut point in different glucose tolerance populations in the plateau region of Kunming,and provide the evidence for further clinical application of HbA1c.