【摘要】 目的 评价FPG、OGTT和HbA1c在筛查糖尿病和IGR时的应用价值。 方法 选取研究对象222名，同时进行FPG 、OGTT和HbA1c检测。进行卡方检验、绘制受试者工作特征性曲线(ROC曲线)，分别研究以OGTT为“金标准”时FPG、HbA1c诊断糖尿病及IGR相对应的临界点。 结果 NGT 43名(19.3%)，糖尿病86例(38.9%)，IGR 96例(43.2%)。单独应用FPG诊断糖尿病，检出45例，会产生显著的漏诊率(P﹤0.05)。通过ROC曲线发现，与OGTT诊断糖尿病相关的FPG的临界点为6.3 mmol/L，敏感性和特异性分别为84.6%和77.1%;以OGTT诊断糖尿病相关的HbA1c的临界点为6.3%，敏感性和特异性分别为66.2%和81.5%;以OGTT诊断IGT时，FPG的临界点为5.6 mmol/L时，敏感性和特异性分别为71.2%和61.2%;以OGTT诊断IGT时，相关的HbA1c的临界点为5.7%时，敏感性和特异性分别为76.3%和67.5%。 结论 本研究FPG和HbA1c诊断DM的切点分别是6.3 mmol/L及6.3%。 当FPG≥6.3 mmol/L，HbA1c≥6.3%时要考虑糖尿病，并进行OGTT以确定诊断。

　　【关键词】糖尿病;糖耐量异常;空腹血糖;糖化血红蛋白;口服糖耐量试验;ROC曲线;筛查

　　Screening abnormal glucose metabolism with FPG, OGTT, and HbA1c SU Wei, WANG Li, SHANG You-quan, et al. Department of Diabetes Mellitus, Baoji Central Hospital, Baoji 721008, China

　　【Abstract】Objective To evaluate the application values of fasting plasma glucose (FPG), oral glucose tolerance test (OGTT), and glycosylated hemoglobin (HbA1c) in screening diabetes mellitus (DM ) and impaired glucose regulation (IGR). Methods The 222 subjects with risk factors for diabetes mellitus (DM) or for confirming diabetes underwent the tests of FPG, OGTT, and HbA1c simultaneously. Through the chi square test and making the receiver operating characteristic curve (ROC curve), the optimal cut points for FPG and HbA1c for diagnosis of DM and DM risks were established with the verification by OGTT as the gold standard. Results There were 43 cases (19.3%) having normal glucose tolerance (NGT), 86 cases (38.9%) having DM, and 96 cases (43.2%) having increased risks for diabetes. Using only FPG as diagnosis criteria, there were 45 cases been screened out, with a high missed diagnosis rate (P<0.05). It was discovered that in using only the ROC curve the optimal cut-point of FPG relating to DM diagnosed by OGTT was 6.3mmol/L, and its sensitivity and specificity were 84.6% and 77.1% respectively; the optimal cut-point of HbA1c relating to DM diagnosed by OGTT was 6.3%, and its sensitivity and specificity were 66.2% and 81.5% respectively. In using OGTT the optimal cut-point of FPG relating to IGT was 5.6mmol/L, and its sensitivity and specificity were 71.2% and 61.2% respectively; the optimal cut-point of HbA1c for IGT was 5.7%, and its sensitivity and specificity were 76.3% and 67.5% respectively. Conclusion Using only FPG as diagnosis criteria may create a high false negative rate. When highly suspecting DM in case of FPG≥6.3mmol/L or HbA1c≥6.3%, the OGTT should be carried out for final diagnosis.

　　【Key words】Diabetes mellitus; Impaired glucose regulation; Fasting plasma glucose (FPG); Glycosylated hemoglobin (HbA1c); Oral glucose tolerance test; Receiver operating characteristic curve (ROC curve); Screening