·HbA1c的测定和应用·

　　【摘要】目的 探讨HbA1c在糖尿病及IFG诊断中的意义。方法 对526名未诊断糖尿病及IFG的研究对象同时检测HbA1c和FPG。按美国糖尿病协会(ADA)诊断标准(FPG≥7.0 mmol/L)、IFG标准(5.6 moml/L≤FPG≤6.9 moml/L)和2010年ADA新标准(HbA1c≥6.5%及5.7%≤HbA1c≤6.4%)将患者分组。以FPG为 “金标准”，计算HbA1c作为诊断的敏感性(S)、特异性(Sp)、阳性似然比(+LR)、阴性似然比(-LR)。结果 HbA1c≥6.5%诊断糖尿病的S为96%，Sp为95%，+LR为19.2,-LR为0.042;5.7%≤HbA1c≤6.4%诊断IFG的S为26%，Sp为94%，+LR为4.3，-LR为0.79。结论 HbA1c诊断糖尿病有较高的诊断敏感性和特异性，在诊断IFG时特异性较高，而敏感性较低。

　　【关键词】糖尿病;空腹血糖受损;空腹血糖;糖化血红蛋白;诊断价值

Value of HbA1c in diagnosis of diabetes mellitus and impaired fasting glucose FAN Hua-ying, CHENG Xing-bo, LU Yi-qun, et al. Department of Endocrinology, The First Hospital Affiliated to Suzhou University, Suzhou 215006, China

Corresponding author: LU Yan, E-mail: fannyhy@163.com

　　【Abstract】Objective To study the value of HbA1c in the diagnosis of diabetes mellitus (DM) and impaired fasting glucose (IFG). Methods The levels of HbA1c and FPG were measured in 526 subjects with suspected DM and IFG. The diagnosis of DM and IFG were made according to ADA diagnosis criteria, FPG ≥7.0 mmol/L and IFG 5.6 mmol/L ≤FPG ≤6.9 mmol/L, and the new diagnosis criteria, HbA1c ≥6.5% and 5.7% ≤HbA1c ≤6.4% in 2010. The subjects were divided into groups. The diagnostic sensitivity (S), specificity (Sp), positive likelihood ratio (+LR), and negative likelihood ratio (-LR) of HbA1c were calculated using FPG as reference. Results To diagnose DM with HbA1c ≥6.5%: S =96%, Sp =95%, +LR =19.2, and –LR =0.042; and to diagnose IFG with 5.7% ≤HbA1c ≤6.4%: S =26%, Sp =94%, +LR = 4.3, and –LR =0.79. Conclusions HbA1c has a high sensitivity and specificity in diagnosing DM, a high specificity but low sensitivity in diagnosing IFG.

　　【Key words】 Diabetes mellitus; Impaired fasting plasma glucose; Fasting plasma glucose; Glycosylated hemoglobin A1c; Diagnostic value