糖化血红蛋白在诊断2型糖尿病中的价值

目的对比分析空腹血糖(FPG)、餐后2h血糖(2hPG)及糖化血红蛋白(HbA1c)诊断糖尿病的敏感性和特异性,探讨HbA1c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HbA1c。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HbA1c水平呈递增趋势(P<0.05)。②Spearman相关分析显示HbA1c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,HbA1c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HbA1c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HbA1c其灵敏度大于2hPG。结论在无法进行OGTT的情况下,HbA1c可用于糖尿病诊断,但应联合FPG检测。

The value of HbA1c for diagnosing type 2 diabetes

Objective To compare the sensitivity and specificity of fasting plasma glucose(FPG),2 h post-load plasma glucose(2hPG) and glycated hemoglobin(HbA1c) in diagnosing type 2 diabetes in order to explore the value of HbA1c 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 HbA1c 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 HbA1c level in the three groups tended to increase(P<0.05).②Spearman correlation analysis demonstrated that HbA1c was positively correlated with FPG and 2hPG level determined by OGTT(r=0.72,0.59,P<0.05).③ The optimal cut-point of HbA1c for diagnosing type 2 diabetes was 6.1%.HbA1c had higher diagnostic sensitivity than FPG,but lower than 2hPG.When HbA1c was≥6.5%,its diagnostic sensitivity was still lower than 2hPG.The diagnostic sensitivity of combined detection of FPG and HbA1c(≥6.5%) was greater than the diagnostic sensitivity of 2hPG.Conclusion HbA1c measurement is valid in diagnosing diabetes when OGTT is not available,but it should be combined with FPG detection.