糖化血红蛋白在诊断2型糖尿病中的价值

摘要

Objective To compare the sensitivity and specificity of fasting plasma glucose (FPG), 2 h post-load plasma glucose (2hPG) and glycated hemoglobin (HbAlc) in diagnosing type 2 diabetes in order to explore the value of HbAlc in diabetes diagnosis. Methods We selected 285 outpatients with risk factor for type 2 diabetes, including 158 males and 127 females, with the mean age of (48±11) years. All the subjects underwent oral glucose tolerance test (OGTT), and their HbAlc level was also measured. Results ① Based on the diabetes diagnosis criteria of WHO (1999), the subjects were divided into diabetes mellitus (DM) group (n = 176), impaired glucose regulation (IGR) group (n = 71), and normal glucose tolerance (NGT) group (n = 38). The HbAlc level in the three groups tended to increase (P<0. 05). ②Spearman correlation analysis demonstrated that HbAlc was positively correlated with FPG and 2hPG level determined by OGTT (r = 0.72, 0.59, P<0.05). ③The optimal cut-point of HbAlc for diagnosing type 2 diabetes was 6.1%. HbAlc had higher diagnostic sensitivity than FPG, but lower than 2hPG. When HbAlc was≧6.5%, its diagnostic sensitivity was still lower than 2hPG. The diagnostic sensitivity of combined detection of FPG and HbAlc (≧6.5%) was greater than the diagnostic sensitivity of 2hPG. Conclusion HbAlc measurement is valid in diagnosing diabetes when OGTT is not available, but it should be combined with FPG detection.%目的 对比分析空腹血糖(FPG)、餐后2h血糖(2hPG)及糖化血红蛋白(HbAlc)诊断糖尿病的敏感性和特异性,探讨HbAlc在诊断糖尿病中的价值.方法 选取门诊查体疑似2型糖尿病患者285例,男158例,女127例,平均年龄(48±11)岁.所有研究对象行口服糖耐量试验(OGTT),同时测定HbAlc.结果 ①按WHO 1999年糖尿病诊断标准判断,285例中2型糖尿病(DM)176例,糖调节受损(IGR)71例,糖耐量正常(NGT) 38例,三组HbAlc水平呈递增趋势(P＜0.05).②Spearman相关分析显示HbAlc与OGTT中FPG、2hPG为直线正相关(r=0.72,0.59,P＜0.05).③通过绘制ROC曲线图,HbAlc诊断糖尿病的最佳切点为6.1％,诊断的灵敏度高于FPG,低于2hPG;当HbAlc的切点为6.5％时,诊断的灵敏度低于FPG和2hPG,但联合检测FPG和HbAlc其灵敏度大于2hPG.结论 在无法进行OGTT的情况下,HbAlc可用于糖尿病诊断,但应联合FPG检测.