·HbA1c的应用·

　　俞丹 向爱华 邓红英 陈素芬 蔡亚华 刘璇 单珊 钱莉 付麒 王知笑 范红旗 张梅 王虹 杨涛 朱广家

　　基金项目：江苏省科技支撑计划(社会发展)(BE2009687，BE2009613);江苏省卫生厅指导性科研项目(Z200901)

　　作者单位：210029南京医科大学第一附属医院内分泌科(俞丹、刘璇、单珊、钱莉、付麒、王知笑、范红旗、张梅、杨涛)，呼吸科(王虹)，预防保健科(向爱华、邓红英、陈素芬、蔡亚华、朱广家)

　　通讯作者：朱广家，E-mail: jszhuguangjia@sina.com

　　【摘要】 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HbA1c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HbA1c≥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。

　　【关键词】糖化血红蛋白;糖尿病;受试者工作特征曲线

　　doi:10.3969/j.issn.1006-6187.2011.11.003

　　The value of glycated hemoglobin versus fasting plasma glucose for the screening of diabetes mellitus

　　YU Dan, XIANG Ai-hua, DENG Hong-ying, et al. Department of Endocrinology, Nanjing Medical University Affiliated NO.1 Hospital, Nanjing 210029, China

　　Corresponding author: ZHU Guang-jia, E-mail: jszhuguangjia@sina.com

　　【Abstract】 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 HbA1c 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≥6.1mmol/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. The simultaneous 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.

　　【Key words】 Glycated hemoglobin; Diabetes mellitus; Receiver operating characteristic curve