【摘要】目的 探讨在我国成人中采用HbA1c筛查和诊断糖尿病的可行性，并确定相应的诊断切点。 方法 收集在我院健康体检中心和门诊进行OGTT及HbA1c检测的1280名受试者，并测定其BMI、SBP、DBP、TC和TG水平，采用受试者工作特征(ROC)曲线获得HbA1c诊断糖尿病的相关切点。 结果 在本组人群中，糖耐量正常(NGT)组、IGR组和DM组的HbA1c平均水平分别为(5.50±0.35)%、(5.91±0.56)%和(7.38±1.52)%，差异具有统计学意义(P<0.05)。依据ROC曲线判定，本组人群中HbA1c筛查糖尿病的最佳临界点为6.1%，敏感性为90.9%，特异性为86.4%，此界点将漏诊9.1%的糖尿病患者17例，并纳入6.6%的NGT人群56名和37.1%的IGR患者93例;按ADA标准HbA1c≥6.5%作为诊断糖尿病的切点时，其敏感性为71.0%，特异性为96.1%。 结论 HbA1c筛查糖尿病的ROC切点为6.1%，HbA1c≥6.5%诊断糖尿病的特异性高。

　　【关键词】 糖尿病;糖尿病前期;糖化血红蛋白;葡萄糖耐量试验

　　Discussion on the HbA1c screening for diagnosis of diabetes mellitus

　　— A cross-sectional analysis on 1280 adults

　　MAO Jia-li, YE Shan-dong, HONG Hai-ou, et al. Department of Endocrinology, Anhui Provincial Hospital affiliated to Anhui Medical University, Hefei 230000, China

　　Corresponding author: YE Shan-dong,E-mail:ysd196406@163.com

　　【Abstract】 Objective To evaluate the hemoglobin A1c (HbA1c) screening in diagnosing diabetes mellitus and identify the optimal HbA1c threshold to be used in Chinese adults. Methods A cross-sectional analysis on 1280 adults without known diabetes and impaired glucose regulation obtained from the Health Examination Center and the Out-patient Department of Anhui Provincial Hospital was conducted. All of them had an oral glucose tolerance test (OGTT) and the measure of HbA1c, and their BMI, SBP, DBP, TC, TG and so on were measured as well. The optimal HbA1c threshold was identified with the ROC curve. Results The HbA1c levels of the NGT,IGR, and DM groups were (5.50±0.35)%, (5.91±0.56)%, and (7.38±1.52)% respectively, being statistically different (P<0.05). According to ROC, the optimal cut-off point of HbA1c for the diagnosis of diabetes was 6.1%, and its sensitivity was 90.9% and specificity 86.4%. No matter diagnosed with OGTT or HbA1c≥6.1%, the newly diagnosed diabetic patients’ age, BMI, BP, and blood lipid were not statistically different. Compared with the result of OGTT, the 6.6% NGT (n=56) and 37.1% IGR (n=93) subjects had an HbA1c≥6.1%. The cut-off point HbA1c≥6.5% in the ADA criteria showed a very high specificity (96.1%) and a corresponding sensitivity 71.0%. Conclusions The optimal cut-off point of HbA1c for the screen of diabetes is 6.1%, which showed higher sensitivity and lower specificity than the HbA1c threshold 6.5%.

　　【Key Words】Diabetes mellitus; Impair glucose regulation (IGR); Glycosylated hemoglobin (HbA1c); Oral glucose tolerance test (OGTT)